Cognitive Behavioral Therapy Versus Sertraline in Patients With Depression and Poorly Controlled Diabetes: The Diabetes and Depression (DAD) Study

Abstract

OBJECTIVEThis study compared the long-term efficacy of a diabetes-specific cognitive behavioral group therapy (CBT) with sertraline in patients with diabetes and depression who initially responded to short-term depression treatment. RESEARCH DESIGN AND METHODSA randomized controlled single-blind trial was conducted in 70 secondary care centers across Germany comparing 12 weeks of CBT with sertraline in 251 patients with type 1 or 2 diabetes (mean HbA 1c 9.3%, 78 mmol/mol) and major depression (Structured Clinical Interview for DSM-IV [SCID]). After 12 weeks, treatment responders ( ‡50% reduction Hamilton Depression Rating Scale ) were included in the 1-year study phase where CBT patients were encouraged to use bibliotherapy and sertraline patients received continuous treatment. We analyzed differences for HbA 1c (primary outcome) and reduction (HAMD-17) or remission (SCID) of depression from baseline to the 1-year follow-up using ANCOVA or logistic regression analysis. RESULTSAfter 12 weeks, 45.8% of patients responded to antidepressant treatment and were included in the 1-year study phase. Adjusted HbA 1c mean score changes from baseline to the end of the long-term phase (20.27, 95% CI 20.62 to 0.08) revealed no significant difference between interventions. Depression improved in both groups, with a significant advantage for sertraline (HAMD-17 change: 22.59, 95% CI 1.15-4.04, P < 0.05). CONCLUSIONSDepression improved under CBT and sertraline in patients with diabetes and depression, with a significant advantage for sertraline, but glycemic control remained unchanged. CBT and sertraline as single treatment are insufficient to treat secondary care diabetes patients with depression and poor glycemic control.

Web-Based Cognitive Behavior Therapy for Depression in People With Diabetes Mellitus: A Randomized Controlled Trial

“…Overall, these findings are consistent with other studies showing that CBT for depression leads to improved depression outcomes, but has a limited effect on HbA1c levels [47]. The future challenge in this area of research is to identify treatment components and interventions that continue to positively impact on depression symptoms, but in addition derive beneficial changes in physical health outcomes, self-management, and biomarkers such as HbA1c levels.…”

Different Approaches to Therapy of Depressive Disorders in Clinical Practice

“…Таковыми в первую очередь явля-ются препараты из группы селективных ингибиторов обратного захвата серотонина (СИОЗС), в частности сер-тралин (Золофт) [32][33][34][35][36][37], а также антидепрессанты двой-ного действия -венлафаксин [38] и препараты из группы норадренергических и специфических серотонинергиче-ских антидепрессантов -миртазапин 6 [39]. 5 Так, постинфарктная депрессия способствует повышению смертности в 2--2,5 раза [31].…”

“…Накоплено достаточно большое количество исследо-ваний, в которых доказана высокая эффективность, без-опасность и хорошая переносимость СИОЗС [32][33][34][35][36][37][45][46][47][48][49], в частности сертралина (Золофт), при терапии депрессий при хронических соматических заболеваниях, таких как сердечно-сосудистая патология [32,34,48], нервные болезни [36,38,44,49], хроническая болезнь почек [35], сахарный диабет [33], заболевания крови [37]. В приведенных работах продемонстрировано меньшее количество побочных эффектов у препаратов группы СИОЗС, их лучшая совместимость с соматотропной тера-и обоснованно.…”

Anxiety and depressive disorders in children and adolescents suffering from diabetes mellitus

“…Some studies show that reducing depressive symptoms by antidepressants in patients with DM is associated not only with better health behaviour, but also with favourable outcomes in glycaemic control 61,62 . Although limited, there is evidence on the safety of antidepressants as related to glycaemic control, but when selecting an antidepressant clinicians should consider present diabetic complications and major side effects of different antidepressant groups 63 .…”