Glucose Metabolism and Antidepressant Medication
Abstract
Impaired glucose tolerance is observed in depressed patients, and patients suffering from depression have an increased risk to develop diabetes mellitus. In depressed and diabetic patients, studies have shown both a beneficial effect of antidepressants on glucose homeostasis and the opposite. This review aims to structure the conflicting data and focuses on the question, which effect specific antidepressants have on glucose homeostasis. We therefore performed a systematic review of all available studies referenced in Medline from 1960 to 2011. We included antidepressant agents indexed in the Anatomical Therapeutic Chemical (ATC) classification system of the WHO in 2011 and searched for studies investigating their effects on glucose metabolism in clinical samples as well as in healthy subjects. Of 876 studies screened we included 66. Most studies had small sample sizes and lacked a placebo group limiting conclusions about antidepressant effects on glucose tolerance. However, some evidence points to beneficial effects on glucose homeostasis of hydrazine-type monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). In case of SSRIs, the effect is more pronounced in diabetic patients or patients with comorbid depression and diabetes mellitus. Noradrenegic substances (and possibly also dualacting antidepressants), in contrast, may deteriorate glucose tolerance. They can be used in depressed patients when favorable effects on mood outweigh adverse metabolic effects, but in depressed diabetics this can be at the expense of worsening of glycemic control. The effects of other antidepressants, like bupropione, mirtazapine or newer agents, require further investigation before reliable conclusions can be made. The synthesis of the findings is discussed in light of the specific pharmacodynamic properties of the antidepressants as well as the pathophysiological changes in depression and impaired glucose homeostasis, including animal studies.
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Some antidepressants may, in some circumstances, reduce hyperglycaemia, normalize glucose homeostasis and increase insulin sensitivity.
“previous studies 45 found that some antidepressants may, in some circumstances, reduce hyperglycaemia, normalize glucose homeostasis and also increase insulin sensitivity”
From Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis (2016) · cites this paper as [45]
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“For example, previous studies (52) found that some antidepressants may, in some circumstances, reduce hyperglycaemia, normalize glucose homeostasis and also increase insulin sensitivity, whereas others, including tricyclic antidepressants, may exacerbate glycaemic dysfunction or have little effect on glucose homeostas…”
ResultVancampfort, D., Correll, C. U., Galling, B., Probst, M., De Hert, M., Ward, P. B., Rosenbaum, S., Gaughran, F., Lally, J., & Stubbs, B. (2016) · World Psychiatry · doi:10.1002/wps.20309 · Cited by 659 · see citing works
“For example, previous studies (45) found that some antidepressants may, in some circumstances, reduce hyperglycaemia, normalize glucose homeostasis and also increase insulin sensitivity, whereas”
ResultVancampfort, D., Correll, C. U., Wampers, M., Sienaert, P., Mitchell, A. J., De Herdt, A., Probst, M., Scheewe, T. W., & De Hert, M. (2014) · Psychological Medicine · doi:10.1017/s0033291713002778 · Cited by 317 · see citing works
“Previous studies have found that some antidepressants may, in some circumstances, reduce hyperglycemia (McIntyre et al. 2006; Atlantis et al. 2012; Hennings et al. 2012), normalize glucose homeostasis and also increase insulin sensitivity, whereas others, including tricyclic antidepressants, may…”
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“For example, previous studies [41,42] found that some antidepressants may, in some circumstances, reduce hyperglycemia, normalize glucose homeostasis and also increase insulin sensitivity, whereas others, including tricyclic antidepressants, may exacerbate glycemic dysfunction or have little effect on glucose homeosta…”
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“Previous studies have found that some antidepressants may reduce hyperglycemia[64, 65] and normalize glucose homeostasis, whereas other”
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“Previous studies have found that some antidepressants may reduce hyperglycemia and normalize glucose homeostasis (49,50), whereas other antidepressants including tricyclic antidepressants may exacerbate glycemic dyscontrol or have little effect on glucose homeostasis (51,52).”
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“The relationship is bidirectional and depression appears as a risk factor for the development of diabetes as demonstrated by impaired glucose tolerance in depressed patients (Hennings et al. 2012).”
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Use of antidepressants and statins and short-term risk of new-onset diabetes among high risk adults
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“Following the methods of Mojtabai (2013), Deuschle (2013), and Hennings et al. (2012), antidepressants were grouped by subclass; categories included only serotonin-norepinephrine reuptake inhibitors (SNRIs), only selective serotonin reuptake inhibitors (SSRIs), only tricyclic antidepressants…”
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“However, other studies have reported that statin use is associated with a greater risk of new-onset diabetes.(8,27,28) Therefore, additional research is required to determine the safety of statin use in high-risk populations, such as in individuals with COPD.”
Mirtazapine Reduces Adipocyte Hypertrophy and Increases Glucose Transporter Expression in Obese Mice
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“In addition, depression itself worsens the symptoms of diabetes,(8) and the favorable effects of antidepressants on mood may outweigh any adverse metabolic effects.(9) To date, there are no published studies that were successfully eliminating confounding factors, and as a result, the findings remain inconclusive.”
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Weight-gain Independent Effect of Mirtazapine on Fasting Plasma Lipids in Healthy MenPreprint
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Self-citationBody Mass Index, energy and macronutrient intake and its correlation with mental health
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- Authors
- M. Hennings, J., Schaaf, L., & Fulda, S.
- Affiliations
- Max Planck Society (DE)
- ORCID
- Fulda, Stephany
- Venue
- Current Pharmaceutical Design
- Publisher
- Bentham Science Publishers Ltd.
- Published
- 2012-10-13
- Volume
- 18
- Issue
- 36
- Pages
- 5900-5919
- ISSN
- 1381-6128 (ISSN-L)
- OpenAlex
- W2099335027
- Cited by
- 64
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 8 · 2021: 4 · 2020: 3 · 2019: 8 · 2018: 4 · 2017: 4 · 2016: 5 · 2015: 4 · 2014: 7 · 2013: 4
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Pharmaceutical Design (publishedVersion)
- PubMed (publishedVersion)
- Max Planck Institute for Plasma Physics (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- antidepressants, glucose metabolism, glucose homeostasis, impaired glucose tolerance, depression, diabetes mellitus, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, noradrenergic antidepressants, bupropion, mirtazapine, glycemic control
- MeSH terms
- Animals, Antidepressive Agents, Blood Glucose, Brain, Depression, Female, Homeostasis, Humans, Insulin Resistance, Male, Risk Factors, Treatment Outcome, Glucose Metabolism Disorders
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