title: Renin-angiotensin-aldosterone-blockade is associated with decreased use of antidepressant therapy in patients with type 1 diabetes and diabetic nephropathy.
abstract: Hypertension and depression are frequent comorbidities of diabetes. Studies suggest that antihypertensive medication affecting the renin-angiotensin-aldosterone system (RAAS) might also relieve depression. Whether this is also seen in patients with type 1 diabetes is not known. We therefore studied whether use of RAAS-modifying medication is associated with reduced antidepressant use in type 1 diabetes. In all, 1,705 participants in the FinnDiane Study were included (57 % men, mean age 46 ± 11 years). Data on medications were obtained from the Drug Prescription Register. Based on their albumin excretion rate (AER), the patients were classified as having normal AER, microalbuminuria, or macroalbuminuria. Diabetic nephropathy was defined as macroalbuminuria or end-stage renal disease (dialysis or renal transplant). A total of 8.4 and 10.9 % of patients with and without RAAS-modifying medication, respectively, had antidepressant medication purchases (NS). In logistic regression analysis, after adjusting for potential confounding factors, use of RAAS-modifying medication was not associated with antidepressant purchases. However, when patients with and without diabetic nephropathy were analyzed separately, RAAS-modifying medication was associated with lower frequency of antidepressant purchases among patients with established diabetic nephropathy. In conclusion, use of RAAS-modifying medication may improve mood in patients with type 1 diabetes and established diabetic nephropathy.
authors.affiliation: Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki C318b, University of Helsinki, PO Box 63, 00014, Helsinki, Finland.
authors.forename: Aila J
authors.initials: AJ
authors.lastname: Ahola
authors.forename: Valma
authors.initials: V
authors.lastname: Harjutsalo
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000378:metabolism; D000809:Angiotensins / Q000037:antagonists & inhibitors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000523:psychology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000523:psychology; D005260:Female; D005387:Finland; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D000092502:Renin Inhibitors
chemical_list: D000450:Aldosterone; D000809:Angiotensins; D000928:Antidepressive Agents; D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D000092502:Renin Inhibitors