University of Maryland, Baltimore.
University of Maryland, Baltimore.
J Am Acad Child Adolesc Psychiatry. 2017 Aug;56(8):642-651. doi: 10.1016/j.jaac.2017.04.004. Epub 2017 May 8.
More than half of youth treated with atypical antipsychotic (AAP) medications are also treated with concomitant antidepressants or stimulants. This study assessed the association between antidepressant or stimulant use concomitant with AAPs and the risk of incident type 2 diabetes mellitus (T2DM).
Medicaid Analytic eXtract data were used to conduct a retrospective cohort study of youth (aged 5-20 years) who initiated AAP treatment. In AAP-treated youth, concomitant antidepressant (selective serotonin reuptake inhibitors [SSRI]/serotonin-norepinephrine reuptake inhibitors [SNRIs], tricyclic/other cyclic antidepressants [TCAs], and other antidepressants) or stimulant use was assessed. The risk of incident T2DM was estimated using discrete time failure models, adjusting for disease risk score estimated using >125 baseline and time-dependent covariates.
Among 73,224 AAP initiators, 43.0% had concomitant antidepressant use (76.4% were SSRI/SNRIs) and 43.8% had concomitant stimulant use. The study cohort had an average follow-up of 24.8 months (median = 22.0 months, interquartile range [IQR] = 10.0-38.0 months). In current AAP-treated youth, concomitant SSRI/SNRI (relative risk [RR] = 1.84, 95% CI = 1.30-2.59) or TCA use (RR = 2.75, 95% CI = 1.28-5.87) was associated with an increased risk of T2DM. By contrast, concomitant use of other antidepressants or stimulants with AAPs was not associated with an increased risk of T2DM. In concomitant users of AAPs and SSRI/SNRIs, the risk of T2DM increased with the duration of SSRI/SNRI use (RR = 2.35, 95% CI = 1.15-4.83 for ≥180 days vs. 1-180 days) as well as with the cumulative SSRI/SNRI dose (RR = 1.99, 95% CI = 1.08-3.67 for >2,700 mg vs. 1-2,700 mg fluoxetine dose equivalents), after adjusting for the duration and cumulative dose of AAP use. By contrast, in concomitant users of AAPs and stimulants, neither duration nor cumulative dose of stimulants was associated with an increased risk of T2DM.
In AAP-treated Medicaid-insured youth, concomitant SSRI/SNRI use was associated with a heightened risk of T2DM, which intensified with increasing duration and dose.
接受非典型抗精神病药物（AAP）治疗的青少年中，超过一半还同时接受抗抑郁药或兴奋剂治疗。本研究评估了 AAP 治疗同时使用抗抑郁药或兴奋剂与 2 型糖尿病（T2DM）发病风险之间的关联。
使用 Medicaid Analytic eXtract 数据对接受 AAP 治疗的青少年（5-20 岁）进行回顾性队列研究。在接受 AAP 治疗的青少年中，评估了同时使用抗抑郁药（选择性 5-羟色胺再摄取抑制剂 [SSRIs]/5-羟色胺去甲肾上腺素再摄取抑制剂 [SNRIs]、三环/其他环类抗抑郁药 [TCAs] 和其他抗抑郁药）或兴奋剂的情况。使用离散时间失效模型估计 T2DM 的发病风险，通过超过 125 个基线和时间依赖性协变量进行疾病风险评分调整。
在 73224 名 AAP 使用者中，43.0%同时使用抗抑郁药（76.4%为 SSRIs/SNRIs），43.8%同时使用兴奋剂。研究队列的平均随访时间为 24.8 个月（中位数=22.0 个月，四分位距 [IQR]=10.0-38.0 个月）。在当前接受 AAP 治疗的青少年中，同时使用 SSRIs/SNRIs（相对风险 [RR] = 1.84，95%置信区间 [CI] = 1.30-2.59）或 TCA 与 T2DM 发病风险增加相关。相比之下，同时使用其他抗抑郁药或兴奋剂与 AAP 与 T2DM 发病风险增加无关。在 AAP 和 SSRIs/SNRIs 同时使用者中，随着 SSRIs/SNRIs 使用时间的延长（RR=2.35，95%CI=1.15-4.83 与 1-180 天相比）以及 SSRIs/SNRIs 累积剂量的增加（RR=1.99，95%CI=1.08-3.67 与 1-2,700mg 氟西汀剂量当量相比），T2DM 发病风险增加，同时调整了 AAP 使用的持续时间和累积剂量。相比之下，在 AAP 和兴奋剂同时使用者中，兴奋剂的使用时间或累积剂量均与 T2DM 发病风险增加无关。
在接受 AAP 治疗的 Medicaid 保险青少年中，同时使用 SSRIs/SNRIs 与 T2DM 发病风险增加相关，且随着时间的延长和剂量的增加而加剧。
