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Selective Serotonin Reuptake Inhibitors Decrease Pancreatic Insulin Secretion in Older Adults and Increase the Risk of Insulin Dependence in Type 2 Diabetes Patients

J Clin Psychiatry 2016;77(9):e1124–e1129
10.4088/JCP.15m10048

Objective: Selective serotonin reuptake inhibitors (SSRIs) may decrease insulin secretion, but evidence from population studies is scarce. We investigated the association between SSRIs and markers for glucose-insulin homeostasis in a nondiabetic older population. Furthermore, we studied the association between SSRI use and insulin dependence in a diabetic population of older adults.

Methods: This study was embedded in the prospective population-based Rotterdam Study cohort (1991–2012). In nondiabetic participants, fasting glucose and insulin levels and the homeostasis model assessment for insulin sensitivity and secretion were compared between participants using SSRIs and participants using no antidepressant. In diabetic patients using oral glucose-lowering agents, the risk of insulin dependence, defined as the start of insulin treatment, was compared between participants using SSRIs and participants using no antidepressant.

Results: In nondiabetic participants, SSRI users (n = 87) had, compared with participants using no antidepressants (n = 5,505), a significantly (P < .05) lower level of insulin (8.8 mU/L and 9.9 mU/L, respectively), a lower degree of insulin resistance (2.2% and 2.4%, respectively), and less insulin secretion (89.1% and 100.4%, respectively), but a similar glucose level. Furthermore, > 90 days of consecutive use of SSRIs in diabetic patients was associated with a 2.17 times higher risk (95% confidence interval, 1.02–4.60) of starting insulin treatment than that of participants using no antidepressants.

Conclusions: Use of SSRIs was associated with lower insulin secretion in nondiabetic participants and an increased risk of insulin dependence in type 2 diabetics in older adults. However, additional studies are required to confirm our results.