HbA1c levels were significantly lower than baseline during depression-free periods, regardless of treatment. Maintenance treatment with the antidepressant sertraline (Zoloft) after a first episode of depression has resolved extends the time to relapse in patients with diabetes, study results suggest. And sustained remission of depression is associated with improved control of blood sugar.
Depression is highly prevalent among patients with diabetes, Dr. Patrick J. Lustman, from Washington University School of Medicine in St. Louis, and colleagues note, and recurrence after initial successful treatment is common. Depression, in turn, is linked to increased morbidity and mortality among diabetics, they point out in the publication.
Previous studies have been limited to no more than 16 weeks of treatment, the authors report. The goal of the current study was to see if continued antidepressant treatment beyond the first remission would be effective in prolonging depression-free periods and improving glycemic (blood sugar) control.
In the first phase of the study, 351 diabetic patients with moderately severe and recurrent major depression were treated with Zoloft, up to 200 mg/day for 16 weeks. Recovery occurred in 156 (44 percent).
The second phase of the trial included 152 diabetics from the first group who were successfully treated for depression. Seventy-nine were randomly assigned to continued Zoloft and 73 to placebo.
Zoloft was significantly more successful than placebo in prolonging the depression-free interval, report the investigators. Time to recurrence in one third of patients was 57 days in the placebo group and 226 days in the Zoloft group.
During the second phase of the trial, changes in HbA1c level — a marker of blood sugar control — did not differ between groups. However, HbA1c levels were significantly lower than baseline during depression-free periods, regardless of treatment.
According to Lustman’s group: "Vigilant monitoring of depression symptoms to prompt treatment augmentation or modification is required and may improve the picture." They also suggest that psychotherapy may help provide more durable relief of depression.
Archives of General Psychiatry May 2006.
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