Long-term antidepressant use is linked to T2D

  • Miidera H & al.
  • Diabetes Care
  • 12 Feb 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Long-term antidepressant use appears to increase type 2 diabetes (T2D) risk.
  • Antidepressant discontinuation and/or dose reduction may reduce T2D risk and/or improve glucose tolerance.
  • HbA1c level should be monitored in patients taking antidepressants.

Why this matters

  • Antidepressants are widely prescribed in developed countries.
  • Evidence has conflicted regarding their link to T2D.

Study design

  • In a Japanese retrospective cohort study of individuals without baseline diabetes, 45,265 antidepressant-exposed patients were propensity-matched to 45,265 nonexposed.
  • Funding: Ministry of Health, Labour and Welfare of Japan.

Key results

  • T2D onset occurred in 170,246.7 vs 407,875.1 person-years in exposed vs nonexposed, respectively.
  • Compared with no antidepressant use, T2D incidence was significantly more frequent, with HRs ranging from 1.27 for short-term, low-dose use (P<.001 to for long-term high-dose use>
  • By single antidepressant types, HRs ranged from 2.99 (95% CI, 2.06-4.35) for tetracyclics to 1.59 (95% CI, 1.43-1.76) for selective serotonin reuptake inhibitors.
  • Compared with antidepressant continuation, T2D risk was lower at years 1, 2, and 3 for discontinuation (P=.02, P<.001 and p=".002," respectively dose reduction>

Limitations

  • Possible residual confounding.
  • Kidney function, medication status not considered as covariates.
  • All employee-insured population.
  • Antidepressant adherence unknown.
  • Small sample size.