Comorbid depression in diabetes is highly prevalent, negatively impacting well-being
and diabetes control. How depression in diabetes is best treated is unknown.
This systematic review and meta-analysis aims to establish the effectiveness of existing
anti-depressant therapies in diabetes.
PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants,
interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment
by psychotherapy, pharmacotherapy or collaborative care of depression in persons with
Type 1 and Type 2 diabetes mellitus.
risk of bias assessment; data extraction. Synthesis methods: data synthesis, random
model meta analysis and publication bias analysis.
Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective
in terms of reduction of depressive symptoms: -0.512; 95% CI -0.633 to -0.390. The
combined effect of all interventions on clinical impact is moderate, -0.370; 95% CI
-0.470 to -0.271; it is large for psychotherapeutic interventions that are often combined
with diabetes self management: -0.581; 95% CI -0.770 to -0.391, n=310 and moderate
for pharmacological treatment: -0.467; 95% CI -0.665 to -0.270, n=281. Delivery of
collaborative care, which provided a stepped care intervention with a choice of starting
with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect
size of -0.292; 95% CI -0.429 to -0.155, n=1133; indicating the effect size that can
be attained on a population scale. Pharmacotherapy and collaborative care aimed at
and succeeded in the reduction of depressive symptoms but, apart from sertraline,
had no effect on glycemic control.
amongst others, the number of RCTs is small.
The treatment of depression in people with diabetes is a necessary step, but improvement
of the general medical condition including glycemic control is likely to require simultaneous
attention to both conditions. Further research is needed.
Copyright 2010 Elsevier Inc. All rights reserved.