A Review of Treating Depression in Diabetes: Emerging Findings

Introduction:  It’s postulated that treating depression in patients with diabetes may improve diabetes treatment adherence, as well as general health outcomes.  Therefore, this review was undertaken of the efficacy of current treatments for comorbid depression in patients with diabetes.

Methods:  Using Cochrane Review, PsychINFO, and Pubmed, searches were conducted to find appropriate studies in the years 1995 to 2008 (inclusive).  There were 17 studies identified, and the interventions studies fell into the following categories:

Results:  In the studies on psychosocial interventions, the authors found that cognitive behavioral therapy is especially effective in improving depression in patients with diabetes.  However, no definite conclusions on the effect of psychosocial interventions on diabetes self-care and health outcomes could be drawn; more research is needed here.

When looking at pharmacologic interventions for treating comorbid depression in people with diabetes, the authors drew the conclusion that SSRIs (in particular fluoxetine and sertraline) are effective at reducing glucose levels.

The 3 studies included on collaborative care interventions provided the conclusion that collaborative care is cost-effective and improves depression in people with diabetes.  It does not, however, seem to have any benefits on A1c levels.

Conclusions:  Some psychosocial, pharmacologic, and collaborative care interventions are effective at treating depression in people with diabetes.  Their efficacy in improving diabetes outcomes was mixed.

Commentary by Leonard E. Egede MD, MS

This article reviewed the literature from 1995 to 2008 to assess which interventions were most effective for treating depression in individuals with diabetes. They grouped effective treatments into three categories: psychosocial, pharmacologic and collaborative care interventions. They found that CBT was the psychosocial treatment with the strongest evidence, while pharmacologic treatment with SSRIs was associated with improvements in depressive symptoms. They also found that collaborative care interventions, where primary care providers worked with psychiatrists to manage depression, were associated with improvements in depressive symptoms. This review provides evidence that cognitive behavioral therapy or selective serotonin reuptake inhibitors (SSRIs) are effective treatment options for depression in individuals with diabetes, especially in the setting of collaborative care between primary care providers and psychiatrists. However, there is strong evidence that whilst treating depression improves depressive symptoms, it does not lead to improvements in glycemic control, unless diabetes education and aggressive glycemic control are incorporated into the treatment [10]. Therefore treatment should be directed at both conditions when they coexist, and combinations of CBT or pharmacologic agents (SSRIs) with oral hypoglycemic agents and/or insulin are reasonable options in these patients.