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