Improved Outcomes Seen with Regular Antidepressant Use in Patients with Diabetes and Depression

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Adherence to antidepressant therapy among patients with comorbid diabetes may reduce the risk for diabetes-related complications and for mortality, according to results of a new study from researchers on Taiwan.

"People with depression and diabetes have poorer health outcomes than those with diabetes alone, and regular antidepressant treatment could lower their risk of complications,” said study author Shi-Heng Wang, PhD, of the China Medical University in Taichung, Taiwan, in a statement.

Writing in the Journal of Clinical Endocrinology & Metabolism Wang et al begin with a note of caution, pointing out that while antidepressant medications may help reduce morbidity in patients with depression and diabetes, the class of drugs, along with psychotropics more broadly, has been associated with a range of negative cardiometabolic effects.

The authors set out to examine the association more closely between antidepressant treatment and advanced complications of diabetes and mortality.

The nationwide retrospective cohort study identified 36 276 patients in Taiwan’s universal health insurance database who had both depression and newly treated diabetes. Participants’ age ranged from 45 to 64 years; the majority (61.8%) of the cohort was women.

The study team noted the presence of other comorbidities including hypertension, 41.75%; dyslipidemia, 37.5%; chronic pulmonary disease, 11.2%; chronic liver disease, 6.73%. Approximately one-fifth of the participants (20.3%) in the year before the study.

The primary outcomes to be assessed were micro- and macrovascular complications and all-cause mortality. Associations would be further analyzed by antidepressant classes.

Antidepressant use was assessed in 30-days intervals, beginning at 6 months after the cohort entry date, and medication adherence was calculated using the medication possession ratio. Use of medications was classified as none, poor use, partial use, and regular use. Benzodiazepines which are not associated with glucose metabolism were selected for negative control exposure.

RESULTS

Wang et al found that compared with poor use of antidepressant therapy, regular use of antidepressants was associated with an 8% decreased risk for macrovascular complications (adjusted HR = 0.92; 95% CI, 0.84-1) and a 14% decreased risk for all-cause mortality (aHR = 0.86; 95% CI, 0.75-0.98). Investigators found no association between regular antidepressant and microvascular complications.

Analysis stratified by antidepressant class found that regular use of selective serotonin reuptake inhibitors (SSRI) was associated with a 17% decreased risk for macrovascular complications (aHR = 0.83; 95% CI, 0.74-0.94) and 25% reduced risk for all-cause mortality (aHR = 0.75; 95% CI, 0.62-0.91).

Among tricyclic or tetratricyclic antidepressants, regular use was associated with a 0.78-fold decrease in risk of all-cause mortality. Regular use of benzodiazepines, the authors found, had no association with diabetes complications.

“People who adhere to their antidepressants have better diabetes outcomes and quality of life than those with poor adherence,” said study author Chi-Shin Wu, MD, PhD, of the National Taiwan University Hospital.