Comparing the Effects of 8-Week Treatment With Fluoxetine and Imipramine on Fasting Blood Glucose of Patients With Major Depressive Disorder

Abstract

This study was designed to compare the effects of fluoxetine and imipramine on fasting blood glucose (FBG) in patients with major depressive disorder. Sixty nondiabetic patients with major depressive disorder (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) entered this randomized, double-blind study. Patients did not receive any medication affecting serum FBG levels for at least 2 weeks before the initiation of the study. Patients were assigned to receive 20 to 40 mg/d of fluoxetine or 75 to 200 mg/d of imipramine for 8 weeks. Pregnant women and patients with diabetes mellitus and a history of any major heart disease were excluded from this study. Additionally, none of the patients should have received electroconvulsive therapy within 6 months before the initiation of the antidepressants. FBG levels were measured at the initiation, as well as 4 and 8 weeks after starting antidepressants. Nineteen patients in the fluoxetine and 24 patients in the imipramine groups completed the study. In the fluoxetine group, FBG level was decreased from 88.5 mg/dL (baseline) to 85.0 mg/dL at week 4 (P = 0.73), and to 79.8 mg/dL at week 8 (P < 0.001). On the other hand, in the imipramine group, FBG level was increased from 86.96 mg/dL (baseline) to 89.71 mg/dL at week 4 (P = 0.079), and to 96.90 mg/dL at week 8 (P < 0.001). This 8-week study showed that FBG levels may decrease in depressive patients receiving fluoxetine and may increase in those patients treated with imipramine. Therefore, it is suggested to measure and monitor FBG before initiation and during treatment with fluoxetine and imipramine.

Impaired Glucose Homeostasis After Imipramine Intake in a Diabetic Patient

“…Earlier evidence in literature suggests that imipramine, as well as other antidepressants, may affect glucose homeostasis. [1][2][3][4][5][6][7][8][9][10][11][12][13] A strong feature of this case is that imipramine was not used for depressive disorder, which itself may be associated with changes in food intake and altered glucose homeostasis, but for urinary incontinence. Moreover, this case report is unique because we were able to illustrate in detail the changes in insulin requirements, which are a very sensitive marker for altered glucose homeostasis.…”

“…3 Diplopia is defined as double vision. Binocular diplopia is a type of double vision that is eliminated when either eye is occluded.…”

Safety and Efficacy of s-Citalopram in Patients with Co-Morbid Major Depression and Diabetes Mellitus

“…There are few controlled clinical trials to determine which antidepressant drug class is the safest and most efficacious for treating depression in patients with diabetes [7,15,17,18] . Rather, most studies have focused on an analgesic effect of TCAs and SSRIs in controlling diabetic neuropathy [12,[43][44][45][46][47] and wound healing [48] .…”

“…Although tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors appear to be effective therapy for depression in patients with diabetes, there is also evidence that these agents may destabilize glycemic control in some diabetic patients [16][17][18] . In contrast, there is growing evidence that selective serotonin reuptake inhibitor (SSRI) antidepressants may facilitate glycemic control in some patients with co-morbid diabetes and depression [14,15,18,19] .…”

“…In contrast, there is growing evidence that selective serotonin reuptake inhibitor (SSRI) antidepressants may facilitate glycemic control in some patients with co-morbid diabetes and depression [14,15,18,19] . Animal studies have shown that the serotonin precursor, 5-hydroxy tryptophan, can lower glucose levels independent of insulin secretion [20] and that SSRIs can reduce plasma glucose levels in humans [16] .…”