Long-term effects of antipsychotics on mortality in patients with schizophrenia: a systematic review and meta-analysis

Abstract

Objective: To gather current evidence on the impact of antipsychotics on long-term mortality in patients with schizophrenia. Methods: We systematically searched for articles in Embase, PubMed, and PsycINFO reporting the long-term mortality (follow-up > 1 year) of patients with schizophrenia who were using any antipsychotics. We then conducted multiple meta-analyses to determine differences in long-term mortality between different types of antipsychotics. Results: We identified 45 articles that provided unadjusted long-term mortality rates, including 46,171 deaths during 2,394,911 person-years. The pooled mortality rate was 9.9 (95%CI = 7.4-12.7) per 1,000 person-years. The unadjusted crude mortality rate of antipsychotic drug users was lower than that of non-users (risk ratio [RR] = 0.546, 95%CI = 0.480-0.621), first-generation antipsychotics caused higher all-cause mortality than second-generation antipsychotics (RR = 1.485, 95%CI = 1.361-1.620), and polypharmacy had better effects than monotherapy on long-term mortality (RR = 0.796, 95%CI = 0.689-0.921). As for the causes of death, heart disease and cardiovascular disease ranked highest among cause-specific mortality (5.6 per 1,000 person-years). Conclusion: Since antipsychotics had a beneficial effect on long-term mortality in schizophrenia, greater precaution should be taken with patients who do not take them. However, since disease severity, comorbidities, and other confounding factors cannot be fully controlled, further research and verification are needed.

A lifetime of mental health treatments for people with schizophrenia: update and narrative review

“…While some believe polypharmacy leads to reduced longevity overall, there is no evidence for that [57]. In fact, others point to the evidence that polypharmacy may work better, cause little harm if any to the individual patient and may be superior to the use of only one antipsychotic [58,59 ▪▪ ].Alternatively, there is some weak evidence from treatment trials for adding medications such as N -acetyl-cysteine (NAC, 1200–3600 mg/day), sarcosine (2 g/day) and minocycline (200–300 mg/day), or even estrogens or estrogen modulators, such as raloxifene [60 ▪ ].…”

Burden of disease, incidence, and spatial distribution of Schizophrenia in Ecuador from 2011 to 2021 using hospital discharge records

“…The disparity in life expectancy between general and clinical populations stands at a striking 15 to 20 years. This is in part due to an elevated risk of cardiovascular diseases and suicide accompanying a schizophrenia diagnosis [12,3,13]. Moreover, these demographics face additional risks including metabolic syndrome, diabetes, sedentary lifestyles, and smoking.…”