It is always fascinating to watch how the media pick up on a story from the world of medical research. No matter how well balanced and scientifically neutral the source material may be, it seems that news must always be more sensational. Only bad news is good news to sell newspapers and keep the advertisers happy. Take a headline, "Toothpaste gives you cancer!" Panic not. I just made that up, but you get the idea.

So, as responsible journalists, how should we approach an article in the January edition of Diabetes Research & Clinical Practice? Well, I jest, of course. Actually approaching it in the first place is difficult because this is hardly a hot-from-the-presses must-read magazine. You actually have to be searching for research with a magnifying glass. Anyway, the authors beat the grasses with a stick in the Canadian province of Saskatchewan to see what snakes would come out. Brown, Mujumdar and Johnson had the data on the incidence of type 2 diabetes from 1st January, 1991 to 31st December, 2001 among patients who were depressed. They also had the medical records showing the medications prescribed. The majority were taking either or both a Selective Serotonin Reuptake Inhibitors (SSRI) like Zoloft or a tricyclic antidepressant (TCA) like Aventyl or Elavil.

So let me start with two relevant findings:

if you live in Saskatchewan and you are depressed (no cause and effect here, of course), you are 30% more likely to develop type 2 diabetes than someone who is not depressed; and

if you take two medications at the same time, this doubles the likelihood that you will develop diabetes (about 10% of those whose records were available did take two).

I can already feel the headlines bubbling up:

Living is Saskatchewan is dangerous to your health!

Zoloft ate my hamster and got diabetes (a reference to the Evil Emperor Zoloft who rules over the Milky Way except our bit and deserves to suffer retribution for all his evil doings).

The TCAs were first used in the 1950s but, as the newer medications including the SSRIs have come on to the markets, the TCAs have been increasingly phased out because they are considered more likely to cause side effects. Thus, in the period covered by the research, it would not be surprising that patients should be taking both. Either they would be phasing out, say, Moxdil in favor of the newer Zoloft (introduced in 1991) or they were adopting a belt-and-braces approach and combining the old with the new, hoping for the best result. Today, it should be quite unusual to find a significant number of people taking Zoloft and one of the TCAs. But, if you are one of these people, you should stop taking the TCA right now.

So let us be absolutely clear on the message here. There is no link in this research between Zoloft and diabetes. Indeed, in the literature, there is a considerable body of evidence to show that the link is more certainly between a depressive illness and diabetes, cardiovascular diseases, etc. The reason is scientific confirmation of a common sense or intuitive truth. That people who are depressed do not look after themselves with the same care and attention as "healthy" people. They lack the motivation to exercise. They eat comfort food and put on weight. This increases the risk factors for diabetes and heart attacks.

So, there is no need to change from Zoloft on the basis of this research, but you still have to watch out for Emperor Zoloft and his hungry-for-hamsters evil empire.

Autor: John Scott

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