title: Antidepressant medication use and risk of hyperglycemia and diabetes mellitus: a noncausal association?
abstract: BACKGROUND
  Previous research suggests a link between antidepressant use and diabetes, but it is unclear whether the association is causal or attributable to detection/ascertainment bias. To examine this, we assessed the associations of antidepressant use with change in glucose levels and incidence of undiagnosed and diagnosed diabetes.
  
  
  METHODS
  During an 18-year period, we monitored antidepressant use, glucose levels, and diabetes status in 5978 civil servants (70.9% male, age range 39-64 years) free of diabetes at baseline (the Whitehall II study). Use of medication and plasma glucose were assessed at four study screenings: 1991/1993, 1997/1999, 2003/2004, and 2008/2009. Incident diabetes cases were classified as either diagnosed (n = 294) if detected using self-report of physician diagnosis and/or the use of diabetes medication or undiagnosed (n = 346) if detected based on fasting and/or 2-hour postload glucose levels using an oral glucose tolerance test at the study screenings.
  
  
  RESULTS
  Incidence of diagnosed diabetes was higher among antidepressant users than nonusers (odds ratio 3.10, 95% confidence interval: 1.66-5.78). However, antidepressant use was not associated with undiagnosed diabetes at any follow-up examination nor with higher fasting or 2-hour postload plasma glucose levels or increasing glucose levels over time. Odds ratio for undiagnosed diabetes for antidepressant users versus nonusers was .88 (95% confidence interval: .45-1.72, p = .70). The mean difference in glucose changes between participants reporting antidepressant use at three screenings compared with those not on antidepressant treatment was .0 mmol/L.
  
  
  CONCLUSIONS
  The link between antidepressant use and diabetes risk may not be causal in nature.
authors.affiliation: Department of Epidemiology and Public Health, University College London, United Kingdom. m.kivimaki@ucl.ac.uk
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.forename: Klaus P
authors.initials: KP
authors.lastname: Ebmeier
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Brunner
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tabak
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Witte
authors.forename: Meena
authors.initials: M
authors.lastname: Kumari
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents; D001786:Blood Glucose; D016001:Confidence Intervals; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000453:epidemiology*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents; D001786:Blood Glucose