The effect of antidepressants on glucose homeostasis and insulin sensitivity: synthesis and mechanisms.
OBJECTIVE
To synthesise results from investigations reporting on the effect of antidepressants on glucose-insulin homeostasis.


METHODS
The authors conducted a MedLine search of all English language articles from 1966 to October 2005 using the keywords: bipolar disorder, major depressive disorder, diabetes mellitus, glucose homeostasis, and the name of each antidepressant that has been indicated for major depression in Canada and the US up to October 2005. The search was supplemented with a manual review of relevant references. Both preclinical and clinical investigations were reviewed.


RESULTS
Some serotonergic antidepressants (e.g., fluoxetine) reduce hyperglycaemia, normalise glucose homeostasis and increase insulin sensitivity, whereas some noradrenergic antidepressants (e.g., desipramine) exert opposite effects. Dual-mechanism antidepressants (e.g., duloxetine and venlafaxine) do not appear to disrupt glucose homeostatic dynamics, whereas nonselective hydrazine monoamine oxidase inhibitors (e.g., phenelzine) are associated with hypoglycaemia and an increased glucose disposal rate.


CONCLUSIONS
Some antidepressants exert a clinically significant effect on metabolism relevant to both therapeutic outcome and adverse events.
McIntyre
Roger S
RS
University of Toronto, Department of Psychiatry, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. roger.mcintyre@uhn.on.ca
Soczynska
Joanna K
JK
Konarski
Jakub Z
JZ
Kennedy
Sidney H
SH
D000928:Antidepressive Agents / Q000009:adverse effects* / Q000494:pharmacology*; D003866:Depressive Disorder / Q000188:drug therapy; D003920:Diabetes Mellitus / Q000139:chemically induced; D005947:Glucose / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance
D000928:Antidepressive Agents; D005947:Glucose