Analysis of a large database points to increased diabetes risk with long-term use of these medications at moderate-to-high doses. Depression seems to increase the risk for diabetes mellitus, but research results have been inconclusive regarding the role of antidepressant use. These researchers used data from the huge U.K. General Practice Research Database, which included 165,958 nondiabetic patients with depression who were 30 or older and who received their first antidepressant prescription between 1990 and 2005. Of these individuals, 2243 patients who developed diabetes after starting antidepressants were compared with 8963 sex- and age-matched patients who remained free of diabetes (mean follow-up, 2.8 years). Risk for developing diabetes was associated with SSRIs or tricyclic medications at or above median doses when use was recent (<6>24 months). The number of patients was too small to permit definitive analyses for many antidepressants, but long-term treatment with paroxetine, fluvoxamine, venlafaxine, and amitriptyline carried an increased diabetes risk. Elevated risk was not associated with long-term use of fluoxetine, citalopram, or sertraline; shorter treatment; or doses below the median level. High body-mass index at baseline was the strongest predictor of new-onset diabetes. Adjusting for depression severity did not alter the findings. Comment: Although diabetes risk is elevated for the major antidepressant classes, the risks posed by individual medications vary widely. Prior obesity is an independent risk factor, and depression per se might also increase the risk. Clinicians should be alert to the possibility of diabetes in patients with depression, particularly overweight or obese individuals or those taking paroxetine or other antidepressants prone to foster obesity. Adjunctive treatment with other classes of psychiatric medications that induce weight gain is likely to further compound diabetes risk.
Journal Watch Psychiatry May 4, 2009