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Selective Serotonin Reuptake Inhibitors Decrease Pancreatic Insulin Secretion in Older Adults and Increase the Risk
Raymond Noordam1,2, Nikkie Aarts1,2, Robin P Peeters1
1Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, the Netherlands.
Objective:
Selective serotonin reuptake inhibitors (SSRIs) may decrease insulin secretion, but evidence from population studies is scarce. We investigated the association between SSRIs and markers for glucose-insulin homeostasis in a nondiabetic older population. Furthermore, we studied the association between SSRI use and insulin dependence in a diabetic population of older adults.
Methods:
This study was embedded in the prospective population-based Rotterdam Study cohort (1991-2012). In nondiabetic participants, fasting glucose and insulin levels and the homeostasis model assessment for insulin sensitivity and secretion were compared between participants using SSRIs and participants using no antidepressant. In diabetic patients using oral glucose-lowering agents, the risk of insulin dependence, defined as the start of insulin treatment, was compared between participants using SSRIs and participants using no antidepressant.
Results:
In nondiabetic participants, SSRI users (n = 87) had, compared with participants using no antidepressants (n = 5,505), a significantly (P < .05) lower level of insulin (8.8 mU/L and 9.9 mU/L, respectively), a lower degree of insulin resistance (2.2% and 2.4%, respectively), and less insulin secretion (89.1% and 100.4%, respectively), but a similar glucose level. Furthermore, > 90 days of consecutive use of SSRIs in diabetic patients was associated with a 2.17 times higher risk (95% confidence interval, 1.02-4.60) of starting insulin treatment than that of participants using no antidepressants.
Conclusions:
Use of SSRIs was associated with lower insulin secretion in nondiabetic participants and an increased risk of insulin dependence in type 2 diabetics in older adults. However, additional studies are required to confirm our results.
Insights
Selective serotonin reuptake inhibitors (SSRIs) are linked to reduced insulin secretion in older adults without diabetes. In those with diabetes, SSRI use increases the risk of insulin dependence.
Area of Science:
- Endocrinology
- Gerontology
- Pharmacology
Background:
- Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants.
- Limited population-based evidence exists on the association between SSRI use and glucose-insulin homeostasis.
- Older adults represent a significant population using SSRIs and are at higher risk for metabolic disturbances.
Purpose of the Study:
- To investigate the association between SSRI use and markers of glucose-insulin homeostasis in a nondiabetic older population.
- To examine the relationship between SSRI use and insulin dependence in older adults with diabetes.
Main Methods:
- Prospective, population-based cohort study (Rotterdam Study, 1991-2012).
- Nondiabetic participants: comparison of fasting glucose and insulin levels, and homeostasis model assessment for insulin sensitivity and secretion between SSRI users and non-users.
- Diabetic patients on oral glucose-lowering agents: comparison of risk for insulin dependence (initiation of insulin treatment) between SSRI users and non-users.
Main Results:
- In nondiabetic participants, SSRI users showed significantly lower insulin levels (8.8 vs 9.9 mU/L), lower insulin resistance (2.2% vs 2.4%), and reduced insulin secretion (89.1% vs 100.4%) compared to non-users.
- SSRI use was associated with a similar glucose level between groups.
- In diabetic patients, >90 days of consecutive SSRI use was linked to a 2.17-fold higher risk of starting insulin treatment compared to non-users.
Conclusions:
- SSRI use is associated with decreased insulin secretion in nondiabetic older adults.
- SSRI use is associated with an increased risk of insulin dependence in older adults with type 2 diabetes.
- Further research is needed to validate these findings and understand the underlying mechanisms.
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