One of every four patients with diabetes experiences clinical depression, according to background information in the article. Among those with diabetes, depression can reduce quality of life and the ability to function and increase the risk for high blood sugar levels, diabetes-related complications and death. Treatment with antidepressant medications and psychotherapy has been shown to be effective, but only in the short term. In previous studies, one in seven patients with diabetes developed recurrent depression that did not respond to treatment and their blood sugar levels generally increased, placing them at a higher risk of complications associated with their diabetes.
Patrick J. Lustman, M.D., Washington University School of Medicine, St. Louis, and colleagues studied 152 patients with diabetes (average age 52.8 years) who had recovered from depression during treatment with sertraline. Participants were followed for up to one year or until their depression recurred, during which time 79 were randomly assigned to continue taking sertraline and 73 were randomly assigned to take a placebo. They visited a physician's office every month and received phone calls at the two-week point to screen for symptoms of depression. If such symptoms were detected, they underwent a psychiatric interview. Patients' hemoglobin (Hb A1c) levels, which reflect the individual's control of blood glucose levels over the previous two to three months, were measured every two months.
Participants taking sertraline were significantly less likely to develop an additional episode of depression. After one year, 65.8 percent of the patients taking sertraline remained in remission from their depression, compared with 47.9 percent of those taking placebo. The amount of time that passed before depression recurred in one-third of the patients increased from 57 days among patients receiving placebo to 226 days among those taking sertraline. "Using data available at the one-year point, the number needed to be treated was six patients, i.e., it would be necessary to treat six patients to spare one patient from depression recurrence," the authors write. All participants' Hb A1c levels had decreased when they recovered from depression and remained lower as long as they remained depression-free, with no difference between the two study groups.
Depression is increasingly understood as a recurrent and debilitating disease, especially for those with diabetes, the authors write. Physicians suspect that the more time an individual spends depressed, the greater the risk for diabetic complications and death. "Our study establishes a clear benefit of sertraline for prevention of depression recurrence in patients with diabetes," they conclude. "Sertraline lengthened the depression-free interval of maintenance and did not interfere with glycemic improvement achieved during the recovery phase. Treatment with sertraline is relatively simple, safe and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity and burden associated with recurrent depression."
(Arch Gen Psychiatry. 2006;63:521-529. Available pre-embargo to journalists at www.jamamedia.org)
Editor's Note: This study was supported in part by grants from the National Institutes of Health, Bethesda, Md., and an unrestricted educational grant from Pfizer, Inc., New York.
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