Depression is more prevalent in diabetes(DM2).Depression can increase the risk of DM2. Do antidepressants alter the glucose homeostasis in non diabetic patients? Michael Deuschle reviews this topic in this article.
Short term effect: Studies indicate that in general, antidepressants can improve insulin sensitivity in the case of improved severity of depression. There is limited evidence to suggest deterioration. Nor- adrenergic antidepressants are an exception and may lead to impaired insulin sensitivity.
Long term effect: There are many routes to diabetes. Amitriptyline, Mirtazapine, and Paroxetine are related to weight gain, whereas Fluoxetine and Bupropion may lead to some weight loss. Epidemiological studies support the notion that antidepressants in long term use may increase the risk of DM2. Some studies suggest that antidepressants rather than depression were related to incident DM2 .Observational studies implicate both TCAs and SSRIs in this.Severe depression as well as use of tricyclics might have added effect.
UK General Practice Research Database study ( 165958 patients with 2243 cases of incident diabetes) found that recent long-term (>24 months) usage of antidepressants in moderate to high dosages was associated with an increased risk of DM2 (OR 1.84). The risk did not differ between tricyclic and SSRI-treated patients, whereas the duration of treatment and the dosage were critical. However, many other studies have failed to support these observations.
It is clear that depression is a risk factor for diabetes. Research support the notion that severe depression increase the risk of diabetes.Lifestyle factors might explain part of this risk. Whether antidepressants increase the risk is still unclear. Studies that show such an association indicate that TCAs, combination treatments, Noradrenergic antidepressants, agents that increase weight gain might contribute to added risk. SSRIs in general remains the choice in such situations.
Summary of the article:
Effects of antidepressants on glucose metabolism and diabetes mellitus type 2 in adults. Deuschle M.Curr Opin Psychiatry. 2013 Jan;26(1):60-5.