Diabetic depression treatable with Prozac.
Diabetic depression treatable with Prozac.
May 24, 2000 -- Depression and diabetes can be double trouble. In addition to making you feel "down," depression interferes with diabetes control. A new study indicates that not only is depression in diabetics treatable, but that the medication might actually improve the body's use of insulin.
"We really don't know yet why depression has such an impact on blood sugar control," says Patrick J. Lustman, PhD, from the Washington University School of Medicine in St. Louis. "Some think that it may be related to certain changes in hormones in the bloodstream and their effect on insulin. Others think that when you are down it is harder to eat right and do the things you need to do to keep it under tight control."
Despite the link between depression and blood sugar control, little research has been done into how best to treat depression in people with diabetes. One study has shown that while nortriptyline -- an older antidepressant medication also used to treat pain associated with nerve damage -- had a positive effect on the depression, it increased bloodglucose levels.
The class of antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs), which includes Prozac (fluoxetine), does not increase sugar levels. Some studies even indicate that more of the brain chemical serotonin may help insulin function more efficiently.
"There are two open questions that need answers," Lustman says. "One is whether it is possible to treat depression in those with diabetes. The other is, would it make any difference in the treatment of the diabetes itself?"
To answer these questions, Lustman and colleagues from Washington University recruited 60 people with either type 1 or type 2 diabetes and major depression into an eight-week study. Some were given Prozac and the rest received a placebo. The researchers used two depression rating scales to follow changes in the depression. Glycated hemoglobin (GHb), a measure of the average blood glucose concentration over a roughly three-month period, was used to track how well the diabetes was controlled.
"Despite the very short time of the trial, we found an unmistakable improvement in the depression of those given the fluoxetine," Lustman says. "In addition, we also see a trend toward improvement in blood sugar control. We will need a trial with a longer time frame before we know if these can be maintained over time."
"We really don't know yet why depression has such an impact on blood sugar control," says Patrick J. Lustman, PhD, from the Washington University School of Medicine in St. Louis. "Some think that it may be related to certain changes in hormones in the bloodstream and their effect on insulin. Others think that when you are down it is harder to eat right and do the things you need to do to keep it under tight control."
Despite the link between depression and blood sugar control, little research has been done into how best to treat depression in people with diabetes. One study has shown that while nortriptyline -- an older antidepressant medication also used to treat pain associated with nerve damage -- had a positive effect on the depression, it increased bloodglucose levels.
The class of antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs), which includes Prozac (fluoxetine), does not increase sugar levels. Some studies even indicate that more of the brain chemical serotonin may help insulin function more efficiently.
"There are two open questions that need answers," Lustman says. "One is whether it is possible to treat depression in those with diabetes. The other is, would it make any difference in the treatment of the diabetes itself?"
To answer these questions, Lustman and colleagues from Washington University recruited 60 people with either type 1 or type 2 diabetes and major depression into an eight-week study. Some were given Prozac and the rest received a placebo. The researchers used two depression rating scales to follow changes in the depression. Glycated hemoglobin (GHb), a measure of the average blood glucose concentration over a roughly three-month period, was used to track how well the diabetes was controlled.
"Despite the very short time of the trial, we found an unmistakable improvement in the depression of those given the fluoxetine," Lustman says. "In addition, we also see a trend toward improvement in blood sugar control. We will need a trial with a longer time frame before we know if these can be maintained over time."
