Long-Term Use of Antidepressants For Depressive Disorders and the Risk of Diabetes Mellitus. Ranked “Changes Clinical Practice” by F1000
Leo Sher; Maria Oquendo
Authors and Disclosures
Andersohn F, Schade R, Suissa S, Garbe E
Am J Psychiatry 2009 May 166(5):591-8
Commentary from Leo Sher and Maria Oquendo
Changes Clinical Practice: Patients receiving a moderate to high daily dose of antidepressants for greater than 12 months should be evaluated for impaired glucose tolerance/diabetes.
The authors of this study have shown that the long-term use of antidepressants in at least moderate daily doses was associated with an increased risk of diabetes. This finding indicates that blood glucose levels should be checked periodically in patients on long-term antidepressant therapy.
Depression is a severe condition that frequently requires a long-term treatment. The authors examined the relationships between the use of antidepressants and a risk of diabetes mellitus in patients of at least 30 years of age and whether the risk is influenced by treatment duration or daily dose. The authors used data from the UK General Practice Research Database (GPRD), which contains medical records for several million patients from about 450 general practices in the UK. Criteria for inclusion in the study included but were not limited to the following: (1) patients had to be at least 30 years of age at the time of cohort entry (only patients 30 years of age were included in the cohort to ensure that incident cases of diabetes were most likely to be type 2 diabetes); (2) have had no diagnosis of diabetes or impaired glucose tolerance and no treatment with oral antidiabetics or insulin before cohort entry; and (3) have had a diagnosis of depression within 180 days before or 90 days after cohort entry. Antidepressants were classified into tricyclic and tetracyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase (MAO) inhibitors, and the heterogeneous group of mixed-action “other antidepressants.” Recent long-term use of antidepressants in moderate or high daily doses was associated with an increased risk of diabetes whereas recent use of shorter duration, use in lower daily doses, former use, and past use were not. This association was observed for both tricyclic antidepressants and SSRIs. In the analysis of individual antidepressants, increased risk estimates were observed for long-term use of amitriptyline, fluvoxamine, paroxetine, and venlafaxine. The results of this study are consistent with a recent report published by the Diabetes Prevention Program Research Group: the randomized Diabetes Prevention Program trial found an increased risk of diabetes in high-risk patients who used antidepressants. A significant strength of this study is that all information was registered prospectively so that recall bias could be ruled out. An important limitation of this study is that weight gain during follow-up was not systematically recorded, and it was not included in the analysis. It is important to note that depression itself increases risk for diabetes. This may contribute to the results observed by the authors of the study. This study indicates that patients receiving antidepressants long-term should be evaluated for impaired glucose tolerance/diabetes. This study contributes to our knowledge of the use and possible adverse effects of antidepressants in the treatment of depression.
Faculty of 1000 Medicine Evaluations, Dissents and Author responses for: [Andersohn F, Schade R, Suissa S, Garbe E et al. Long-term use of antidepressants for depressive disorders and the risk of diabetes mellitus. Am J Psychiatry 2009 May 166(5):591-8 ]. 2009 May www.f1000medicine.com/article/id/1161024
1. Rubin et al. Diabetes Care 2008, 31:420-6
Authors and Disclosures
The following article was selected and commented on by these Faculty Members of Faculty of 1000 Medicine:
Leo Sher and Maria Oquendo, Columbia University, United States of America Psychiatry
Disclosure: No potential interests relevant to this article were reported.