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Pia Burman

Physician

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Psychotropic Drugs in Patients with Cushing's Disease Before Diagnosis and at Long-Term Follow-Up : A Nationwide Study

Author

  • Daniel Bengtsson
  • Oskar Ragnarsson
  • Katarina Berinder
  • Per Dahlqvist
  • Britt Edén Engström
  • Bertil Ekman
  • Charlotte Höybye
  • Pia Burman
  • Jeanette Wahlberg

Summary, in English

CONTEXT: Psychiatric symptoms are common in Cushing's disease (CD) and seem only partly reversible following treatment. OBJECTIVE: To investigate drug dispenses associated to psychiatric morbidity in CD patients before treatment and during long-term follow-up. DESIGN: Nationwide longitudinal register-based study. SETTING: University Hospitals in Sweden. SUBJECTS: CD patients diagnosed between 1990 and 2018 (N = 372) were identified in the Swedish Pituitary Register. Longitudinal data was collected from 5 years before, at diagnosis, and during follow-up. Four matched controls per patient were included. Cross-sectional subgroup analysis of 76 patients in sustained remission was also performed. MAIN OUTCOME MEASURES: Data from the Swedish Prescribed Drug Register and the Patient Register. RESULTS: In the 5-year period before and at diagnosis, use of antidepressants (odds ratio [OR] 2.2 [95% confidence interval (CI) 1.3-3.7]) and 2.3 [1.6-3.5]), anxiolytics [2.9 (1.6-5.3) and 3.9 (2.3-6.6)], and sleeping pills [2.1 (1.2-3.7) and 3.8 (2.4-5.9)] was more common in CD than controls. ORs remained elevated at 5-year follow-up for antidepressants [2.4 (1.5-3.9)] and sleeping pills [3.1 (1.9-5.3)]. Proportions of CD patients using antidepressants (26%) and sleeping pills (22%) were unchanged at diagnosis and 5-year follow-up, whereas drugs for hypertension and diabetes decreased. Patients in sustained remission for median 9.3 years (interquartile range 8.1-10.4) had higher use of antidepressants [OR 2.0 (1.1-3.8)] and sleeping pills [2.4 (1.3-4.7)], but not of drugs for hypertension. CONCLUSIONS: Increased use of psychotropic drugs in CD was observed before diagnosis and remained elevated regardless of remission status, suggesting persisting negative effects on mental health. The study highlights the importance of early diagnosis of CD, and the need for long-term monitoring of mental health.

Department/s

  • Genomics, Diabetes and Endocrinology
  • EXODIAB: Excellence in Diabetes Research in Sweden

Publishing year

2021-05-13

Language

English

Pages

1750-1760

Publication/Series

The Journal of clinical endocrinology and metabolism

Volume

106

Issue

6

Document type

Journal article

Publisher

Oxford University Press

Topic

  • Endocrinology and Diabetes

Keywords

  • Cushing’s syndrome
  • depression
  • hypercortisolism
  • neuropsychiatry
  • sleeping disorder

Status

Published

Research group

  • Genomics, Diabetes and Endocrinology

ISBN/ISSN/Other

  • ISSN: 1945-7197