A Systematic Review of Long-term Antidepressant Outcomes in Comorbid Depression and Type 2 Diabetes

Jeffery, Annie; Buckman, Joshua E J; Francis, Emma; Walters, Kate; Wong, Ian C. K.; Osborn, David; Hayes, Joseph F.

doi:10.1101/2022.04.11.22273519

Cited by 4 publications

(3 citation statements)

References 94 publications

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“…However, antidepressants have common side effects that may be of particular concern for people with type 2 diabetes; such as increased weight, cardiac symptoms, nausea and drug-drug interactions (8). There is also very limited evidence concerning the effects of antidepressants on long-term physical health in people with type 2 diabetes (9). This can make for difficult prescribing decisions, which could result in inappropriate prescribing or, alternatively, inequalities in access to treatment.…”

Section: Introductionmentioning

confidence: 99%

Antidepressant prescribing inequalities in people with comorbid depression and type 2 diabetes: a UK primary care electronic health record study

Ng,

Hayes,

Jeffery

2024

Preprint

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Aims: To compare the likelihood of being prescribed an antidepressant in depressed individuals with and without type 2 diabetes. Methods: We performed a matched cohort study using primary care record data from the UK Clinical Practice Research Datalink. We used multivariable logistic regression to compare antidepressant prescribing during the first five years of starting oral antidiabetic medication to a comparison group without type 2 diabetes, matched based on GP practice, age and sex. We performed subgroup analyses stratified by sex, age and ethnicity. Results: People with type 2 diabetes and depression were 75% less likely to be prescribed an antidepressant compared to people with depression alone (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.25 to 0.26). This difference was greater in males (OR 0.23, 95% CI, 0.22 to 0.24), people older than 56 years (OR 0.23, 95% CI, 0.22 to 0.24), or from a minoritised ethnic background (Asian OR 0.14, 95% CI 0.12-0.14; Black OR 0.12, 95% CI 0.09-0.14). Conclusions: There may be inequalities in access to antidepressant treatment for people with type 2 diabetes, particularly those who are male, older or from minoritised ethnic backgrounds. Key words: type 2 diabetes, depression, antidepressant, inequality, primary care, multimorbidity

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Section: Introductionmentioning

confidence: 99%

Antidepressant prescribing inequalities in people with comorbid depression and type 2 diabetes: a UK primary care electronic health record study

Ng,

Hayes,

Jeffery

2024

Preprint

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“…[6][7][8][9] However, there are no previous studies that investigate longer-term outcomes, including depression relapse, in individuals with T2DM following the discontinuation of antidepressant treatment. 10 Therefore, understanding factors associated with depression relapse in individuals with T2DM is an unmet research need.…”

Section: Introductionmentioning

confidence: 99%

Association between polypharmacy and depression relapse in individuals with comorbid depression and type 2 diabetes: a UK electronic health record study

et al. 2022

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Background Individuals with physical comorbidities and polypharmacy may be at higher risk of depression relapse, however, they are not included in the ‘high risk of relapse’ group for whom longer antidepressant treatment durations are recommended. Aims In individuals with comorbid depression and type 2 diabetes (T2DM), we aimed to investigate the association and interaction between depression relapse and (a) polypharmacy, (b) previous duration of antidepressant treatment. Method This was a cohort study using primary care data from the UK Clinical Practice Research Datalink (CPRD) from years 2000 to 2018. We used Cox regression models with penalised B-splines to describe the association between restarting antidepressants and our two exposures. Results We identified 48 001 individuals with comorbid depression and T2DM, who started and discontinued antidepressant treatment during follow-up. Within 1 year of antidepressant discontinuation, 35% of participants restarted treatment indicating depression relapse. As polypharmacy increased, the rate of restarting antidepressants increased until a maximum of 18 concurrent medications, where individuals were more than twice as likely to restart antidepressants (hazard ratio (HR) = 2.15, 95% CI 1.32–3.51). As the duration of previous antidepressant treatment increased, the rate of restarting antidepressants increased – individuals with a previous duration of ≥25 months were more than twice as likely to restart antidepressants than those who previously discontinued in <7 months (HR = 2.36, 95% CI 2.25–2.48). We found no interaction between polypharmacy and previous antidepressant duration. Conclusions Polypharmacy and longer durations of previous antidepressant treatment may be associated with depression relapse following the discontinuation of antidepressant treatment.

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“…There is a lack of evidence concerning the long-term effects of antidepressant treatment on physical health outcomes in people with type 2 diabetes. 10 Thus, although there is a need to treat depression in this patient group, the long-term effects of antidepressant treatment on physical health, and ultimately mortality, are unclear. We are aware of only one study investigating the association between antidepressant treatment and mortality in people with comorbid depression and diabetes (type unspecified): a large ( N = 53 412) population-based cohort study in Taiwan, which found that people with comorbid depression and diabetes who were prescribed antidepressants had reduced rates of mortality compared with those who were not prescribed antidepressants.…”

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confidence: 99%

Antidepressant treatment and mortality in people with comorbid depression and type 2 diabetes: UK electronic health record study

Jeffery,

Walters,

Wong

et al. 2024

BJPsych open

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Background Depression is associated with higher rates of premature mortality in people with physical comorbidities, such as type 2 diabetes. Conceptually, the successful treatment of depression in people with type 2 diabetes could prevent premature mortality. Aims To investigate the association between antidepressant prescribing and the rates of all-cause and cause-specific (endocrine, cardiovascular, respiratory, cancer, unnatural) mortality in individuals with comorbid depression and type 2 diabetes. Method Using UK primary care records between years 2000 and 2018, we completed a nested case–control study in a cohort of people with comorbid depression and type 2 diabetes who were starting oral antidiabetic treatment for the first time. We used incident density sampling to identify cases who died and matched controls who remained alive after the same number of days observation. We estimated incidence rate ratios for the association between antidepressant prescribing and mortality, adjusting for demographic characteristics, comorbidities, medication use and health behaviours. Results We included 5222 cases with a recorded date of death, and 18 675 controls, observed for a median of 7 years. Increased rates of all-cause mortality were associated with any antidepressant prescribing during the observation period (incidence rate ratio 2.77, 95% CI 2.48–3.10). These results were consistent across all causes of mortality that we investigated. Conclusions Antidepressant prescribing was highly associated with higher rates of mortality. However, we suspect that this is not a direct causal effect, but that antidepressant treatment is a marker of more severe and unsuccessfully treated depression.

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A Systematic Review of Long-term Antidepressant Outcomes in Comorbid Depression and Type 2 Diabetes

Cited by 4 publications

References 94 publications

Antidepressant prescribing inequalities in people with comorbid depression and type 2 diabetes: a UK primary care electronic health record study

Antidepressant prescribing inequalities in people with comorbid depression and type 2 diabetes: a UK primary care electronic health record study

Association between polypharmacy and depression relapse in individuals with comorbid depression and type 2 diabetes: a UK electronic health record study

Antidepressant treatment and mortality in people with comorbid depression and type 2 diabetes: UK electronic health record study

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