title: The association of antidepressant medications and diabetic retinopathy among people with diabetes.
abstract: OBJECTIVE
  To determine if the use of antidepressants was associated with lower odds of diabetic retinopathy and if so, to determine if this association was mediated by decreased inflammation as measured by C-reactive protein (CRP).
  
  
  METHODS
  This was a cross sectional study of 1,041 participants with type 2 diabetes 40-85years old from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Multiple logistic regression was used to examine the association between the outcome of diabetic retinopathy and the primary exposure of antidepressant medication usage. We also determined whether CRP meets standard criteria as a mediator between antidepressant use and diabetic retinopathy.
  
  
  RESULTS
  Participants using antidepressants were less likely to have diabetic retinopathy (OR 0.50, 95% CI: 0.31-0.82). CRP did not meet one of the criteria for mediation. However, CRP was an effect modifier such that the association of antidepressant use and diabetic retinopathy was only present among participants with CRP ≥0.3mg/dl. Among the antidepressant drug classes, selective serotonin reuptake inhibitor (SSRI) users had significantly lower odds of developing diabetic retinopathy compared to non-users of antidepressants.
  
  
  CONCLUSIONS
  Using representative survey data of US adults with type-2 diabetes, this study found that antidepressant use was associated with lower odds of diabetic retinopathy. Further longitudinal and experimental studies are necessary to confirm this finding and to determine if there is a role for antidepressants in preventing diabetic retinopathy in select patient populations.
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: yekta@mail.med.upenn.edu.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Yekta
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: dxie@mail.med.upenn.edu.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: bogner@mail.med.upenn.edu.
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: david_weber@urmc.rochester.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Weber
authors.affiliation: Health Scientist Administrator at National Institutes of Health, Bethesda, MD, USA. Electronic address: xinzhi.zhang@nih.gov.
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: mharhay@mail.med.upenn.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Harhay
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: peter.reese@uphs.upenn.edu.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis / Q000037:antagonists & inhibitors; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000523:psychology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D015415:Biomarkers; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D017367:Selective Serotonin Reuptake Inhibitors; C517652:hemoglobin A1c protein, human
keywords: Antidepressant medication; Depression; Pharmacoepidemiology; Retinopathy; Type 2 diabetes