Do Antidepressants Cause Type 2 Diabetes?

Antidepressants and type 2 diabetes are linked. There is a mutual risk between diabetes and depression so that someone with one of these life-altering conditions has an increased risk of developing the other. This bi-directional relationship between the illnesses has led many to wonder if the treatment for one impacts the other; after all, a significant amount of people with type 2 diabetes are also taking antidepressants. Do antidepressants cause type 2 diabetes?

In seeking an answer to this important question, researchers have discovered that antidepressants do affect diabetes. The picture is still unclear, however, because the effects of this type of psychiatric medication on diabetes vary:

• Some types of antidepressants are harmful to diabetes, lowering glucose control and increasing hyperglycemia.
• Some antidepressants improve diabetes by increasing glucose control.
• Others have mixed results, sometimes worsening and sometimes improving depression.

Let’s examine what researchers know thus far regarding antidepressants and diabetes type 2.

Antidepressants and the Risk of Type 2 Diabetes

Medication for depression can contribute to the development of new diabetes, and it can also worsen existing diabetes. Numerous studies have uncovered three connections:

• Weight gain caused by antidepressants
• Medication’s negative effect on glucose control
• Skyrocketing hypoglycemia

Many antidepressants cause significant weight gain ("Antidepressants and Weight Gain – SSRIs and Weight Gain"). Overweight and obesity are major risk factors for type 2 diabetes. It’s possible that without the weight gain, antidepressants wouldn’t be a potential cause of diabetes. Complicating things, though, is the speculation that certain antidepressants affect blood glucose regardless of weight gain. Some people who don’t gain weight on antidepressants develop diabetes nonetheless.

Whether it’s via weight gain or direct effect, antidepressants often inhibit glucose control. Glucose control refers to the body’s ability to keep blood sugar levels within a healthy range, neither climbing too high nor dropping too low. Antidepressants can interfere in the body’s glucose regulation, which leads to dangerous spikes and drops.

Hypoglycemia is high blood glucose (blood sugar). For someone with diabetes, blood sugar levels should be 180 mg/dL or less. Some antidepressants can cause blood sugar to spike to 500 mg/dL or more, a very dangerous level.

While studies have identified these negative effects, research has also shown that some antidepressants can sometimes help diabetes.

Can Antidepressants Improve Diabetes?

Some medications for depression have been shown to improve, not worsen, glycemic control. Still others lead to improved insulin sensitivity by helping the body use insulin to carry glucose into cells more efficiently, which reduces the risk for hyperglycemia.

Part of the reason for improvement may be that receiving depression treatment in general leads to improved depression symptoms and positive lifestyle and behavior changes. When depression improves, people are more likely to eat nutritiously, exercise, take necessary medications (especially for diabetes), and monitor their blood glucose levels. This, in turn, improves diabetes.

The mixed effects of antidepressants lead to more questions. Could it be possible that the type of antidepressant taken for depression makes a difference?

Effects of Antidepressants on Type 2 Diabetes: Type of Antidepressant Might Matter

Doctors prescribe different classes of antidepressants to treat depression, plus several different medications exist within each class. The following lists aren’t exhaustive, as there are other classes of antidepressants and numerous other individual medications, but they do highlight many antidepressants researched thus far and discovered to impact diabetes.

Antidepressants That Seem To Improve Type 2 Diabetes

Several studies indicate that the best antidepressant medication for diabetes may be the group known as selective serotonin reuptake inhibitors (SSRIs). Among them:

• citalopram (Celexa)
• escitalopram (Lexapro)
• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)

Antidepressants That Might Cause or Worsen Diabetes

Studies indicate that the most detrimental depression medications include tricyclic antidepressants and noradrenergic antidepressants. Additionally, many combination treatments, regardless of the drugs used, increase the risk of developing or complicating diabetes. Taking high dosages of medication and/or taking medication for long periods of time increase the diabetes risk as well.  Anything that leads to weight gain is also problematic.

Some tricyclic antidepressants are

• amitriptyline (Elavil)
• desipramine (Norpramin)
• doxepin (Sinequan)
• imipramine (Iofranil)
• nortriptyline (Pamelor)

Examples of noradrenergic antidepressants:

• nefazodone (Serzone)
• vortioxetine (Trintellix)

Antidepressants with No Apparent Effects on Diabetes

The following antidepressants didn’t show an increased risk for the development of diabetes:

• venlafaxine (Effexor); SNRI
• fluoxetine (Prozac, Sarafem); SSRI
• citalopram (Celexa); SSRI
• mirtazapine (Remeron); Tetracyclic Antidepressant

Enough studies have found a link between antidepressants and diabetes that caution is warranted in using antidepressants if you already have type 2 diabetes or are at risk of developing the disease. Further research is needed to determine whether antidepressants directly cause type 2 diabetes. In the meantime, awareness of the connection is important, as is staying in regular contact with your doctor to have your health monitored. Eating healthy and exercising are crucial, too, and will go a long way in improving both depression and diabetes.

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