Study author Shi-Heng Wang, PhD, of the China Medical University in Taichung, Taiwan, along with coauthors Le-Yin Hsu of the National Taiwan University in Taipei, Taiwan; and Yi-Jiun Pan of the China Medical University in Taichung, Taiwan, conducted a retrospective cohort study of 36,276 patients with newly treated diabetes mellitus and depression. The results were published in the Journal of Clinical Endocrinology & Metabolism.

Using the universal health insurance database in Taiwan, they studied a nationwide cohort as they explored the potential association of advanced complications of diabetes and mortality and the use of antidepressants to treat comorbid depression. The researchers hypothesized that comorbid depression in patients with diabetes worsens the prognosis and compromises chances of successful disease outcomes.

The researchers theorize that “antidepressants might attenuate the adverse effects of depression; however, they are associated with cardiometabolic adverse effects." According to Dr. Wang, “People with depression and diabetes have poorer health outcomes than those with diabetes alone, and regular antidepressant treatment could lower their risk of complications,” he said.

After classifying antidepressant treatment patterns within a 6-month window as either none, poor, partial, and regular use, accounting for time-dependent variables using the Cox proportional hazards regression analysis with adjustment for time-dependent comorbidity and concomitant use of medications, the team reported their results.  

Regular use of antidepressants was associated with a reduced risk of macrovascular complications (aHR = 0.92; 95% CI, 0.84-1.00; P = 0.04) and all-cause mortality (aHR = 0.86; 95% CI, 0.75-0.98) but not microvascular complications (aHR = 0.98; 95% CI, 0.88-1.09) when compared with poor use of antidepressants. Different classes of antidepressants were compared, and the team highlighted that the regular use of selective serotonin reuptake inhibitors was associated with a reduced risk of macrovascular complications (aHR = 0.83; 95% CI, 0.74-0.94) and all-cause mortality (aHR = 0.75; 95% CI, 0.62-0.91). Benzodiazepines were chosen as a negative control exposure.

“People who adhere to their antidepressants have better diabetes outcomes and quality of life than those with poor adherence,” said study author Chi-Shin Wu, MD, PhD, of the National Taiwan University Hospital. The authors concluded that individuals who are consistently adherent to taking prescribed antidepressants experienced lower risks of diabetic complications, particularly advanced problems, when compared with peers who did not take their antidepressants regularly. “Clinicians should emphasize antidepressant treatment adherence among patients with depression and diabetes mellitus,” they added.

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