Selective Serotonin Reuptake Inhibitors linked to Diabetes risk in kids: JAMA

According to the recent findings of a study published in JAMA Psychiatry, children and adolescents initiating SSRI treatment may be at a small increased risk of developing type 2 diabetes(T2D), particularly publicly insured patients.

However the magnitude of association was more modest than previously reported, and the absolute risk was small.

SSRI use in young patients remains widespread, given the increasing prevalence of depression in this population and the efficacy of SSRIs for pediatric depression and anxiety disorders. Selective serotonin reuptake inhibitors are generally associated with modest weight gain, but this may be sufficient in transitioning some patients from normal weight to overweight/obesity and elevate the risk of T2D.

Rapid changes in growth during childhood and adolescence can alter drugs' pharmacokinetics and pharmacodynamics, so high-quality age-specific drug safety data are needed to inform prescribing decisions.

An association between SSRIs and type 2 diabetes (T2D) has been reported in several studies conducted in adults, but evidence in children and adolescents is limited due to the absence of a real-world randomized clinical trial.

With this in mind, Jenny W. Sun et al, sought to carry out a study to access the safety of SSRI use in children and adolescents concerning the associated risk of T2D.

This cohort study of patients aged 10 to 19 years with a diagnosis for an SSRI treatment indication was conducted within the nationwide Medicaid Analytic eXtract (MAX; January 1, 2000, to December 31, 2014) and the IBM MarketScan (January 1, 2003, to September 30, 2015) databases. Data were analyzed from November 1, 2018, to December 6, 2019.

The inclusion criteria for the sample population were new users of an SSRI medication and comparator groups with no known metabolic adverse effects (no antidepressant exposure, bupropion hydrochloride exposure, or psychotherapy exposure).

The primary outcome to be assessed was incident T2D during follow-up.

On data analysis, th following key facts were revealed.

• A total of 1 582 914 patients were included in the analysis (58.3% female; mean [SD] age, 15.1 [2.3] years).
• In publicly insured patients, initiation of SSRI treatment was associated with a 13% increased hazard of T2DM (intention-to-treat adjusted hazard ratio [aHR], 1.13; 95% CI, 1.04-1.22) compared with untreated patients.
• The association strengthened for continuous SSRI treatment (as-treated aHR, 1.33; 95% CI, 1.21-1.47), corresponding to 6.6 (95% CI, 4.2-10.4) additional cases of T2D per 10 000 patients treated for at least 2 years.
• Adjusted HRs were lower in privately insured patients (intention-to-treat aHR, 1.01 [95% CI, 0.84-1.23]; as-treated aHR, 1.10 [95% CI, 0.88-1.36]).
• Findings were similar when comparing SSRI treatment with psychotherapy (publicly insured as-treated aHR, 1.44 [95% CI, 1.25-1.65]; privately insured as-treated aHR, 1.21 [95% CI, 0.93-1.57]), whereas no increased risk was observed compared with bupropion treatment publicly insured as-treated aHR, 1.01 [95% CI, 0.79-1.29]; privately insured as-treated aHR, 0.87 [95% CI, 0.44-1.70]).
• For the within-class analysis, no medication had an increased hazard of T2D compared with fluoxetine.

"When making treatment decisions in young patients, this potential small risk of T2D, along with other potential adverse effects of SSRIs such as nausea and sleep disturbances,2,3,71 should be weighed against the benefits of treating pediatric depression and anxiety disorders." said the team.

For the full article click on the link: Sun JW, et al. JAMA Psychiatry. 2020;DOI:10.1001/jamapsychiatry.2020.2762.

Source: JAMA Psychiatry