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Antidepressant May Affect Glucose Metabolism

Antidepressants can worsen glycemic control and/or induce hyperglycemia….

The use of antidepressants has increased over recent years. There have been concerns about the use of antidepressants in patients with diabetes. Selective serotonin reuptake inhibitors (SSRIs) can worsen glycemic control in diabetics while tricyclic antidepressants can induce hyperglycemia in patients. Some studies adjusted for the change in body weight and still observed an increase risk of diabetes in patients using antidepressants. This may suggest other factors are contributing to diabetes. Other medications such as antipsychotics may alter insulin resistance or secretion.

Crucitti et al’s study on the effects of duloxetine showed no significant change in fasting plasma glucose or HbA1c in short-term therapy. But in the long-term, the researchers saw a statistically significant increase in HbA1c in patients with chronic lower back pain.

The authors concluded there might be a link between antidepressants and diabetes. But since the probability is low, the majority of patients who are receiving the medication will not develop diabetes. More studies should be conducted to see if the combination of antidepressants with diabetic patients has additive effects. As of now, there are many conflicting studies.

Practice Pearls:  
  • Antidepressants may contribute to insulin resistance with weight gain.
  • TCAs induce hyperglycemia.
  • Antipsychotics may alter insulin resistance.

American Diabetes Association October 2013