Two birds with one stone: How depression and distress in diabetes respond to antidepressants
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Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad
Kasturba Medical College, Mangalore
Submission date: 2018-10-10
Final revision date: 2019-01-29
Acceptance date: 2019-02-02
Online publication date: 2019-06-15
Publication date: 2019-06-15
Corresponding author
Dr Harshil Yogesh Chauhan   

Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad
Arch Psych Psych 2019;21(2):41-47
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 affects diabetes related outcomes. This study aims at identifying comprehensive effects of antidepressant treatment in patients with type 2 diabetes mellitus and co-morbid depression.

Subject or material and methods:
124 subjects of type 2 diabetes mellitus were screened for depression using Patient Health Questionnaire – 9 (PHQ-9). 34 subjects with PHQ score > 10 were recruited in the study. Subjects were rated on Beck’s Depressive Inventory (BDI), Montgomery Asberg Depression Rating Scale (MADRS) and Diabetes Distress Scale (DDS). Subjects’ glycemic parameters – Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS) and Glycated Hemoglobin (HbA1C) were recorded. 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.

Antidepressant treatment lead to 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).

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.

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.

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