Glucose Tolerance in Depressed Inpatients, under Treatment with Mirtazapine and in Healthy Controls

Abstract

Impaired glucose tolerance and diabetes have been associated with depression, and antidepressant treatment is assumed to improve impaired glucose tolerance. However, antidepressant treatment is also considered as a risk factor for the development of diabetes. Reports about glucose tolerance under antidepressant treatment frequently lack appropriate control groups. We conducted the oral glucose tolerance test (OGTT) in 10 healthy controls selected from an epidemiological sample with a negative lifetime history of mental Axis I disorder. Controls were carefully matched to a sample of inpatients with major depression that participated in an OGTT before and after antidepressant treatment with mirtazapine. All participants underwent a standard OGTT protocol. In patients, a second (after 2 weeks) and a third (after 4–6 weeks) OGTT was performed under treatment with mirtazapine. Compared to healthy controls, we observed significantly impaired glucose tolerance in acutely depressed patients. Effect size calculation indicated a moderate to large effects on glucose and insulin concentrations in response to an OGTT. Although glucose tolerance improved under mirtazapine treatment, insulin sensitivity was still impaired and remained significantly lower in patients compared to controls.

depression - glucose tolerance - glucose challenge test - insulin sensitivity - mirtazapine

References

• 1 American Diabetes Association . Standards of medical care in diabetes.  Diabetes Care. 2006;  29 S4-S42
• 2 Andersohn F, Schade R, Suissa S. et al . Long-term use of antidepressants for depressive disorders and the risk of diabetes mellitus.  Am J Psychiatry. 2009;  [Epub ahead of print] 
• 3 Cohen J. A power primer.  Psychological Bulletin. 1992;  112 155-159
• 4 Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence.  Med J Aust. 2009;  190 S54-S60
• 5 Heck A, Lieb R, Unschuld PG. et al . Evidence for associations between PDE4D polymorphisms and a subtype of neuroticism.  Mol Psychiatry. 2008;  13 831-832
• 6 Himmerich H, Fulda S, Schaaf L. et al . Changes in weight and glucose tolerance during treatment with mirtazapine.  Diabetes Care. 2006;  29 170
• 7 Horstmann S, Dose T, Lucae S. et al . Suppressive effect of mirtazapine on the HPA system in acutely depressed women seems to be transient and not related to antidepressant action.  Psychoneuroendocrinology. 2009;  34 238-248
• 8 Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.  Diabetes Care. 1999;  22 1462-1470
• 9 Mueller PS, Heninger GR, McDonald RK. Intravenous glucose tolerance test in depression.  Arch Gen Psychiatry. 1969;  21 470-477
• 10 Weber B, Schweiger U, Deuschle M. et al . Major depression and impaired glucose tolerance.  Exp Clin Endocrinol Diabetes. 2000;  108 187-190
• 11 Weber-Hamann B, Gilles M, Lederbogen F. et al . Improved insulin sensitivity in 80 nondiabetic patients with MDD after clinical remission in a double-blind, randomized trial of amitriptyline and paroxetine.  J Clin Psychiatry. 2006;  67 1856-1861
• 12 Weber-Hamann B, Gilles M, Schilling C. et al . Improved insulin sensitivity in 51 nondiabetic depressed inpatients remitting during antidepressive treatment with mirtazapine and venlafaxine.  J Clin Psychopharmacol. 2008;  28 581-584
• 13 Winokur A, Maislin G, Phillips JL. et al . Insulin resistance after oral glucose tolerance testing in patients with major depression.  Am J Psychiatry. 1988;  145 325-330

1 Submitted as a short communication to: Experimental and Clinical Endocrinology and Diabetes.

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