Antidepressant drug prescriptions may harm people with diabetic neuropathy

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A recent study conducted by the Regenstrief Institute and Purdue University College of Pharmacy has shed light on the prescribing patterns of tricyclic antidepressants for diabetic peripheral neuropathy, particularly in healthcare facilities serving diverse and low socioeconomic status populations.

Led by Dr. Noll Campbell, the research examined the dosage levels of these medications, which are commonly prescribed to manage pain and depression in diabetes patients.

The study’s findings revealed concerning trends, especially regarding the dosages prescribed. Data showed that nearly two-thirds of the tricyclic antidepressant prescriptions exceeded dosage levels associated with an increased risk of dementia in older adults.

Moreover, Black patients were found to be more likely to receive higher doses of these drugs, placing them at a greater risk of developing dementia compared to their white counterparts.

Diabetic peripheral neuropathy is a common complication in individuals with long-standing or poorly controlled diabetes, characterized by nerve damage that leads to pain, numbness, and an increased risk of infections among other issues.

While tricyclic antidepressants are endorsed in diabetes care guidelines for their effectiveness in managing neuropathic pain and co-occurring depression, the risks associated with long-term use of these drugs are not adequately highlighted in these guidelines.

Dr. Campbell, a researcher specializing in the aging brain and pharmacy services, pointed out the alarming frequency and duration of these prescriptions.

“Using data from electronic health records, we found tricyclic antidepressants being prescribed for periods of five to even nine years,” he noted, emphasizing that such extended use significantly raises the risk of dementia.

The study also criticizes the lack of routine checks on the effectiveness of prescribed medications in the clinical settings studied. Dr. Campbell suggested that deprescribing, or the process of tapering off unnecessary medications, could mitigate the risk of dementia.

He also mentioned that alternative treatments not associated with cognitive impairment might be equally effective but are underutilized.

This issue is particularly urgent considering the higher rates of dementia diagnosis among older Black adults in the U.S. compared to white adults.

“Is it the disease or is it the medication they are taking?” Dr. Campbell questioned, highlighting the potential for medical intervention to prevent medication-related dementia risks.

The study titled “Evaluation of Tricyclic Antidepressant Deprescribing in the Treatment of Diabetic Peripheral Neuropathy within Federally Qualified Health Centers” was published in the Journal of the American Pharmacists Association.

This research underscores the necessity for healthcare providers to re-evaluate the prescribing practices of tricyclic antidepressants to prevent long-term cognitive risks in patients with diabetic peripheral neuropathy.

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The research findings can be found in the Journal of the American Pharmacists Association.

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