Treatment of depression in diabetes: an update.
OBJECTIVE
The combination of depression and diabetes is common and especially harmful because depression has a strong impact on psychosocial as well as medical outcomes in patients with diabetes. Consequently, treatment for depression in diabetes is also aimed at improvement in glycemic control and risk reduction for diabetes complications and mortality. This review provides an overview of all published, randomized controlled trials on the treatment of depression in patients with diabetes and summarizes current, ongoing research.


RESULTS
The best results for medical and psychological outcomes were observed for psychological treatments; however, the generalizability of these results is restricted by methodological limitations. Most antidepressants were effective treatments for depression in diabetes but failed to show benefits regarding diabetes-related medical variables. Algorithm-based care, including psychological and psychopharmacological approaches, provides the best scientific evidence for successful depression treatment but not for glycemic control.


CONCLUSIONS
Depression can be treated with antidepressants, psychotherapy or a flexible combination of both with relatively good results that are comparable to those for patients who have depression but not diabetes. Up to now, no single treatment that consistently leads to better medical outcomes in patients with both depression and diabetes has been clearly identified.
Petrak
Frank
F
Department of Psychosomatic Medicine and Psychotherapy, LWL-Clinic Dortmund/Ruhr-University of Bochum, Dortmund, Germany. mail@dr-frank-petrak.de
Herpertz
Stephan
S
D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D003131:Combined Modality Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D048909:Diabetes Complications / Q000097:blood / Q000517:prevention & control / Q000523:psychology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000523:psychology; D012803:Sick Role
D000928:Antidepressive Agents; D001786:Blood Glucose