SLR - July 2009 - Jean-Jacques Kassis
Reference:
Anderson, F., Shace, R., Suissa, S., Garde, E. (2009). Long-term Use of Antidepressants for Depressive Disorder and Risk of Diabetes Mellitus. American Journal of Psychiatry, 166, 591-598.
Scientific Literature Reviews
Reviewed by: Jean-Jacques Kassis, DPM
Residency Program: Miami VA Medical Center
Podiatric Relevance:
This study investigated whether the use of antidepressants in the treatment of depressive disorder is associated with an increased risk of diabetes mellitus.
Methods:
This was a case control study in a cohort of depressed patients treated with at least one new prescription for an antidepressant between January 1, 1990 and June 30, 2005. The study was approved by the Scientific and Ethical Advisory Group of the UK General Practice Research Database (GPRD). Cohort entry was defined as the date of the first prescription of an antidepressant. This study included patients of at least 30 years of age, no diagnosis of diabetes or impaired glucose tolerance before
cohort entry, no treatment with oral antidiabetics or insulin before cohort entry, and a diagnosis of depression within 180 days before or 90 days after cohort entry. Antidepressants were classified into tricyclic and tetracyclic, SSRIs, monoamine oxidase (MOA) inhibitors, and the heterogeneous group of mixed-action “other antidepressants” (i.e. bupropion, and mirtazapine).
Results:
A total of 2,243 cases of incident diabetes mellitus and 8,963 matched comparison subjects were identified. Compared with no use of antidepressants during the previous 2 years, recent long-term use (> 24 months) of antidepressants in moderate to high daily doses was associated with an increased risk of diabetes (incidence rate ratio = 1.84, 95% CI=1.35-2.52). The magnitude of the risk was similar for long-term use of moderate to high daily doses of tricyclic antidepressants (incidence rate ratio= 1.77,
95% CI=1.21-2.59) and SSRIs (incidence rate ratio= 2.06, 95% CI=1.20-3.52). Treatment for shorter periods or with lower daily doses was not associated with an increase risk. In the analysis of individual antidepressants, increased risk estimates were observed for recent use of amitriptyline, fluvoxamine, paroxetine, and venlafaxine. This effect was again evident only in long-term users.
Conclusions:
Long-term use of antidepressants in at least moderate daily doses was associated with an increase risk of diabetes. This association was observed for both tricyclic antidepressants and selective serotonin reuptake inhibitors. Overall, those patients who used long term antidepressants were 1.84 times as likely to develop diabetes.