Patients with recent-onset systemic lupus erythematosus use more antidepressant medication than matched controls: A case–control study

Systemic lupus erythematosus (SLE) is associated with mental health concerns. We evaluated the quantity, frequency, and risk of antidepressant and antipsychotic medication use associated with recent-onset SLE in a case-control study. SLE patients were identified by their drug reimbursement decisions for SLE medication made during January 1, 2000 to December 31, 2014 from the register of the Social Insurance Institution. The study included 1006 SLE cases and 3005 controls. The information about new purchases of the antidepressants and antipsychotics was retrieved from the National Drug Purchase Register starting 1 year before the reimbursement decision (index day [ID]) until 5 years after the ID, death or December 31, 2015. The defined daily dose (DDD) was used to measure the drug consumption. During the 12 months before the ID, the mean daily antidepressant consumption was 62.3 DDDs and 57.9 DDDs (P < .001) for patients and controls, respectively. The mean antidepressant consumption rose to 87.3/1000/day in patients and 77.4/1000/day in controls (P < .001) during the 5-year period after the ID. The adjusted hazard ratio for purchasing antidepressants was 1.45 (95% confidence interval: 1.19-1.77; P < .001) for patients compared to controls. No significant difference was found between patients and controls concerning antipsychotics. An increase in antidepressant use was found among SLE cases, suggesting the presence of mood disorders already at the time of SLE diagnosis. No difference was recorded in the use of antipsychotics, indicating the rarity of chronic psychotic disorders needing long-term antipsychotic treatment in SLE.