Depression Symptoms and Antidepressant Medicine Use in Diabetes Prevention Program Participants

Abstract

OBJECTIVE -To assess depression markers (symptoms and antidepressant medicine use) in Diabetes Prevention Program (DPP) participants and to determine whether changes in depression markers during the course of the study were associated with treatment arm, weight change, physical activity level, or participant demographic characteristics.RESEARCH DESIGN AND METHODS -DPP participants (n ϭ 3,187) in three treatment arms (intensive lifestyle, metformin, and placebo) completed the Beck Depression Inventory (BDI) and reported on use of antidepressant medicines at randomization and subsequently at each annual visit (average duration in study 3.2 years).RESULTS -On study entry, 10.3% of participants had BDI scores Ն11, which was used as a threshold for mild depression, 5.7% took antidepressant medicines, and 0.9% had both depression markers. During the DPP, the proportion of participants with elevated BDI scores declined (from 10.3% at baseline to 8.4% at year 3), while the proportion taking antidepressant medicines increased (from 5.7% at baseline to 8.7% at year 3), leaving the proportion with either marker unchanged. These time trends were not significantly associated with the DPP treatment arm. Depression markers throughout the study were associated with some participant demographic factors, adjusted for other factors. Men were less likely to have elevated depression scores and less likely to use antidepressant medicine at baseline (9.0% of men and 17.9% of women had at least one marker of depression) and throughout the study (P Ͻ0.0001). Those with more education were less likely to have elevated symptom scores (P ϭ 0.0007) but more likely to be taking antidepressant medicine (P ϭ 0.002). Non-Hispanic white participants were less likely than African Americans to have BDI scores Ն11 (P ϭ 0.03), but white participants were more likely to be taking antidepressant medicine than any other racial/ethnic group (P Ͻ0.0001).CONCLUSIONS -DPP participation was not associated with changes in levels of depression. Countervailing trends in the proportion of DPP participants with elevated depression symptoms and the proportion taking antidepressant medicine resulted in no significant change in the proportion with either marker. The finding that those taking antidepressant medicine often do not have elevated depression symptoms indicates the value of assessing both markers when estimating overall depression rates. Diabetes Care 28:830 -837, 2005D epression is more common among people with diabetes than in the general population (1,2). The causal relationships between depression and glucose metabolism are not well understood, but some associations have been documented. People with diabetes who are depressed have higher HbA 1c levels (3), more diabetes complications (4,5), and much higher general health care costs than people with diabetes who are not depressed (6,7). Treating depression in people with diabetes may be associated with improved glucose control (8,9), but this has not been seen in patients with lower HbA 1c levels (10,1...

Patient-reported outcomes in the practice-based opportunities for weight reduction (POWER) trial

“…Depression symptoms in the DPP [19] and Look AHEAD [20], assessed using the Beck Depression Inventory (BDI), improved more in the lifestyle arm than in the control arm, but the differences were small, and sample sizes were very large, increasing the likelihood that small differences would be statistically significant. Also, antidepressant medication use increased while BDI scores declined, suggesting that reduced symptom scores could be attributable to effective antidepressant medication [36]. The similarity in findings across the Hopkins POWER intervention and other similar interventions in trials reflects the fact that behavioral weight loss interventions, as currently designed, do not affect mental wellbeing (i.e.…”

Prevention of Diabetes Through Lifestyle Intervention: Lessons Learned from the Diabetes Prevention Program and Outcomes Study and its Translation to Practice

“…Psychological and depression measures were unrelated to goal achievement. After adjusting for multiple factors related to weight gain, antidepressant use, not depressive symptoms, was associated with weight regain but not rate of or success of loss or goal achievement [20-22]. …”

Testosterone and depressive symptoms among men in the Diabetes Prevention Program

“…Like Travison et al, we examined a mid-life population who had minimal changes in depression scores over time. The DPP has previously reported that weight loss (regardless of randomization assignment) was associated with a significant but small reduction in the likelihood of depression symptoms over the course of the randomized trial (22), although most of the improvement in depression symptoms was due to increased anti-depressant use over time rather than randomization assignment. Significant depression was an exclusion criteria, which may have minimized the impact of interventions upon depressive symptoms.…”

“…Participants also brought all prescription medicines to each clinic visit, from which the use of antidepressants was recorded. Due to the mild nature of symptoms in the DPP cohort, significant depressive symptoms have been previously defined in the DPP as BDI scores ≥ 11 or use of anti-depressant medication (22). We also examined the relationship between androgen changes and other measurements of mood and well-being in the DPP, including the Beck Anxiety Inventory (BAI) (27) using a cut point of 8 to define significant anxiety, and the physical (PCS) and mental components (MCS) of the Medical Outcomes Study 36-item short form (SF-36) (28).…”

“…Previous DPP reports have noted that participants reported a decline in depressive symptoms over the course of the study, largely attributable to the concurrent trend of increased anti-depressant medication use, but also due to weight loss (22). The DPP measured androgen levels at baseline and at one-year follow-up and concurrently assessed mood, anti-depressant medication use, and weight.…”