Regular antidepressant use may lower risk for advanced diabetes complications
Adults with diabetes and depression who take antidepressant medications as prescribed are less likely to develop serious diabetes complications or die compared with those not taking antidepressants regularly, data from Taiwan show.
“Antidepressants might carry cardiometabolic adverse effects; however, patients with depression also have higher risk for diabetes complications,” Shi-Heng Wang, PhD, assistant professor at China Medical University College of Public Health in Taichung, Taiwan, told Healio. “Our study demonstrated regular antidepressant treatment could attenuate the adverse effect of depression among patients with depression and diabetes mellitus.”
People with diabetes face a higher risk for depression, which makes them more likely to die or develop diabetes complications, including cardiovascular and kidney disease, stroke, eye and foot problems, Wang and colleagues wrote in the Journal of Clinical Endocrinology & Metabolism. Antidepressants might attenuate the adverse effects of depression; however, they are associated with cardiometabolic adverse effects, the researchers wrote.
In a retrospective study, Wang and colleagues analyzed data from 36,276 adults with depression and newly treated diabetes, using Taiwan’s universal health insurance database. Antidepressant treatment patterns within a 6-month window were classified into none, poor, partial and regular use. Researchers used Cox proportional hazards regression models, accounting for time-dependent variables with adjustment for time-dependent comorbidity and concomitant use of medications. Primary outcomes were macrovascular and microvascular complications and all-cause mortality. Researchers chose benzodiazepines as a negative control exposure.
Within the cohort, most patients with diabetes and depression were women (61.8%) and aged 45 to 64 years (55.62%). Mean follow-up duration was 5.3 years, excluding the first 6-month observation period. Overall, 9,670 patients developed macrovascular complications, 6,837 patients developed microvascular complications and 3,820 patients died.
Compared with poor use of antidepressants, regular use was associated with a 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). Regular antidepressant use was not associated with microvascular complications.
In analyses stratified by medication type, regular use of selective serotonin reuptake inhibitors 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). Regular use of tricyclic or tetracyclic antidepressants was associated with a 0.78-fold decreased risk for all-cause mortality. Regular use of benzodiazepine showed no association with diabetic outcomes.
“However, antidepressant polypharmacy was associated with an increased risk of macrovascular complications,” the researchers wrote.
The researchers noted that clinicians should emphasize antidepressant treatment adherence among patients with depression and diabetes. Additionally, they wrote that the effect of regular antidepressant treatment on reducing diabetic complications may not have been mediated directly by glycemic control.
“Clinicians should emphasize the importance of regular antidepressant treatment among patients with depression and diabetes mellitus,” Wang told Healio. “Some unmeasured factors, such as BMI, HbA1c level and lifestyle factors may bias our results. Our findings need to be replicated and confirmed in further investigations.”
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Shi-Heng Wang, PhD, can be reached at firstname.lastname@example.org.