June 16, 2000
SAN ANTONIO (San Antonio Express-News) - When a diabetic is depressed, it may not be just a case of the blues.
Scientists studying the link between the two conditions long have been fascinated with how one feeds off the other, tending to make things worse for diabetics. But little has been done to translate such knowledge into successful treatment options for the depressed diabetic.
A new study detailed this week at the American Diabetes Association's 60th annual meeting represents a step in that direction. Research indicates diabetics experience decreased depression and improved blood sugar levels after only eight weeks of treatment with the popular anti-depressant fluoxetine, or Prozac.
Patrick Lustman, a psychologist at Washington University School of Medicine in St. Louis who conducted the study, said it highlights the importance of doctors recognizing symptoms of depression in diabetics.
"If you've got both (conditions) and you treat both, then both will improve," he said.
Lustman spoke during the nation's largest gathering of diabetes specialists, which drew more than 7,000 doctors and researchers to San Antonio.
Depression often goes undiagnosed in diabetics, who face twice the risk of developing the mood disorder, Lustman said.
"We recognize that managed care has constrained the time of a primary care visit to about five minutes," he said. "So unfortunately, it falls back to patients to mention it specifically to their doctors, because it's a very treatable condition."
Lustman's study, published in the most recent edition of the American Diabetes Association journal, Diabetes Care, followed 60 patients, some with Type 1 diabetes and some with Type 2. Patients were separated into two groups of 30, and one group was given a daily dose of Prozac. The control group was given a placebo.
At the end of eight weeks, the group receiving treatment showed a depression remission rate of 48 percent, compared with the control group's 26 percent, Lustman said.
Patients receiving Prozac also demonstrated a significantly greater improvement in blood sugar, or glucose, levels, he said. The use of an anti-depressant likely improves glycemic control because it dampens the body's response to the hormone cortisol, which is released during times of stress, he said.
Previous studies also have shown depression is associated with hyperglycemia and an increased risk of Type 2 diabetes.
Type I is insulin-dependent diabetes mellitus, formerly called juvenile onset diabetes, for which an insulin injection is required. Type II, non-insulin-dependent diabetes mellitus, formerly referred to adult onset diabetes, can be controlled by dietary restrictions.
Interest in finding therapies that help diabetics with depression is increasing, Lustman noted. This summer, the National Institutes of Health will convene a panel of doctors and behavioral scientists to help identify which clinical trials to pursue in an attempt to improve the treatment of depressed diabetics.
Another study presented at the diabetes conference considered the much-debated question: Does depression cause diabetes or does diabetes cause depression?
Researchers at Kaiser Permanente's Center for Health Research in Portland, Ore., looked at 1,680 diabetic members of its health maintenance organization. They found that when compared with nondiabetics, those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis, said Gregory Nichols, a Kaiser researcher who conducted the study.
About 84 percent of those diabetics also reported a higher rate of earlier depressive episodes than those in the control group, he said.
While the data did not show a causal link, Nichols said the study suggests depression frequently precedes the onset of diabetes, rather than vice versa.
"Looking at it in terms of causation may not be the right way to do things," he said, noting the two conditions may be linked rather than directly related.
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