The use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) is associated with an increased risk of type 2 diabetes in young adults that intensifies with increasing duration of use, cumulative dose, and average daily dose, according to a study published in JAMA Pediatrics.
Mehmet Burcu, PhD, MS, from the Department of Pharmaceutical Health Services Research, at the University of Maryland, Baltimore, and colleagues used the Medicaid Analytic eXtract (MAX) database to identify the study cohort of 119,608 youths who initiated antidepressant treatment. Data were extracted from California, Florida, Illinois, and New Jersey from January 1, 2004, through December 31, 2009.
The incidence of type 2 diabetes was expressed as the number of new cases of type 2 diabetes per 10,000 person-months of follow-up. Medication use accounted for status of use (current vs former use), duration of use (in days), cumulative dose exposure, and average daily dose. Antidepressants identified included SSRIs, SNRIs, tricyclic or other cyclic antidepressants, and other antidepressants.
The study included 119,608 youths (59,087 female) who were aged 5 to 20, with 54.7% between 5 and 14 years of age.. With an average follow-up of 22.8 months, 79,285 (66.3%) had SSRI or SNRI exposure. The risk of type 2 diabetes was significantly greater during current use than former use of SSRIs or SNRIs (absolute risk, 1.29 per 10 000 person-months vs 0.64 per 10 000 person-months; adjusted relative risk [RR], 1.88) and tricyclic or other cyclic antidepressants (0.89 vs 0.48; RR, 2.15), but not for other antidepressants (1.15 vs 1.12; RR, 0.99).
For youths currently using SSRIs or SNRIs, the risk of type 2 diabetes increased with the duration of use (RR, 2.66 for >210 days and RR, 2.56 for 151 to 210 days compared with 1 to 90 days) and with the cumulative dose (RR, 2.44 for more than 4500 mg and RR, 2.17 for 3001 to 4500 mg compared with 1 to 1500 mg in fluoxetine hydrochloride dose equivalents). Neither the duration nor the cumulative dose of other antidepressants was associated with an increased risk of type 2 diabetes. The risk of type 2 diabetes increased significantly with the average daily dose among youths with more than 150 days of SSRI or SNRI use (RR, 2.39 for >15.0 vs ≤15.0 mg/d) but not among youths with 1 to 150 days of SSRI or SNRI use.
“In this large cohort of youths insured by Medicaid who initiated treatment with antidepressant medications, our main finding indicates that there was a substantially greater risk of incident type 2 diabetes for those currently using SSRIs or SNRIs than for those who formerly used these medications,” stated the authors. “Furthermore, for youths currently using SSRIs or SNRIs, the risk of type 2 diabetes intensified with increasing duration of use, cumulative dose, and average daily dose.”
Burcu M, Zito JM, Safer DJ, et al. Association of antidepressant medications with incident type 2 diabetes among Medicaid-insured youths. JAMA Pediatr. 16 Oct 16 2017. doi:10.1001/jamapediatrics.2017.2896