The relationship between antipsychotic medication and diabetes has been well demonstrated and is widely recognized by clinicians. Unfortunately, the relatively limited selection of antipsychotics sometimes requires that in order to achieve symptom control, new-onset diabetes must be accepted as a consequence.

The population of individuals treated with antidepressants far eclipses those treated with antipsychotics. The earliest commonly used antidepressants, tricyclics, were associated with weight gain due to activity and the post-synaptic histamine receptor site, which of course could be diabetogenic.

Wu et al report on a case-control study based on the Taiwan National Health Insurance Research Database. Over the 1998-2009 interval, they compared use of antidepressants among patients with diabetes (n = 47,885) and controls (n = 95,770).

Overall, persons treated with antidepressants for at least 2 years were 20% more likely to develop diabetes. In particular, younger individuals were adversely affected: Persons < 44 years of age had more than a doubling of risk for new onset diabetes.

The mechanism(s) by which antidepressants impart increased risk for diabetes are not clear. For instance, the above-mentioned weight gain with tricyclic antidepressants was not reflected in a greater incidence of diabetes than that seen with newer antidepressants (e.g., SSRIs, SNRIs). Recent studies have shown that other commonly used medications are associated with increased risk for new onset diabetes, including statins and thiazide diuretics. The frequency of prescription of antidepressants merits enhanced clinician vigilance for the development of diabetes.