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Antidepressant use may increase risk for diabetes in youth

Use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors was associated with an increased risk for type 2 diabetes among Medicaid-insured youth.

“During the past decade, there has been a growing number of published studies — all conducted for adults — that report a substantially increased risk of type 2 diabetes associated with antidepressant use,” Mehmet Burcu, PhD, MS, of the University of Maryland, Baltimore, and colleagues wrote. “By contrast, evidence of such a risk among youths is scarce and limited to only a few studies, wherein antidepressant use concomitant with antipsychotics was associated with an additive increased risk of type 2 diabetes.”

To assess associations between antidepressant use and risk for type 2 diabetes in youths, researchers analyzed Medicaid claims data from four geographically diverse, large states for 119,608 youths aged 5 to 20 years who initiated antidepressant treatment from January 2005 to December 2009. Mean follow-up was 22.8 months.

Risk for type 2 diabetes was significantly greater during current use vs. former use of SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs), with an absolute risk of 1.29 per 10,000 person-months vs. 0.64 per 10,000 person-months (adjusted RR = 1.88; 95% CI, 1.34-2.64).

The same association was found for tricyclic or other cyclic antidepressants, with an absolute risk of 0.89 per 10,000 person-months vs. 0.48 per 10,000 person-months (aRR = 2.15; 95% CI, 1.06-4.36).

Risk for type 2 diabetes increased with duration of use among youths currently using SSRIs or SNRIs, with an RR of 2.66 (95% CI, 1.45-4.88) for more than 210 days of use and 2.56 (95% CI, 1.29-5.08) for 151 to 210 days of use, compared with 1 to 90 days of use.

Risk for type 2 diabetes also increased with cumulative dose among youths currently using SSRIs or SNRIs, with an RR of 2.44 (95% CI, 1.35-4.43) for more than 4,500 mg and 2.17 (95% CI, 1.07-4.4) for 3,001 to 4,500 mg, compared with 1 to 1,500 mg of fluoxetine hydrochloride dose equivalents.

Conversely, duration and cumulative dose of other antidepressants were not associated with increased risk for type 2 diabetes.

Risk for type 2 diabetes significantly increased with average daily dose among youths who used SSRIs or SNRIs for more than 150 days (RR = 2.39; 95% CI, 1.04-5.52), but not among youths with 1 to 150 days of SSRI or SNRI use.

“In the face of recent growth in the pediatric use of antidepressants in the U.S., as well as other Western countries, the findings from this study support the need for further research to shed light on the underlying biological mechanism of treatment-emergent type 2 diabetes associated with antidepressants,” the researchers wrote. “Also, given that more than half of antidepressant prescriptions to U.S. youths occur in outpatient visits to pediatricians and other primary care physicians, the study findings provide an impetus for policy development to improve monitoring for the benefits vs. risks of antidepressant use in pediatric care models, specifically for serotonin reuptake inhibitors, the most commonly used antidepressant subclass.” – by Amanda Oldt

Disclosures: The authors report no relevant financial disclosures.