Association of SSRI Treatment and T2D Incidence in Children and Adolescents

diabetes care
diabetes care
There are concerns exist that the use of selective serotonin reuptake inhibitors increases the risk of developing type 2 diabetes in adults, but the evidence for children and adolescents is limited.

There is a modest risk for the development of type 2 diabetes (T2D) in publicly insured children and adolescents who initiate selective serotonin reuptake inhibitor (SSRI) treatment, according to results of a study published in JAMA Psychiatry.

Studies have suggested an association between SSRIs or serotonin and norepinephrine reuptake inhibitors use and a 90% increased risk for T2D in individuals 5-20 years of age, but the impact of SSRIs specifically has not yet been determined.

To evaluate the association of SSRI use in children and adolescents with risk for T2D, data from 1,582,914 patients (58.3% girls) were analyzed. Patients 10-19 years of age with a diagnosis for an SSRI indication were included. The average age of included patients was 15.1±2.3 years of age. Patients were categorized as publicly or privately insured. Patients were categorized as intention-to-treat (ITT) group were either additionally prescribed ≥1 SSRI prescriptions within 180 days after initiating treatment or were not treated with SSRIs and had ≥1 medical encounter within the same period. Patients in the as-treated category were censored after discontinuing their medication for the treatment group, or started antidepressant medication for the untreated group.

Patients who were in the SSRI treatment group were more likely to be girls (62.9%), and white (61.8%). There was no difference in markers for obesity and metabolic conditions between patients in the treated and untreated groups. In fully adjusted models, publicly insured individuals in the ITT group who initiated SSRI treatment were only slightly more at risk for T2D (adjusted hazard ratio [aHR], 1.13; 95% CI, 1.04-1.22) than untreated patients in the ITT group. A greater risk was observed for publicly insured individuals in the as-treated group that initiated SSRI treatment (aHR, 1.33; 95% CI, 1.21-1.47) compared with individuals in the as-treated group that did not initiate treatment.  In fully adjusted models, initiation of SSRI treatment was not associated with an increased risk for T2D in privately insured patients in the ITT or as-treated groups.

Limitations to this study include that no individuals were diagnosed with T2D at baseline, and thus cannot inform the treatment of patients with established T2D. Further investigation into the association of other antidepressants with T2D incidence is warranted.

The results of this study indicated that only a small increase in risk for T2D was observed for children and adolescents who initiated SSRI treatment and who were publicly insured. “This association was not apparent during the first year of treatment and strengthened slightly with longer follow-up,” according to the study authors. This conflicts with previous studies, which indicated a greater association.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Sun JW, Hernández-Díaz S, Haneuse S, et al. Association of selective serotonin reuptake inhibitors with they risk of type 2 diabetes in children and adolescents. [published online September 2, 2020]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.2762