Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis.

Abstract

BACKGROUND:

Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown.

OBJECTIVE:

This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes.

METHODS:

DATA SOURCES:

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.

STUDY APPRAISAL:

risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis.

RESULTS:

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.

LIMITATIONS:

amongst others, the number of RCTs is small.

CONCLUSION:

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.

• Authors: Christina M van der Feltz-Cornelis, Jasper Nuyen, Corinne Stoop, Juliana Chan, Alan M Jacobson, Wayne Katon, Frank Snoek, Norman Sartorius
• Journal: General hospital psychiatry (Gen Hosp Psychiatry) 2010 Jul-Aug Vol. 32 Issue 4 Pg. 380-95 ISSN: 1873-7714 [Electronic] United States
• PMID: 20633742 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: Copyright 2010 Elsevier Inc. All rights reserved.

Chemical References

• Antidepressive Agents
• Blood Glucose

Topics

• Antidepressive Agents (therapeutic use)
• Blood Glucose (analysis)
• Depressive Disorder, Major (complications, drug therapy, psychology, therapy)
• Diabetes Complications (psychology)
• Diabetes Mellitus, Type 1 (complications, psychology)
• Diabetes Mellitus, Type 2 (complications, psychology)
• Humans
• Psychotherapy
• Treatment Outcome