Two birds with one stone: How depression and distress in diabetes respond to antidepressants

Aim of the study: As with other chronic diseases, depression is more prevalent among the patients with type 2 diabetes mellitus. Depression and diabetes-related distress adversely affect diabetes-related outcomes. This study aims at identifying comprehensive effects of antidepressant treatment in patients with type 2 diabetes mellitus and co-morbid depression. Material and methods: 124 subjects with type 2 diabetes mellitus were screened for depression using the Patient Health Questionnaire – 9 (PHQ-9). 34 subjects with PHQ score > 10 were recruited to the study and rated on Beck’s Depression Inventory (BDI), the Montgomery Asberg Depression Rating Scale (MADRS) and the Diabetes Distress Scale (DDS). Subjects’ glycemic parameters – Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS) and Glycated Hemoglobin (HbA1C) were recorded. All subjects were treated with either escitalopram or mirtazapine for a period of 8 weeks. Post-intervention changes in BDI, MADRS, DDS and glycemic parameters were noted. Results: Antidepressant treatment has led to a significant improvement in depressive symptoms (reduction in BDI: 19.13 ± 8.06; reduction in MADRS: 17.16 ± 5.3) and diabetes-related distress (reduction in DDS: 17.81 ± 8.93). Significant improvements were also noticed in glycemic parameters: FBS (p= 0.015) and HbA1C (p=0.004). Discussion: Distress in diabetes leads to poor self-care and higher HbA1C, while depression predicts poorer glycemic control, more complications and higher health-care costs. Improvement in depression and distress in diabetes yields much greater benefits. Conclusions: Antidepressant treatment with escitalopram or mirtazapine can effectively treat depression and reduce diabetes-related distress in patients with type 2 diabetes mellitus. Beneficial effects are noted on glycemic parameters as well.