94 - Recommendations

Recommendations

424 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Recommendations ■ ■All patients with a diagnosis of depression should be screened for diabetes. ■ ■In those who are diabetic: ■ ■use SSRIs first line; data support sertraline, escitalopram and fluoxetine ■ ■SNRIs, bupropion, vortioxetine and agomelatine are also likely to be safe but there are fewer supporting data ■ ■avoid TCAs and MAOIs if possible, because of their effects on weight and glucose homeostasis ■ ■monitor blood glucose and HbA1c carefully when antidepressant treatment is initiated, when the dose is changed and after discontinuation ■ ■metformin may be a preferred diabetes treatment because of its putative beneficial effects on mood in type II diabetes.35,36 References

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7. Maheux P, et al. Fluoxetine improves insulin sensitivity in obese patients with non-­insulin-­dependent diabetes mellitus independently of weight loss. Int J Obes Relat Metab Disord 1997; 21:97–102.
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9. Lustman PJ, et al. Sertraline for prevention of depression recurrence in diabetes mellitus: a randomized, double-­blind, placebo-­controlled trial. Arch Gen Psychiatry 2006; 63:521–529.
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11. Knol MJ, et al. Influence of antidepressants on glycaemic control in patients with diabetes mellitus. Pharmacoepidemiol Drug Saf 2008; 17:577–586. Table 3.16  (Continued) Antidepressant class Effect on glucose homeostasis Agomelatine19 ■ ■A few studies suggest agomelatine is effective with some improvement or no worsening of glycaemic parameters ■ ■Agomelatine also demonstrated a minimum effect on body weight Bupropion ■ ■Improved weight and HbA1c in one open study33 Vortioxetine ■ ■No clinically relevant changes in weight or blood in one subgroup analysis of clinical trial data.34 Limited evidence of an improvement in HbA1c.19 Reboxetine, trazodone ■ ■No data in patients with diabetes ■ ■One study revealed 20% increased risk of type 2 diabetes in people prescribed trazodone20 HbA1c, glycated haemoglobin; MAOI, monoamine oxidase inhibitor; TCA, tricyclic antidepressant.