measuring blood sugar, Invokana and Farxiga

There is a diabetes epidemic in the United States. It is also striking the rest of the world. Some experts are calling the diabetes epidemic the largest epidemic in human history. The International Diabetes Federation (IDF) estimates that over 400 million people around the world have diabetes. According to the CDC, more than 100 million U.S. adults “are now living with diabetes or pre diabetes.” That fits our definition of a diabetes epidemic.

Younger People Are Part of the Diabetes Epidemic:

The rate of type 2 diabetes, formerly known as “adult onset diabetes,” has been rising rapidly among young Americans. While many experts attribute this increase to changes in diet, a new study indicates that medication use also plays a role.

Antidepressants and the Diabetes Epidemic:

An article in JAMA Internal Medicine (Feb. 2017) reported that roughly 1 in 6 Americans takes a psychiatric drug. Not surprisingly, antidepressants were at the top of the pyramid. Such drugs may be contributing to the diabetes epidemic.

Recently, researchers from the University of Maryland Schools of Pharmacy and Medicine collaborated to analyze medical records of 119,000 children and adolescents covered by Medicaid (JAMA Pediatrics, online Oct. 16, 2017 ). The investigators included only youngsters who had taken an antidepressant.

Those who were still taking a serotonin-type drug such as fluoxetine were roughly twice as likely to develop type 2 diabetes as those who took such a drug for only a short time. Higher doses appeared to create more risk. Other types of antidepressants did not appear linked to a higher risk for metabolic disruption.

Why Would Antidepressants Impact the Diabetes Epidemic?

Other studies suggest that SSRI medicines may interfere with the proper function of beta cells in the pancreas. Beta cells produce insulin, and when they fail, the patient develops diabetes. Although doctors have known about this effect of SSRIs for some time, they have seemingly ignored it.

For example, research published in the Journal of Biological Chemistry (Feb. 22, 2013) notes that:

“Long term use of SSRIs is associated with an increased risk of diabetes…Insulin resistance is a common pathological state in which target cells fail to respond to ordinary levels of circulating insulin. Individuals with insulin resistance suffer from impaired insulin action and are predisposed to developing type 2 diabetes, a 21st century epidemic…”

“In conclusion, we have demonstrated that SSRIs are potential inducers of insulin resistance, acting by directly inhibiting the insulin signaling cascade in beta cells…Given that SSRIs promote obesity and insulin resistance but inhibit insulin secretion, they might accelerate the transition from an insulin resistant state to overt diabetes. Further studies are therefore required to assess the clinical relevance of our findings and to devise effective means to block the adverse metabolic changes induced by SSRIs.”

The People’s Pharmacy Perspective:

Antidepressant medications are widely prescribed in the U.S. and around the world. Millions of people take selective serotonin re-uptake inhibitors (SSRIs) like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil). We suspect that few prescribers are paying attention to a possible connection with insulin resistance or type 2 diabetes.

Additionally, many other medications can also raise blood sugar levels. These include diuretics in blood pressure pills, estrogen, corticosteroids like prednisone and statins to lower cholesterol. For a more complete list of medicines that might increase the risk for diabetes, you may find our Guide to Managing Diabetes of interest. It also offers many nondrug approaches to helping control glucose. Perhaps prescribers should consider the possibility that some of the medicines they prescribe could be contributing to the diabetes epidemic.

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  1. Mary
    MD
    Reply

    I have been taking an antidepressant for going on 30 yrs now. Even though I continue to exercise and actually eat less than I did those years ago, I have continued to gain weight. My blood sugar levels are never real high, ranging from 100-105, but there is no doubt that I am insulin resistant. I often have hypoglycemic symptoms. I have always felt that this was somehow related to my medication(s) as I have always eaten a healthy diet and exercised. I also take a beta blocker, proprananol, which I understand also affects blood sugar levels. I take fluoxetine 10 mg. for panic attacks. Because it has been effective in almost eliminating them I hesitate to stop taking it. What’s a person to do?

  2. Anne
    NY
    Reply

    I discussed this with my prescribing psychiatrist of SSRIs (I am on two). She said that while yes these medications, as well as most medications on the market today, have some negative side effects, it is always a cost-benefit analysis.

    So if a patient is severely depressed (as I was), if not suicidal, then it’s better to alleviate that depression than to worry about the potential side effects. She looks at the efficacy of the medication versus the possible side effects.

    The issue of course is whether the prescribing physician (it is often a primary care doctor and not a psychiatrist) informs that patient of each and every possible side effect. As many of us know, when we get a prescription there is a very fine printed, detailed, and often technical as to laymen, list of all of the possible side effects. Actually reading those can scare you away from taking any medication. So the issue to me is how much should be disclosed by the prescribing physician versus the inserts.

    Is a depressed, possibly suicidal, patient even capable of making that cost-benefit analysis? I trust my prescribing psychiatrist to make the cost-benefit analysis and put me on the smallest possible dose of the safest SSRI.

    Were it not for SSRIs I would still be depressed, and that meant for me that I was barely functioning at all and at times suicidal. I am not aware of anything other than SSRIs that could have alleviated that.

  3. Bonnie O
    Illinois
    Reply

    Please add an obvious cause: the beef, pork, & poultry we eat has artificial growth hormone in it. It is designed to bulk animals up, & it does the same to humans who ingest it. A couple of decades ago, this was not the case. And a couple of decades ago, obesity was not an epidemic. But people still ate meat then. Only one difference – the growth hormone.

    A chicken producer recently stopped injecting his hens with antibiotics. Why? The bad publicity over germs which now defy medical antibiotic treatment – they have become immune due to the quantity of antibiotics already in human bodies. We as a nation must pressure this industry to stop injecting growth hormone. Watch the national weight loss happen when that does. PS – there are no overweight vegetarians.

  4. G
    Reply

    This does not surprise me. I would also posit that PPIs (proton pump inhibitor for GERDS and a gastric ulcer) is also contributing to this phenom. While I cannot prove it, due to risk factors present, I am convinced that a PPI I was on for a year, triggered my AODM.

    It is listed as a rare side effect, but I am also convinced that AODM occurs more frequently with this type of drug. My doctors said I would take it for the rest of my life. I did not. I researched, tapered off, suffered the rebound, and now control the GERDS with a common sense approach. My GERD symptoms have been in remission for years now.

    My GI doc was surprised when I pointed out the side effect and had to look it up on her laptop to see for herself. She did not think it was related.

  5. Bonnie
    Reply

    I have never had any issues with blood sugar butt this article was enlightening because recently my Dr had blood work done on me and said that my A1C was 5.7 which means that I am now identified as being prediabetic. I take Celexa and have gained quite a bit of weight from it and since I eat well, on a low carb plan, and have moderate exercise, I was very surprised to see this number and told this. I have asked my Dr to take me off of Celexa by January and hope to change to another med to get out of this class of drugs. I am hoping that it will help many things as I have been on low carb since May and lost 17 lbs but have hit a plateau for well over a month. Quite discouraging! Anyone else had weight gain issues with Celexa?

  6. Luke
    Reply

    People like to blame everything else on diabetes..except their weight and lifestyles.

  7. Luke
    Reply

    With 70% of America’s population overweight, 41+% obese..now what do you think. Use a little common sense.

  8. susan
    NC
    Reply

    Does stopping the SSRIs make the problem go away? Or is it there forever?

  9. Elise
    New Jersey
    Reply

    With people taking multiple medicines like never before in history it doesn’t surprise me that it is doing some serious damage to their bodies. I stopped taking hydrochlorothiazide because my blood sugar was slowly climbing up and when it reached 117 I stopped taking it. I only took two other medicines but now I don’t take any. Natural vitamins and nutrients are doing the job for me and others should also do the same to save their lives of a lot of Big Pharmacy’s caused misery, not to mention huge expense.

    • Natasha
      Reply

      You don’t mention what you are taking in lieu of hydrochlorothiazide. My blood sugar has been elevated also.

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