Use of antidepressant medication and risk of type 2 diabetes: results from three cohorts of US adults.

Department of Nutrition, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA.
Diabetologia (Impact Factor: 6.88). 08/2011; 55(1):63-72. DOI: 10.1007/s00125-011-2268-4
Source: PubMed

ABSTRACT The results of several studies have suggested a potential positive association between use of antidepressant medication (ADM) and incident type 2 diabetes mellitus. We examined this association in three cohorts of US adults.
We followed 29,776 men in the Health Professionals Follow-up Study (HPFS, 1990-2006), 61,791 women in the Nurses' Health Study I (NHS I, 1996-2008) and 76,868 women in NHS II (1993-2005), who were free of diabetes mellitus, cardiovascular disease or cancer at baseline. The mean baseline ages for participants from the HPFS and NHS I and II were 56.4, 61.3 and 38.1 years, respectively. ADM use and other covariates were assessed at baseline and updated every 2 years. A time-dependent Cox proportional hazards model was used, and HRs were pooled together across the three cohorts.
During 1,644,679 person-years of follow-up, we documented 6,641 new cases of type 2 diabetes. ADM use was associated with an increased risk of diabetes in all three cohorts in age-adjusted models (pooled HR 1.68 [95% CI 1.27, 2.23]). The association was attenuated after adjustment for diabetes risk factors and histories of high cholesterol and hypertension (1.30 [1.14, 1.49]), and further attenuated by controlling for updated BMI (1.17 [1.09, 1.25]). Use of selective serotonin reuptake inhibitors and other antidepressants (mainly tricyclic antidepressants) were both associated with an elevated risk of diabetes, with pooled multivariate-adjusted HRs of 1.10 (1.00, 1.22) and 1.26 (1.11, 1.42), respectively.
The results suggest that ADM users had a moderately elevated risk of type 2 diabetes mellitus compared with non-users, even after adjustment for BMI.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims We evaluated the association of combined use ofantidepressants andstatinsand the risk of new-onset diabetes among high-risk adults. Methods We used a retrospective, observational, longitudinal design among adults (age≥22 years) who were diabetes free at baseline and had reported hypertension or hyperlipidemia or heart disease. We used data were from 2004-2009 Medical Expenditure panel Survey and identified from self-reported diabetes or insulin use. We categorized antidepressants andstatins use into four groups: antidepressants only, statins only, combined use of antidepressants and statins (antidepressants-statins), and neither antidepressant nor statins.We conducted chi-square and multivariable logistic regressions to examine the association between use of antidepressants-statinsand new-onset diabetes after controlling fordemographic and economic characteristics, health-status, access to care, presence of depression, and lifestyle risk factors. Results In our study sample, 9.3% used antidepressants only, 10.7% used statins only and 2.4% adults reported use of antidepressants-statins. Nearly 2% of the study sample reportednew-onset diabetes. In unadjusted analyses, significantly higher proportion of adults using antidepressants-statins (3.2%) reported new-onset diabetes compared to those using neither antidepressants nor statins (1.1%).However, after controlling for all other variables in multivariable regression we did not observe a statistically significant association between use of antidepressants-statins and new-onset diabetes. Conclusions Our study results do not suggest that use ofantidepressants-statins may increase the risk of new-onset diabetes. Future research needs to examine this relationship with specific combinations of these drug classes and using longer follow up periods.
    Diabetes Research and Clinical Practice 08/2014; 105(2). DOI:10.1016/j.diabres.2014.04.016 · 2.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Depression and diabetes are serious diseases with an increasing global prevalence. Intriguingly, recent meta-analyses have highlighted an asymmetrical relationship between the two conditions as depressed patients were found to display a higher risk of developing type 2 diabetes than those individuals suffering from diabetes are to become depressed. Based on recent findings, we favor a hypothesis where by decreased peripheral serotonin (5-HT) transporter (5-HTT) function is a reciprocal risk factor for the co-morbidity of depression and diabetes, as it can trigger inflammatory pathogenetic mechanisms of both conditions. Higher intestinal levels of 5-HT and 5-HT3 receptor stimulation lead to increased intestinal permeability in 5-HTT deficient mice, which is viewed one of the most relevant animal models of depression. We hypothesize that this leakage of bacterial endotoxins can activate both central and peripheral Toll-like receptor 4 (TLR4), which inhibits insulin signaling and IRS1/PI3K/Akt and thus, contribute to the pathogenesis of diabetes and depression that are associated with this pathway. Antidepressant therapies, which also suppress intestinal 5-HTT, may have potentiating effects on the association between depression and diabetes. It is also of interest that high carbohydrate and fat intake ("cafeteria-type diet") increases intestinal 5-HT leading to TLR4 activation. Thus, endotoxaemia and inflammation owing to increased intestinal 5-HT may underpin the depression and diabetes association, where the risk of the latter pathology becomes particularly preeminent after the onset of depression and not vice versa. The evidence presented here shows the further investigation into peripheral mechanisms that linked diabetes to depression is clearly warranted.
    Behavioural brain research 05/2014; DOI:10.1016/j.bbr.2014.04.049 · 3.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The aim of the present study was to examine the association between antidepressant use, diagnosed depression, and new-onset diabetes among elderly Medicare beneficiaries. Methods Longitudinal data from merged survey and claims from the nationally representative Medicare Current Beneficiary Survey(MCBS) from 1999 to 2005 were used. Diabetes incidence was extracted from claims and survey data over a 3-year period. Data regarding depression and antidepressant use over time were obtained. Multivariate logistic regression analysis was used to examine associations between antidepressant use, depression, and new-onset diabetes, adjusted for demographic, socioeconomic, and lifestyle risk factors. Analyses accounted for the complex design of the MCBS. ResultsThe incident diabetes rate was 4.8% for those “without depression and without antidepressants” and 9.5% for those with any antidepressant use in all 3 years and diagnosed depression”. Compared with Medicare beneficiaries who did not report any antidepressant use, beneficiaries reporting antidepressant use in all 3 years were 50% more likely to have new-onset diabetes. However, when diagnosed depression was entered in the model, there was no significant association between long-term antidepressant use and new-onset diabetes. Medicare beneficiaries with any depression were twice as likely as those without depression to develop diabetes (adjusted odds ratio 2.04; 95% confidence interval 1.51, 2.75). Conclusions Depression independently increased the risk of developing diabetes in the MCBS population, although there is no evidence of an association between antidepressant use and new-onset diabetes. If replicated, these results have significant clinical implications. 摘要 背景本研究的目的是在老年医疗保险受益者中调查抗抑郁药的使用、抑郁症的诊断与新发糖尿病之间的关系。 方法纵向数据来自于合并的调查与索赔数据,即1999至2005年间全国典型的医疗保险当前受益人调查(Medicare Current Beneficiary Survey MCBS)数据。糖尿病发生率来自于超过3年的索赔与调查数据。并获取有关抑郁症以及随着时间的推移抗抑郁药使用情况的数据。使用多因素Logistic回归分析来检验抗抑郁药的使用情况以及抑郁症与新发糖尿病之间的关系,并且经过了人口统计学、社会经济学以及生活方式等危险因素的校正。分析解释了MCBS的复杂设计。 结果那些“没有抑郁症也没有使用抗抑郁药物”的老年人糖尿病发生率为4.8%,那些“使用任何抗抑郁药物总共达到3年以及已经诊断抑郁症”的老年人糖尿病发生率为9.5%。与那些没有报告使用任何抗抑郁药的医疗保险受益者相比较,报告使用任何抗抑郁药物总共达到3年的受益者出现新发糖尿病的可能性高50%。然而,若将已经诊断的抑郁症也并入模型中,则长期使用抗抑郁药与新发糖尿病之间就没有显著的相关性了。合并任何程度抑郁症的医疗保险受益者发生糖尿病的可能性是那些未合并抑郁症受益者的2倍(校正后优势比为2.04;95%CI为1.51,2.75)。 结论在MCBS人群中,抑郁症可独立增加患糖尿病的风险,虽然目前还没有证据表明抗抑郁药的使用与新发糖尿病之间具有相关性。如果能够得到重复研究的证实,那么这些结果将具有重要的临床意义。
    Journal of Diabetes 09/2013; 5(3). DOI:10.1111/1753-0407.12014 · 2.94 Impact Factor


Available from
Jun 2, 2014