{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T20:21:21Z","timestamp":1777580481960,"version":"3.51.4"},"reference-count":43,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T00:00:00Z","timestamp":1623715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000034","name":"Institute of Neurosciences, Mental Health and Addiction","doi-asserted-by":"publisher","award":["CIHR Team Grant (Health Challenges in Chronic Infl"],"award-info":[{"award-number":["CIHR Team Grant (Health Challenges in Chronic Infl"]}],"id":[{"id":"10.13039\/501100000034","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>The effect of major depression and antidepressant use on patient survival in chronic liver disease is unknown. We evaluated the impact of major depressive disorder (MDD) and antidepressants on survival among patients with alcoholic liver disease (ALD) and non\u2010alcoholic fatty liver disease (NAFLD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Health Improvement Network database, the largest medical database in the United Kingdom, was used to identify incident ALD (n\u00a0=\u00a04148) and NAFLD (n\u00a0=\u00a019\u00a0053) in patients between 1986 and 2017. Our primary outcome was development of decompensated cirrhosis or death. MDD and each class of antidepressants were assessed in multivariate Cox proportional hazards models as time\u2010varying covariates. Models were adjusted for age, sex, socio\u2010economic status and comorbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MDD rate was higher among patients with ALD (22.8%) compared to those with NAFLD (16.1%), <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01. Antidepressant usage was common in patients with ALD (47.4%) and NAFLD (40.8%). After adjusting for covariates, MDD (adjusted hazard ratio [AHR]: 0.80, 95% CI: 0.63\u20101.02 for NAFLD; and AHR 1.01, 0.88\u20101.15 for ALD) was not associated with improved decompensated cirrhosis\u2010free survival. The antidepressant mirtazapine was associated with worse decompensated cirrhosis\u2010free survival among NAFLD (AHR 2.16, 95% CI: 1.32\u20103.52) and ALD (AHR 1.53, 1.09\u20102.15) cohorts. Similarly, mirtazapine was associated with mortality in both cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MDD was not associated with worse outcomes for ALD or NAFLD. Mirtazapine was associated with an increased risk of decompensated cirrhosis or death, which was not observed with other antidepressants. Prospective studies are warranted to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14973","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T10:25:21Z","timestamp":1622024721000},"page":"2308-2317","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Impact of major depression and antidepressant use on alcoholic and non\u2010alcoholic fatty liver disease: A population\u2010based study"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2940-897X","authenticated-orcid":false,"given":"Abdel Aziz","family":"Shaheen","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Cumming School of Medicine University of Calgary Calgary Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilaad G.","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Cumming School of Medicine University of Calgary Calgary Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith A.","family":"Sharkey","sequence":"additional","affiliation":[{"name":"Snyder Institute for Chronic Diseases Cumming School of Medicine University of Calgary Calgary Alberta Canada"},{"name":"Department of Physiology and Pharmacology University of Calgary Calgary Alberta Canada"},{"name":"Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan Cord","family":"Lethebe","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Cumming School of Medicine University of Calgary Calgary Alberta 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