SSRIs and SNRIs Linked to Type 2 Diabetes in Children, Adolescents
The use of antidepressant medications by US children and adolescents has increased significantly since the late 1990s.
The use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) was associated with an increased risk for type 2 diabetes in a large cohort of young people insured by Medicaid, according to results of a retrospective cohort study published in JAMA Pediatrics.
The researchers sought to evaluate the relationship between antidepressant use in young people and incident type 2 diabetes by antidepressant subclass.
Using Medicaid data for 119,608 people age 5 to 20 years who started taking antidepressants between January 2005 and December 2009, the investigators looked at 4 classes of drugs, including the most commonly used SSRIs and SNRIs, as well as tricyclic or other cyclic antidepressants. They also examined 4 time-varying measures: current or former use, duration of use, cumulative dose, and average daily dose.
A diagnosis of incident type 2 diabetes was identified through the use of a validated, computerized database algorithm using more than 125 baseline and time-dependent covariates.
Current use of SSRIs or SNRIs was associated with an increased risk for type 2 diabetes compared with prior use of these agents (absolute risk, 1.29 per 10,000 person-months vs 0.64 per 10,000 person-months; adjusted relative risk [RR], 1.88; 95% CI, 1.34-2.64) and tricyclic or other cyclic antidepressants (absolute risk, 0.89 per 10,000 person-months vs 0.48 per 10,000 per-months; RR, 2.15; 95% CI, 1.06-4.36). However, there was no increased risk for type 2 diabetes seen with the use of other antidepressant agents.
An increased risk for type 2 diabetes was also found to be associated with increasing duration and cumulative dose of SSRI and SNRI antidepressants. Neither duration nor cumulative dose of other antidepressants was associated with an increased risk for type 2 diabetes.
The large size of the cohort contributed to the overall strength of the study. Another strength was that the investigators nested the study solely in a cohort of youths who initiated antidepressant treatment to compare current vs former users.
Although the investigators caution against drawing conclusions regarding causality because of the observational design of the study, “…the study used a rigorous design and rigorous statistical approaches to account for confounding,” researchers wrote, “and it provides new information on the risk of a rare, but serious adverse outcome that is often difficult to assess in randomized clinical trials owing to limited sample size and inadequate follow up.”
“The findings from this study support the need for further research to shed light on underlying biological mechanism of treatment-emergent type 2 diabetes associated with antidepressants,” investigators wrote.
Burcu M, Zito JM, Safer DJ, et al. Association of antidepressant medications with incident type 2 diabetes among Medicaid-insured youths [published online October 16, 2017]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2017.2896