October 24, 2017

Study Finds Link Between Antidepressant Use, Type 2 Diabetes in Youth

BALTIMORE, Md -- October 24, 2017 -- Current, prolonged use of serotonin reuptake inhibitors (SRIs) in children and adolescents was associated with a nearly 2-fold increased risk of developing type 2 diabetes when compared with youths who formerly used (but eventually discontinued) those medications.

The study, published online by JAMA Pediatrics, is the first population-based study that comprehensively examined paediatric patients’ risk of developing type 2 diabetes after beginning treatment with an antidepressant.

“Antidepressants are one of the most commonly used psychotropic medication classes among youth in the United States, with serotonin reuptake inhibitors representing a majority of total antidepressant use in this population,” said Mehmet Burcu, PhD, University of Maryland, Baltimore, Maryland. “These findings provide new information on the risk of a rare, but serious adverse outcome that is often difficult to assess in clinical trials due to limited sample size and inadequate follow-up.”

Although a number of studies have demonstrated a link between antidepressant use and risk for type 2 diabetes in adults, evidence of a similar risk among children and adolescents remains limited.

For the current study, Dr. Burcu and his team analysed Medicaid administrative claim files for nearly 120,000 children and adolescents aged 5 to 20 years from California, Florida, Illinois, and New Jersey, who initiated treatment with an antidepressant between January 1, 2005 and December 31, 2009, for conditions such as depressive disorder, attention-deficit/hyperactivity disorder, and anxiety disorders. Medications that patients were prescribed included SRIs, tricyclic or other cyclic antidepressants, and other antidepressants.

The team applied rigorous design and statistical approaches to compare incident cases of diabetes in current antidepressant users to former users, rather than non-users (children and adolescents who were never prescribed an antidepressant).

“This approach represented a methodological strength of our study, as the comparison of current users to non-users could potentially lead to biased estimates due to several factors, such as confounding by indication and medical care utilisation intensity bias,” said Dr. Burcu.

There were a total of 233 incident cases of type 2 diabetes, of which 156 occurred during current use and 77 occurred during former use of antidepressants, demonstrating that current use of antidepressants in children and adolescents was associated with a 2-fold increased risk of developing type 2 diabetes.

In addition, within current users, the team assessed the risk of incident diabetes according to duration of use, cumulative dose, and average daily dose. This secondary analysis showed that the risk for children and adolescents who were prescribed SRIs further intensified with an increasing duration of use (long-term use), cumulative dose, and average daily dose.

“The increased risk of type 2 diabetes following prolonged use of serotonin reuptake inhibitor antidepressants in youth is clearly supported by these findings, with the data showing a greater effect on those youths who were prescribed the medications over longer durations and at higher doses,” said Daniel J. Safer, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland. “We know that long-term use of these antidepressants is not without risk, and further research on outcomes, especially for current, long-term users, is warranted to assure a favourable benefit-risk balance for patients.”

Reference: DOI: 10.1001/jamapediatrics.2017.2896

SOURCE: University of Maryland
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