Roles of sedative-hypnotics in patients with recurrent major depressive disorder: a nationwide population-based 14-year follow-up study in Taiwan

Background: The use of sedatives or hypnotics and the recurrence of depression have not been adequately explored. This study investigated the roles of sedative-hypnotics in patients with major depressive disorder (MDD). Various characteristics of sedative-hypnotic use were tested as risk factors for recurrence. Methods: Clinical records of 15,510 patients with major depressive disorder who prescribed selective serotonin reuptake inhibitors (SSR) during 1997–2009 were collected from the National Health Insurance Research Database (NHIRD). Cox proportional hazard regression models were used to analyze factors related to depression recurrence. Results: The risk of MDD recurrence was lower for patients using SED/HYP with an indication of both anxiolytics and hypnotics (AHR = 0.66; 95% CI = 0.59–0.72) than for those using SED/HYP with an indication of anxiolytics only. AHR was slightly greater in current users than in recent users (AHR = 0.77; 95% CI = 0.72–0.83) and past users (AHR = 0.70; 95% CI = 0.67–0.74). There was a higher AHR of MDD recurrence in patients who used SED/HYP over 1 DDD in 1 month than those who used SED/HYP less than 1 DDD in 1 month, with the highest-dose users having the highest risk of MDD recurrence (AHR = 7.91; 95% CI = 6.86–9.11). Conclusions: Patterns and characteristics of sedative-hypnotic use may affect depression recurrence. These findings should be considered by clinicians when combining sedative-hypnotics with antidepressant treatment.