Miidera H, Enomoto M, Kitamura S, et al. Association Between the Use of Antidepressants and the Risk of Type 2 Diabetes: A Large, Population-Based Cohort Study in Japan. Diabetes Care. 2020 Apr;43(4):885-893. doi: 10.2337/dc19-1175. Epub 2020 Feb 12. (Original study)

OBJECTIVE: This study aimed to reveal the associations between the risk of new-onset type 2 diabetes and the duration of antidepressant use and the antidepressant dose, and between antidepressant use after diabetes onset and clinical outcomes.

RESEARCH DESIGN AND METHODS: In this large-scale retrospective cohort study in Japan, new users of antidepressants (exposure group) and nonusers (nonexposure group), aged 20-79 years, were included between 1 April 2006 and 31 May 2015. Patients with a history of diabetes or receipt of antidiabetes treatment were excluded. Covariates were adjusted by using propensity score matching; the associations were analyzed between risk of new-onset type 2 diabetes and the duration of antidepressant use/dose of antidepressant in the exposure and nonexposure groups by using Cox proportional hazards models. Changes in glycated hemoglobin (HbA1c) level were examined in groups with continuous use, discontinuation, or a reduction in the dose of antidepressants.

RESULTS: Of 90,530 subjects, 45,265 were in both the exposure and the nonexposure group after propensity score matching; 5,225 patients (5.8%) developed diabetes. Antidepressant use was associated with the risk of diabetes onset in a time- and dose-dependent manner. The adjusted hazard ratio was 1.27 (95% CI 1.16-1.39) for short-term low-dose and 3.95 (95% CI 3.31-4.72) for long-term high-dose antidepressant use. HbA1c levels were lower in patients who discontinued or reduced the dose of antidepressants (F[2,49] = 8.17; P < 0.001).

CONCLUSIONS: Long-term antidepressant use increased the risk of type 2 diabetes onset in a time- and dose-dependent manner. Glucose tolerance improved when antidepressants were discontinued or the dose was reduced after diabetes onset.

Discipline Area Score
Psychiatry 6 / 7
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Internal Medicine 6 / 7
FM/GP/Mental Health 6 / 7
Endocrine 5 / 7
Comments from MORE raters

FM/GP/Mental Health rater

It is a well elaborated article with a large number of patients, but it would be necessary to take into account biases regarding the hygienic and dietary characteristics that may be present in both the diabetic and depressive population. For example: bad dietary habits, lack of exercise, ...

FM/GP/Mental Health rater

This observational study raises an interesting hypothesis. However, further research is needed. Based on this study alone, it would be harmful to patients if primary care physicians, such as myself, stopped treating depression because of fear of causing diabetes.
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