Fluoxetine in the Treatment of Obese Type 2 Diabetic Patients

Abstract

In a 12-month randomly allocated double-blind trial in 19 obese Type 2 diabetic patients, fluoxetine 60 mg daily compared to placebo produced a significant fall in median body weight after 3 months (3.8 kg), 6 months (6.5 kg), 9 months (7.1 kg) and at 1 year (5.8 kg). Median fasting blood glucose and HbA1c levels fell significantly after 3 months (1.9 mmol l-1) and 1.7%, respectively) and 6 months (1.8 mmol l-1 and 1.7%) but neither showed a significant difference to placebo after 9 or 12 months therapy with fluoxetine. There were no significant changes in serum cholesterol levels in the year but patients on fluoxetine showed a significant fall in serum triglyceride level (0.5 mmol l-1) after 3 months therapy but not thereafter. Compared to placebo there was a significant fall in median energy intake on fluoxetine after 3 months (257 kcal day-1) and 6 months (199 kcal day-1) but this difference was not significant at 9 or 12 months. There was also a significant fall in carbohydrate intake after 3 months (30 g day-1) and 6 months (23 g day-1) on fluoxetine as well as a significant fall in carbohydrate intake expressed as a percentage of the total daily energy intake; 5.9% at 3 months, 6.1% at 6 months, and 4.0% at 9 months. There were no significant effects on protein or fat intake except a significant increase in the intake of fat expressed as a percentage of daily energy intake, 5.9% after 6 months. Two of the nine patients on fluoxetine dropped out of the study due to gastrointestinal side-effects. Fluoxetine might prove to be a useful adjunct therapy in obese Type 2 diabetic patients where short-term weight loss and fall in carbohydrate intake and an improvement in glycaemia are indicated.

Review: The treatment and prevention of obesity: a systematic review of the literature

“…67 A second trial focused on non-insulin dependent diabetics. 69 In this smaller study,¯uoxetine produced a statistically signi®cant fall in median body weight between 3 and 12 months when compared to placebo. However, weight regain commenced at nine months.…”

Acute effect of different antidepressants on glycemia in diabetic and non-diabetic rats

“…However, it is recognized that fluoxetine increases insulin receptor sensitivity (31) and competes with sulfonylurea for cytochrome P-450 metabolism (29), requiring adjustment of the doses of insulin or hypoglycemic agents to avoid hypoglycemia (32,33). On the other hand, non-insulin-dependent diabetic patients who are treated with fluoxetine show a consistent reduction in carbohydrate consumption and weight loss associated with a decrease in HbA1c (34,35). Ultimately, sertraline may be a better agent for depression treatment in diabetic patients (36).…”

A review of the relationship between depression and diabetes in adults: is there a link?

“…More recently, Lustman et al (15) extended these results to cognitive behavior therapy. Double-blind placebo and controlled treatment studies of MDD have also suggested a hypoglycemic effect of antidepressant medication (16,17). Possible mechanisms include changes in the effects of catecholamine levels and serotonin concentrations on glucose regulation (18).…”