As compared to other depressants or even clinical depression, this large population-based study found the use of mirtazapine to be linked with the higher likelihood of decompensated cirrhosis or mortality in people with fatty liver disease.

This study examined the effect of clinical depression and the use of antidepressant medications on survival in people suffering from fatty liver disease (alcoholic liver disease [ALD] and non-alcoholic fatty liver disease [NAFLD]).

The biggest medical database in the UK was used to explore the prevalence of ALD (4148 patients) and NAFLD (19053 patients) in 30 years. Development of decompensated cirrhosis or mortality was reported as the primary outcome.

Clinical depression and different classes of antidepressants were evaluated in the multivariate Cox proportional hazards models. Adjustments were made for gender, age, socio-economic status, and comorbidities.

The rate of clinical depression and antidepressant usage was greater in patients with ALD than those with NAFLD, as shown in Table 1:

Clinical depression was not linked with better decompensated cirrhosis-free survival following the adjustment for covariates. The use of antidepressant mirtazapine was linked with poorer decompensated cirrhosis-free survival and mortality among NAFLD and ALD groups.

Mirtazapine but not clinical depression was linked with poorer outcomes (higher probability of decompensated hepatic cirrhosis or mortality) for ALD or NAFLD.