Depression and Diabetes: Prioritizing Treatment Goals
An article in The Lancet Diabetes & Endocrinology reviews evidence on screening and treatment for depression in adult patients with type 1 and type 2 diabetes and issues recommendations on treating these comorbid conditions. The paper was published to coincide with the annual meeting of the American Psychiatric Association, held from May 16–20 in Toronto.
Although many diabetes guidelines recommend screening for depression, the use of questionnaires is generally not specific and may lead to a substantial overestimation of depression. While “diabetes distress” is a concept related to depression, it should be evaluated separately from depressive symptoms or depression as a mental disorder in patients with diabetes. The authors state that a positive screening questionnaire should be followed with a formal clinical assessment to confirm to diagnosis and consider other diagnoses as well, along with a treatment plan and patient monitoring. A previous review found that the Beck Depression Inventory (BDI; BDI-II), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Hospital Anxiety and Depression Scale (HADS), showed adequate clinical specificity and sensitivity in the screening of depression in diabetes patients, but the Patient Health Questionnaire (PHQ) was the screening questionnaire best validated in diabetic patients.
While the optimal treatment for depression in diabetes would simultaneously improve depressive symptoms and glycemic control, treatments for diabetes can take several months for improved glycemic control while clinical improvements in depression may be seen in 2–4 weeks after initiation of antidepressant therapy. As such, the authors recommend that clinicians focus on treating the depression with antidepressants and/or psychological interventions because this may also lead to improved diabetic treatment adherence in patients. Several studies have shown that antidepressant therapy significantly reduces depression severity compared to placebo, although there are concerns that some antidepressants may increase the risk of type 2 diabetes directly or indirectly via weight gain.
Clinicians should assess each patients with comorbid diabetes and depression on an individual basis to review the benefits and risks associated with any treatment for depression or diabetes, the authors note. They also emphasize that training should promote cross-disciplinary collaboration for preventing, treating diabetes and depression.
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