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A preliminary study performed at the Tehran University of Medical Sciences suggests that adding pioglitazone (Actos) to a commonly prescribed anti-depressant, citalopram (Celexa), boosts the effects of antidepressants in patients whether they have diabetes or not.

Although this study was performed on only 40 patients, the conclusion of the study suggests that it will be repeated using a larger group of patients and may lead to new uses for the diabetes drugs, Actos.

This study begs the question, is the University of Tehran Psychiatric Research Centre reading the same news we are? In June of 2011, The U.S. Food and Drug Administration (FDA) warned the public that using Actos for more than one year may be associated with an increased risk of bladder cancer. Health Canada followed suit with a similar warning and France and Germany took the additional step of pulling Actos from their market.

Does it make sense to look for additional uses for a drug that has gathered this much negative attention? Takeda Pharmaceutical, the manufacturer of Actos, is currently facing a large amount of lawsuits from individuals who believe they got bladder cancer as a result of their Actos usage. These lawsuits come from individuals who took Actos for Type 2 diabetes because there were very few options available for treating their disease. To now increase the market of Actos users to include those without Diabetes but who have a major depressive disorder would be to ignore the guidance of regulatory agencies in the U.S, Canada and Europe.

And, to make matters worse, Celexa, a selective serotonin reuptake inhibitor prescribed commonly as an anti-depressant, has been linked to a wide range of birth defects. It seems completely irresponsible to combine two drugs with so such serious and varied side effects and to increase the number of people exposed to risks such as these.


  1. Gravatar for A.M

    Well, I think you did not read the paper well enough. The patients who are pregnant are not allowed to enter this study (and most other studies with the same design) . Pregnant patients with depression are usually studied in a different setting and design.

    Second, As you noticed, risk of bladder cancer only increases after one year of pioglitazone and in susceptible population (older age, etc.). Moreover, a recent large study contradicted increased risk of bladder cancer in pioglitazone compared with other antidiabetic agents.

    In fact, the mentioned study was designed to address the rapid action of pioglitazone and NOT to suggest its long-term use.

    At last, combination of two drugs with different problem would not increase either problem further. This is not only the case for this particular combination but also for any other combinations.


    Study author

  2. Gravatar for George

    The most recent and well-designed study regarding the risk of bladder cancer with pioglitazone did not show an increased risk.

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