Posted by katekite on August 5, 2002, at 18:58:14
In reply to Do AD's mess with your blood sugar levels?, posted by Jaynee on August 5, 2002, at 15:33:06
Well you made me curious. It looks like most ssris reduce (too high) blood glucose in diabetic patients. ie that they may make the insulin-glucose system work better. The few reports I could find did not suggest they reduced glucose levels in non-diabetics. So if you are at all prone to insulin/glucose problems and went down on your ssri it makes sense that your insulin-glucose regulation would be doing less well. Hopefully its an effect limited to withdrawal! But if it goes on at all maybe would be enough reason to ask your doc about testing for some pre-diabetic type condition. -- kate
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Ann Clin Psychiatry 2001 Mar;13(1):31-41 Related Articles, Books, LinkOut
Use of antidepressants in treatment of comorbid diabetes mellitus and depression as well as in diabetic neuropathy.Goodnick PJ.
Department of Psychiatry, University of Miami School of Medicine, Florida 33136, USA. goodnick@aol.com
After a brief review of epidemiology, the focus is on biochemistry of diabetes. Animal and human studies are reviewed in terms of the impact of alterations in catecholamines and serotonin (5-hydroxytryptamine, 5HT) on glucose utilization. Then, the implications of these experimental results for the choice of antidepressant in comorbid diabetes mellitus and depression as well as in diabetic neuropathy are discussed. Results of clinical investigations are then reviewed in terms of the above hypotheses. An Index Medicus Search for the past 10 years was supplemented by references from previous related reviews of the topic as well as by pending results, where available, not previously published. The range of prevalence of depression in diabetic patients has been 8-27%, depending on study criteria and procedures. An increase of catecholamines appears to increase glucose while both reducing insulin release and reducing sensitivity to insulin that is available. In contrast, increases in serotonergic function by increased precursor, increased release, or blocked metabolism and blocked reuptake in contrast seem to increase sensitivity to insulin and reduce plasma glucose. There have been six studies of fluoxetine, a selective serotonin reuptake inhibitor (SSRI), at a dose of 60 mg/day pursued up to 12 months that have demonstrated that medication's usefulness in diabetic patients, with reductions in weight (to 9.3 kg), in FPG (to 45 mg%), and in HbA1c (to 2.5%). In studies in comorbid diabetes mellitus and depression, nortriptyline, a norepinephrine reuptake inhibitor that produces increased synaptic catechols, has led to worsening of indices of glucose control. However, fluoxetine and sertraline, both selective serotonin reuptake inhibitors, in the same patient group, have produced results consistent with reductions in glucose levels. In diabetic neuropathy, perhaps due to the fact that catecholamines and serotonin may both be implicated in pain pathways, dual-action antidepressants appear more effective at lower doses than do specific serotonergic agents. The tricyclic antidepressants (TCA) (66.7%) have had success in double-blind studies, particularly imipramine, with a 81% response rate. Yet, there are positive reports concerning the SSRIs (paroxetine, citalopram, sertraline), as well as nefazodone, that focus on serotonin selectivity. CONCLUSIONS: In comorbid diabetes mellitus and depression, most evidence supports the use of fluoxetine in control of glucose handling. Other characteristics in terms dosing, drug interactions, cognition, and sleep make sertraline an attractive alternative agent. In diabetic neuropathy without depression, the best choices among non-TCAs may include sertraline, citalopram, and perhaps, venlafaxine, since the TCAs appear to increase cravings and increase FBG levels.
poster:katekite
thread:115325
URL: http://www.dr-bob.org/babble/20020731/msgs/115340.html