Antidepressants and Type 2 Diabetes

People with type 2 diabetes are also often diagnosed with depression. Antidepressants have been shown to help improve diabetes in some cases but, in other instances, they can worsen existing diabetes. They may even bring diabetes on in individuals who previously had no symptoms.

In this article, learn how different antidepressants can affect blood sugar and what to know about taking antidepressants with diabetes.

What Are Antidepressants?

Antidepressants are prescription medications used to treat depression. In some cases, they are also used to treat certain anxiety disorders.

Antidepressants work by balancing the levels of neurotransmitters in the brain; however, there are various types of antidepressants, and each works a little differently.

Types of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and noradrenaline reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)
• Noradrenergic and specific serotonergic antidepressants (NaSSAs) 

Antidepressants That Lower Blood Sugar 

Some antidepressants can lower blood sugar, which may initially seem good if you have diabetes.

One study found that antidepressant use among people with type 2 diabetes and depression was associated with improved blood sugar. The study found that participants taking antidepressants were twice as likely to have good glycemic control (blood sugar control) than those who weren't taking antidepressants.

SSRIs and SNRIs that are associated with improved blood sugar include:

• Prozac (fluoxetine)
• Lexapro (escitalopram)
• Celexa (citalopram) 
• Savella (milnacipran)

This improvement may due to a direct response to the medication itself, or it may be a result of improved depression symptoms carrying over to better diabetes management.

However, when blood sugar gets too low, it can cause dangerous levels of hypoglycemia (blood sugar that is too low).

It is not yet clear exactly how common antidepressant-induced hypoglycemia is, but it's believed to be rare. Some case studies indicate it may be a more common issue among people who do not have diabetes.

In short, some antidepressants may lower blood sugar, but sometimes it can drop too much, particularly when starting a new antidepressant. If you have diabetes, you should talk to your healthcare provider about adjusting your insulin dosage or the frequency you should be checking your blood sugar if you are starting an antidepressant.

Antidepressants That Raise Blood Sugar

Conversely, some antidepressants may raise blood sugar (hyperglycemia) or worsen blood sugar control. These include:

• Cymbalta (duloxetine)
• Zoloft (sertraline)
• Remeron (mirtazapine)
• Luvox (fluvoxamine)
• Paxil (paroxetine)

Antidepressants That Raise the Risk of Diabetes

Unfortunately, antidepressant use has also been linked to developing new onset diabetes, particularly with long-term use or higher dosages.

One study with over 90,000 participants found that antidepressants increased the risk of type 2 diabetes. This risk increased with longer-term use of antidepressants and higher dosages. The study also found that glucose tolerance improved when antidepressants were discontinued or reduced.

The risk of developing new onset type 2 diabetes has been found to be significantly higher when taking:

• SSRIs
• SNRIs
• TCAs
• NaSSAs

However, the research regarding SSRIs is mixed. Some studies have found that SSRIs help control blood sugar in the short term, whereas only TCAs and NaSSAs negatively affect blood sugar control.

Managing Diabetes and Depression

It can be challenging to manage your injections, appointments, diet, and more if you struggle with depression. Additionally, the difficulties of managing diabetes may lead to feelings of stress and depression. In short, diabetes and depression can both affect one another. This also means that better management of one condition may help you with the other condition, too.

Taking an antidepressant is just one way to cope with depression symptoms. Other treatments for depression include:

• Cognitive behavioral therapy (CBT)
• Family therapy
• Interpersonal therapy (ITP)
• Psychodynamic therapy
• Stress management techniques
• Exercise
• Dietary supplements
• Lifestyle changes

Summary

The connection between antidepressant use and diabetes is complicated, to say the least. Currently, we know that antidepressants can lower blood sugar, raise blood sugar, improve blood sugar control, and even lead to new onset diabetes. It is difficult to tease out which antidepressants may or may not cause which result, if any, in individuals because the current body of research is of varying quality and covers a wide variety of medications.

It's important to speak with your healthcare provider about how to manage your depression and diabetes, especially when starting a new antidepressant, increasing antidepressant dosage, or taking an antidepressant long term.

A Word From Verywell

While it may be hard to predict exactly how your antidepressant use may affect your diabetes (or even lead to diabetes), it is clear that there is some relationship. If you're experiencing depression with or without diabetes, speak to your healthcare provider about potential risks of taking antidepressants and determine a safe treatment plan together.