Association of Megestrol Use With the Development of New Psychiatric Diagnoses

Objective: To analyze the risk of megestrol, a glucocorticoid and progesterone receptor agonist used to enhance appetite, on the development of a new psychiatric diagnosis. Design and Participants: Deidentified data of megestrol (n = 706) and propensity score-matched comparison (age, gender, and body mass index) patients (n = 2,118) from January 1, 2001 to June 30, 2018 were obtained from the UT Southwestern patient database. Data were analyzed using a series of conditional binary logistic regressions controlling for comorbidities, pre-existing psychiatric disorders, and number of patient encounters. Setting: A large academic medical center database of megestrol-treated patients and matched comparison patients was used. Measurements and Results: The regression model showed that megestrol was significantly associated with developing a new psychiatric diagnosis (B = 1.28, Wald χ²¹ = 83.12, odds ratio [OR] = 3.60, p <0.001). In subgroup analyses, development of cognitive (B = 2.42, Wald χ²¹ = 16.09, OR = 11.30, p <0.001), mood (B = 1.31, Wald χ²¹ = 40.38, OR = 3.70, p <0.001), and anxiety (B = 1.72, Wald χ²¹ = 45.28, OR = 5.60, p <0.001) disorders were also associated with megestrol use. Conclusions: Patients taking megestrol were significantly more likely to develop a new psychiatric diagnosis than comparison patients. Highest risks were associated with the development of cognitive diagnoses. The findings suggest that megestrol, like other glucocorticoid agonists, is associated with an increased risk of developing a psychiatric disorder. This risk should be considered when determining the risk-to-benefit ratio of megestrol use in patients.