Treating Depression in Diabetic Patients: Is There an Alternative to Medications?

Editorials15 October 1998Treating Depression in Diabetic Patients: Is There an Alternative to Medications?Alan M. Jacobson, MD and Katie Weinger, EdDAlan M. Jacobson, MDJoslin Diabetes Center; Harvard Medical School; Boston, MA 02215 and Katie Weinger, EdDJoslin Diabetes Center; Harvard Medical School; Boston, MA 02215Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-8-199810150-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In the general population, depression is exceedingly common, sometimes difficult to diagnose, and undertreated but remediable [1, 2]. In patients with chronic conditions such as diabetes, depressive disorders seem to occur even more frequently [3], have a high rate of recurrence [4], and seem to be associated with worsened medical outcomes [5]. The high prevalence of depression in diabetes [3], the frequency of depression onset before diabetes complications [6, 7], the similarity in the hypothalamic-pituitary axis changes found in depression and poorly controlled diabetes mellitus [8], indications that diabetic rats are more susceptible to neurochemical and behavioral changes similar to ...References1. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994; 51:8-19. Google Scholar2. Katon W, von Korff M, Lin E, Bush T, Ormel J. Adequacy and duration of antidepressant treatment in primary care. Med Care. 1992; 30:67-76. Google Scholar3. Gavard JA, Lustman PJ, Clouse RE. Prevalence of depression in adults with diabetes. An epidemiological evaluation. Diabetes Care. 1993; 16:1167-78. Google Scholar4. Lustman PJ, Griffith LS, Freedland KE, Clouse RE. 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Stress and behavior in streptozotocin diabetic rats: biochemical correlates of passive avoidance learning. Behav Neurosci. 1989; 103:144-50. Google Scholar10. Weinger K, Jacobson AM, Draelos MT, Finkelstein D, Simonson DC. Blood glucose estimation and symptoms during hyperglycemia and hypoglycemia in patients with insulin-dependent diabetes mellitus. Am J Med. 1995; 98:22-31. Google Scholar11. Mazze RS, Lucido D, Shamoon H. Psychological and social correlates of glycemic control. Diabetes Care. 1984; 7:360-6. Google Scholar12. Lustman PJ, Griffith LS, Clouse RE. Depression in adults with diabetes. Results of 5-year follow-up study. Diabetes Care. 1988; 11:605-12. Google Scholar13. Leedom L, Meehan WP, Procci W, Zeidler A. Symptoms of depression in patients with type II diabetes mellitus. Psychosomatics. 1991; 32:280-6. Google Scholar14. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993; 329:977-86. Google Scholar15. Lustman PJ, Griffith LS, Freedland KE, Kissel SS, Clouse RE. Cognitive behavior therapy for depression in type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1998; 129:613-21. Google Scholar16. Blackburn IM, Moore RG. Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression. Br J Psychiatry. 1997; 171:328-34. Google Scholar17. Goodnick PJ, Henry JH, Buki VM. Treatment of depression in patients with diabetes mellitus. J Clin Psychiatry. 1995; 56:128-36. Google Scholar18. Sank LI, Shaffer CS. A Therapist's Manual for Cognitive Behavioral Therapy in Groups. New York: Plenum; 1984. Google Scholar19. Keefe FJ, Van Horn Y. Cognitive-behavioral treatment of rheumatoid arthritis pain: maintaining treatment gains. Arthritis Care Res. 1993; 6:213-22. Google Scholar20. Jacobson AM. The psychological care of patients with insulin-dependent diabetes mellitus. N Engl J Med. 1996; 334:1249-53. Google Scholar Author, Article, and Disclosure InformationAuthors: Alan M. Jacobson, MD; Katie Weinger, EdDAffiliations: Joslin Diabetes Center; Harvard Medical School; Boston, MA 02215Grant Support: In part by grants R01 DK 42315 and NR07157 from the National Institutes of Health.Corresponding Author: Alan M. Jacobson, MD, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215; e-mail, [email protected].Current Author Addresses: Drs. Jacobson and Weinger: Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus Patrick J. Lustman , Linda S. Griffith , Kenneth E. Freedland , Sarah S. Kissel , and Ray E. 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