Posted by SLS on July 20, 2009, at 5:36:00
In reply to Re: nortriptyline + diabetes, posted by linkadge on July 19, 2009, at 21:43:24
> Just do a google search:
>
> tricyclic antidepressant + diabetes
>
> There are reports of worsening diabetes in humans and some animal data that suggests a diabetogenic effect.
>
> Linkadge
A drug like nortriptyline can cause hypoglycemia also. Is there any indication just how frequently hypo- or hyper- glycemia occur with this drug? What do the studies you have found report as the absolute risk factor for diabetes?Since 1982, I have spent more time on TCAs than off them. I have had my blood sugar tested on numerous occasions, and it has been normal; this despite having gained weight (much of which I blame Abilify for).
I remember being a 17 year old who was prescribed nortriptyline as his very first antidepressant. I had at first been diagnosed as having hypoglycemia as the cause of my fatigue and feelings of depression. I was smart enough to read the drug label. It described hypoglycemia as a possible side effect. I took the drug for four days before deciding that I wouldn't take a drug that plays with blood sugar. I might have missed a golden opportunity to avoid a life of depression.
No doctor that I have seen has thus far expressed any worries over the development of diabetes with TCA. I'm not sure why. Maybe it just doesn't happen often enough to rise to that level of concern. Either that, or the association has never been made prior to recently. You would think someone would have figured it out a long time ago, though, if it were to occur frequently. From what I can see, amitriptyline is the big offender. It is also the TCA drug that I have seen produce the most weight in others. The really significant statistical increase in the occurrence in diabetes is reported when TCAs are combined with SSRIs.
All in all, I am not surprised that type 2 diabetes can be an outcome of taking TCA (amitriptyline) or SSRI (paroxetine) as is now reported. The only concern I have is that it might not happen with sufficient frequency to justify avoiding these drugs entirely. What I was surprised to find out, however, is that the combination of SSRI with TCA is substantially higher than either drug alone. Taking metformin can reduce this risk, though.
Several investigators believe that the diabetes is secondary to weight-gain. I'm not so sure, though. Perhaps there is something going on with noradrenergic control over blood glucose.
Just one more thing to worry about, I guess. Getting regular blood tests might be a good idea for those who are at an elevated risk for diabetes.
- Scott
poster:SLS
thread:907374
URL: http://www.dr-bob.org/babble/20090709/msgs/907594.html