Can We Blame Antidepressants For Type 2 Diabetes?

There are many reasons why people use antidepressants. After all, depression is a very common disorder that affects almost 15 million US adults. However, even children, teenagers and older adults may be affected. It is estimated that by 2020, depression will be a major cause of disability, ranking second to ischemic heart disease.

Depression and Antidepressants

Depression can lead to physical, mental, social, and emotional disability. Aside from these, it can also increase one’s risk for suicidal tendencies, leading doctors to prescribe long-term use of antidepressants in many patients. In most patients, these now commonly prescribed drugs lead to a remission of symptoms and an improved quality of life.

These can increase one’s risk for type 2 diabetes. This leads patients and doctors to ask, can we blame antidepressants for type 2 diabetes? Although some people may think that depression itself could increase one's tendency to overeat or remain sedentary and put on weight, researchers have found a possible link between antidepressant therapy, weight gain, and diabetes.

Treatment of Depression

People who experience long-lasting symptoms or sadness, anxiety, poor appetite, inability to concentrate, social withdrawal, and having thoughts of dying or suicidal tendencies are often diagnosed to be suffering from depression. These symptoms can lead to physical and mental health problems, decreased work productivity and disability. Because of these, physicians may prescribe different types of antidepressants to reduce these symptoms, which include:

• Tricyclic antidepressants, which help restore the balance of neurochemicals in the brain, such as serotonin and norepinephrine. This class of drugs includes Norpramin, Elavil, and Pamelor.

• SSRIs, or selective serotonin re-uptake inhibitors, which prevent the reabsorption of the serotonin, thus helping to enhance its availability to the brain cells. These include Lexapro, Paxil, Prozac, and Zoloft.

• SNRIs, or serotonin norepinephrine reuptake inhibitors, such as Pristiq, Effexor, and Cymbalta. These prevent the reabsorption of the norepinephrine, thus helping to enhance its availability to the brain cells.

These drugs help boost energy and improve the mood of depressed individuals. They also help prevent relapsesin the long term. Some patients experience mild side effects such as dizziness, difficulty falling asleep, nausea, and headaches, which often disappear or become tolerable over some time.

These problems pose a serious concern for patients and can even increase their level of anxiety. Some would opt to stop taking their medications, which is not favorable, since it would trigger relapses or exacerbation of their depressive symptoms.

Antidepressants And Diabetes: Is There A Connection?

Many people who are taking antidepressants may be relieved that they are able to overcome chronic sadness and anxiety and manage to improve their social life and work productivity. However, a lot of these people also notice that they have been gaining a significant amount of weight or are unable to lose weight in spite of diet and exercise.

Researchers at the University of Southampton warn that clinicians must be more careful in prescribing antidepressants since these can increase their patients’ risk of developing the disease. Close to 47 million UK adults were prescribed some antidepressants in 2011. A systematic review of 22 studies plus three previews reviews done in the University revealed that patients who used antidepressants at higher doses or for extended duration were at increased risk of developing diabetes type 2.

Experts recommend that doctors should be aware of this risk when prescribing these drugs, and that they should monitor their patients for diabetes and encourage them to reduce that risk through lifestyle modification.

The results of the latest systematic reviews support previous findings in population-based studies in other countries, such as those conducted in Canada, which involved 2,400 people, and in Finland, which involved more than 15,000 adults. Scientists found that increasing daily doses of antidepressants were associated with elevated absolute risk for type 2 diabetes.

Studies show that these effects occurred in patients who used tricyclic antidepressants or SSRIs, and that the effect was increased when both were used.

Other studies also suggest that aside from antidepressants, antipsychotic drugs used to treat other mental illnesses such as schizophrenia, as well as atypical antipsychotics, which are often prescribed for mood disorders, can also increase the risk for weight gain and diabetes.

Recommendations

Experts do not recommend abruptly stopping their treatment for depression because major depressive symptoms are bound to come back. Instead, one can ask their doctors to prescribe other types of antidepressants with lesser risk of weight gain, or to combine their current medications with another type of medication that can boost its positive effects and reduce its side effects. Some doctors may combine serotonin-based antidepressants with bupropion (Wellbutrin), another type of antidepressant that does not cause weight gain, or with other "antidotes" such as orlistat (Xenical), an anti-obesity drug, and metformin (Glucophage), an anti-diabetic drug.

For some patients, however, weight gain is not necessarily a negative effect. Many depressed patients who have lost a lot of weight, such as cancer patients, may benefit from an increase in appetite. This weight gain does not necessarily lead to diabetes, but in fact, may improve their sense of well-being.

Physicians can also suggest the use other modes of treatment such as cognitive behavioral therapy or group therapy to manage their depression and reduce the need for medications. Alternative treatments such as acupuncture, yoga, and other meditation and relaxation techniques have also been found to be helpful.

Finally, patients taking antidepressants may reduce their intake of these drugs by combining their treatment with lifestyle modifications that can reduce weight gain, such as diet and exercise. Eating a healthy diet and increasing physical activity not only help control weight and blood sugar levels, but they can also boost one's mood and self-confidence, thus reducing anxiety levels.