Aims: To compare the likelihood of being prescribed an antidepressant in depressed individuals with and without type 2 diabetes. Methods: We performed a matched cohort study using primary care record data from the UK Clinical Practice Research Datalink. We used multivariable logistic regression to compare antidepressant prescribing during the first five years of starting oral antidiabetic medication to a comparison group without type 2 diabetes, matched based on GP practice, age and sex. We performed subgroup analyses stratified by sex, age and ethnicity. Results: People with type 2 diabetes and depression were 75% less likely to be prescribed an antidepressant compared to people with depression alone (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.25 to 0.26). This difference was greater in males (OR 0.23, 95% CI, 0.22 to 0.24), people older than 56 years (OR 0.23, 95% CI, 0.22 to 0.24), or from a minoritised ethnic background (Asian OR 0.14, 95% CI 0.12-0.14; Black OR 0.12, 95% CI 0.09-0.14). Conclusions: There may be inequalities in access to antidepressant treatment for people with type 2 diabetes, particularly those who are male, older or from minoritised ethnic backgrounds. Key words: type 2 diabetes, depression, antidepressant, inequality, primary care, multimorbidity

The authors have declared no competing interest.

This study was a student project and did not receive funding. Annie Jeffery and Joseph Hayes report a relationship with Wellcome Trust that includes: funding grants. Annie Jeffery and Joseph Hayes report a relationship with National Institute for Health Research that includes: funding grants. Joseph Hayes reports a relationship with the UKRI which includes: funding grants. None of the reported relationships had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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