The risk of new-onset diabetes in antidepressant users - A systematic review and meta-analysis

Disparities in the management of cardiovascular risk factors in patients with psychiatric disorders: a systematic review and meta-analysis

BACKGROUND

The high cardiovascular (CV) morbidity and mortality reported for patients with psychiatric disorders may possibly be due to a poorer management of CV risk factors (CVRFs). However, these healthcare disparities remain poorly understood. In this paper, studies comparing the management of smoking, diabetes, hypertension and dyslipidaemia, in patients with and without depression, anxiety, schizophrenia, bipolar or personality disorder, were reviewed.

METHODS

Prospective studies comparing rates of screening, diagnosis, treatment and control of CVRFs were searched in PubMed, Embase, PsychInfo, Scopus and Web of Science (inception to January 2017). The Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria were used. Studies were assessed for quality. Wherever possible, meta-analyses were conducted to summarize the findings.

RESULTS

Twenty studies, out of the 18 333 references initially identified, were included. Most studies were heterogeneous in design. Two areas permitted meta-analyses: the pooled odds ratio for quitting smoking for those with depression was 0.64 (0.49-0.80) p < 0.001; the pooled difference of glycated haemoglobin for patients with type 2 diabetes and depression was 0.18 (0.06-0.31) p = 0.005. Individual studies showed associations between: schizophrenia and lower probability of having smoking habit recorded; schizoid personality disorder and higher probability of remaining non-smokers after quitting; anxiety and poorer control of type I diabetes; depression, anxiety or schizophrenia and lower probability of having a diagnosis of hypertension; schizophrenia or bipolar disorder and lower use of antihypertensive and lipid-lowering drugs.

CONCLUSIONS

A proactive clinical management, together with further studies, are needed to reduce the CV morbidity and mortality of patients with psychiatric disorders.

The effect of selective serotonin re-uptake inhibitors on risk of type II diabetes mellitus and acute pancreatitis: a meta-analysis

To explore the effect of selective serotonin re-uptake inhibitors (SSRIs) on risk of type II diabetes mellitus (T2DM) and acute pancreatitis (AP), expecting to provide guidance for clinic. Literature was retrieved by searching Pubmed, Embase, Cochrane and Scopus and hand searching of reference lists of related articles. Stata 14.0 was utilized for processing and analysis, and adjusted odds ratios (aORs) were applied. Our study included 113898 T2DM patients and 284131 controls from nine studies and 17548 AP patients and 108108 controls from four studies. The pooled aORs of SSRIs on the risk of T2DM and AP were 1.38 (95% confidence interval (CI) = 1.24–1.54) and 1.26 (95% CI = 1.13–1.40), respectively. Study design, quality, ethnicity, follow-up, and sample size of patients were the resources of heterogeneity. Subgroup analysis showed that 2 weeks is a high-risk time for AP after SSRIs use, with 1.48-fold-times as much after it. This meta-analysis provides evidence of a significant positive association between SSRIs use and risks of T2DM or AP, and duration of 2 weeks of SSRIs use has higher risk of AP, which should be paid much attention to.

Detecting a potential safety signal of antidepressants and type 2 diabetes: a pharmacovigilance-pharmacodynamic study

AIMS

Recent data suggest that antidepressants are associated with incident diabetes but the possible pharmacological mechanism is still questioned. The aim of the present study was to evaluate antidepressant's risk for reporting diabetes using disproportionality analysis of the FDA adverse events spontaneous reporting system (FAERS) database and to investigate possible receptor/transporter mechanisms involved.

METHODS

Data from 2004 to 2017 were analysed using OpenVigil2 and adjusted reporting odds ratio (aROR) for reporting diabetes was calculated for 22 antidepressants. Events included in the narrow scope of the SMQ 'hyperglycaemia/new-onset diabetes mellitus' were defined as cases and all the other events as non-cases. The pharmacodynamic profile was extracted using the PDSP and IUPHAR/BPS databases and the occupancy on receptors (serotonin, alpha adrenoreceptors, dopamine, muscarinic, histamine) and transporters (SERT, NET, DAT) was estimated. The relationship between aROR for diabetes and receptor occupancy was investigated with Pearson's correlation coefficient (r) and univariate linear regression.

RESULTS

Six antidepressants were associated with diabetes: nortriptyline with aROR [95% CI] of 2.01 [1.41-2.87], doxepin 1.97 [1.31-2.97], imipramine 1.82 [1.09-3.06], sertraline 1.47 [1.29-1.68], mirtazapine 1.33 [1.04-1.69] and amitriptyline 1.31 [1.09-1.59]. Strong positive correlation coefficients between occupancy and aROR for diabetes were identified for the receptors M₁ , M₃ , M₄ , M₅ and H₁ .

CONCLUSION

Most of the tricyclic antidepressants, mirtazapine and sertraline seem to be associated with reporting diabetes in FAERS. Higher degrees of occupancy on muscarinic receptors and H₁ may be a plausible pharmacological mechanism. Further clinical assessment and pharmacovigilance data is needed to validate this potential safety signal.

Visceral adipose tissue in patients with severe mental illness

Background Severe mental illnesses (SMIs), i.e. major depression, schizophrenia and bipolar disorder, are associated with an elevated risk for the development of type-2 diabetes mellitus and cardiovascular disorders. Several factors have been associated with increased cardiometabolic morbidity and mortality in SMI, including lifestyle factors (smoking, inactivity, unhealthy diet), endocrine and immunologic alterations; however, the underlying mechanisms remain to be fully uncovered. It is now well accepted that visceral adipose tissue (VAT) promotes the development of cardiometabolic disorders, at least in part by inflammatory and metabolic functions. Methods This paper reviews studies concerning VAT, with special focus on intra-abdominal and pericardial adipose tissue, in SMI. Results In patients with SMI, several studies have been performed concerning VAT. Most of these studies reported alterations of VAT particularly in patients with major depression and schizophrenia, independent of body weight and body mass index. Some of the studies also reported an increased cardiometabolic risk. Conclusion Patients with SMI are at increased risk of developing cardiometabolic disorders, and display increased amounts of VAT. As studies so far were mainly performed on patients before the onset of cardiometabolic disorders, VAT may serve as a biomarker for patients with SMI to assess cardiometabolic risks beyond established risk scores. Further, interventions aiming at reducing VAT in SMI are highly recommended in long-term multimodal treatment plans.

Prevalence and risk factors of type 2 diabetes in insomnia sufferers: a study on 1311 individuals referred for sleep examinations

BACKGROUND

Several studies have investigated the particular relationship between insomnia and type 2 diabetes. However, few studies have investigated the prevalence and risk factors for type 2 diabetes in insomnia sufferers. The aim of this study was to examine the prevalence and risk factors of type 2 diabetes in a large sample of insomnia sufferers.

METHODS

Data from 1311 insomnia sufferers recruited from the research database of the Erasme Hospital sleep laboratory were analyzed. Only individuals with a diagnosis of type 2 diabetes according to the diagnostic criteria of the American Diabetes Association at admission were included in the diabetes group. Logistic regression analyses were conducted to examine clinical and demographic risk factors of type 2 diabetes in insomnia sufferers.

RESULTS

The prevalence of type 2 diabetes in insomnia sufferers is 21.13%. Multivariate logistic regression analysis revealed that significant risk factors of type 2 diabetes in insomnia sufferers were as follows: being male, Z-drugs use, high blood pressure, hypertriglyceridemia, alcohol consumption of ≥4 units/day, BMI ≥25 & <30 kg/m², BMI ≥30 kg/m², age ≥50 years, C-reactive protein ≥4.5 mg/L, a sleep duration of <6.5 h, apnea-hypopnea index ≥15/hour, periodic limb movements index ≥26/hour, and severe complaints of early morning awakening.

CONCLUSION

Type 2 diabetes is a common pathology in insomnia sufferers. In this subpopulation, most of the risk factors for type 2 diabetes are reversible, which justifies better prevention and management of this pathology in order to avoid its negative consequences.

Increased Risk of Metabolic Syndrome in Antidepressants Users: A Mini Review

Mounting evidence has shown that the risk of metabolic syndrome (MetS) is substantially overlapping in the diagnostic subgroups of psychiatric disorders. While it is widely acknowledged that patients receiving antipsychotic medications are at higher risk of MetS than antipsychotic-naive ones, the association between antidepressants and MetS is still debated. The goal of our mini review was to analyse the relationship among depressive symptoms, antidepressant use and the occurrence of MetS. Adhering to PRISMA guidelines, we searched MEDLINE, reference lists and journals, using the following search string: ((("Mental Disorders"[Mesh]) AND "Metabolic Syndrome"[Mesh]) AND "Antidepressive Agents"[Mesh]), and retrieved 36 records. Two reviewers independently assessed records and the mini review eventually included the data extracted from 8 studies. The Newcastle-Ottawa Scale was used to assess the quality of the selected studies. Overall, the results of the mini review seem to support the association among depressive symptoms, antidepressants therapy and MetS. Except for H1-R high-affinity ones, the relationship between antidepressants and MetS still needs to be clarified. Considering the widespread prescription of antidepressants, both on behalf of psychiatrists and primary care physicians, further research on this topic is recommended.