Analysis of more than 35,000 patients with diabetes and depressive disorder indicates patients with greater adherence to antidepressants appeared to experience fewer complications and a lower rate of mortality than those with suboptimal use.
Despite concerns over their impact on cardiometabolic health, new research suggests antidepressant use in those with depression and diabetes mellitus could lower risk of complications and mortality among these patients.
A retrospective cohort study of Taiwan’s universal health insurance database, results of the 36,000-patient study indicate regular use of antidepressants was associated with a decreased risk of macrovascular complications and all-cause mortality.
"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.
Wang, along with a team of colleagues from other institutions in Taiwan, designed the current study with an aim of addressing the current dearth of evidence surrounding the effect of antidepressants on advanced diabetes outcomes. With this in mind, investigators designed their study as a retrospective cohort study using claims data from Taiwan’s National Health Insurance program.
Using this database, investigators identified more than 1.8 million patients with incident diabetes at 20 years or older. After exclusion of those with missing data, those with preexisting conditions, and those with depressive disorder, 36,276 patients were identified for inclusion in the final analyses.
The majority of the study cohort was female and between 45-64 years. Investigators also noted 41.75% had hypertension, 37.5% had dyslipidemia, 6.73% had comorbid chronic liver disease, 11.2% had chronic pulmonary diseases, and 20.26% had been hospitalized in the past year.
The primary outcomes of interest for the analyses was incidence of microvascular complications, microvascular complications, and all-cause mortality. Investigators pointed out plans to further assess associations according to different classes of antidepressants.
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. For the purpose of analysis, benzodiazepines were used as negative control exposures because they are not involved in glucose metabolism.
Upon analysis, regular use of antidepressants was associated with a 0.92-fold decrease in risk of microvascular complications and a 0.86-fold decrease in risk of all-cause mortality, but not associated with decreased risk of microvascular complications when compared to those with poor use. Further analysis indicated regular use of selective serotonin reuptake inhibitors (SSRI) was associated with a 083-fold decrease in risk of macrovascular complications and a 0.75-fold decrease in risk of all-cause mortality.
Additionally, use of tricyclic or tetracyclic antidepressants was associated with a 0.78-fold decrease in risk of all-cause mortality. Investigators also noted no evidence was observed for associations between regular benzodiazepine use and 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.
This study, “Associations Between Antidepressant Use and Advanced Diabetes Outcomes in Patients with Depression and Diabetes Mellitus,” was published in The Journal of Clinical Endocrinology & Metabolism.