Sertraline Maintains Mood in Diabetes

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University in St. Louis.

Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. Depression not only impairs their function and quality of life but also increases their risk of death, largely by accelerating coronary heart disease, and their risk of diabetes complications, Dr. Lustman and his associates said (Arch. Gen. Psychiatry 2006;63:521–9).

Pharmacotherapy and psychotherapy improve both mood and glycemic control in depressed diabetic patients, but the benefits appear to be short-lived, with up to 60% of such patients developing a recurrence in the year following successful treatment. Maintenance therapy is known to reduce recurrences in 15%–30% of nondiabetic depressed patients but had not been assessed in diabetic patients until this study was done.

The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression.

The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred.

Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Both the Beck Depression Inventory and the Hamilton Depression Rating scale were used to measure depression symptoms.

Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote.

The interval until one-third of the subjects developed a recurrence was 226 days in those taking sertraline, compared with 57 days in those taking placebo. The median time to recurrence exceeded 365 days, the maximum duration of follow-up, for subjects taking sertraline, compared with 251 days for those taking placebo.

Nearly 77% of recurrences developed early, within 4 months of randomization.

Sertraline did not interfere with glycemic control. In fact, glycemic control improved as depression improved with initial therapy, and it was maintained at that improved level throughout the depression-free interval.

“Treatment with sertraline is relatively simple, safe, and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity, and burden associated with recurrent depression,” Dr. Lustman and his associates said.

This study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Improvements in glycemic control were maintained throughout the depression-free interval. DR. LUSTMAN

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University in St. Louis.

Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. Depression not only impairs their function and quality of life but also increases their risk of death, largely by accelerating coronary heart disease, and their risk of diabetes complications, Dr. Lustman and his associates said (Arch. Gen. Psychiatry 2006;63:521–9).

Pharmacotherapy and psychotherapy improve both mood and glycemic control in depressed diabetic patients, but the benefits appear to be short-lived, with up to 60% of such patients developing a recurrence in the year following successful treatment. Maintenance therapy is known to reduce recurrences in 15%–30% of nondiabetic depressed patients but had not been assessed in diabetic patients until this study was done.

The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression.

The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred.

Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Both the Beck Depression Inventory and the Hamilton Depression Rating scale were used to measure depression symptoms.

Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote.

The interval until one-third of the subjects developed a recurrence was 226 days in those taking sertraline, compared with 57 days in those taking placebo. The median time to recurrence exceeded 365 days, the maximum duration of follow-up, for subjects taking sertraline, compared with 251 days for those taking placebo.

Nearly 77% of recurrences developed early, within 4 months of randomization.

Sertraline did not interfere with glycemic control. In fact, glycemic control improved as depression improved with initial therapy, and it was maintained at that improved level throughout the depression-free interval.

“Treatment with sertraline is relatively simple, safe, and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity, and burden associated with recurrent depression,” Dr. Lustman and his associates said.

This study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Improvements in glycemic control were maintained throughout the depression-free interval. DR. LUSTMAN

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University in St. Louis.

Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. Depression not only impairs their function and quality of life but also increases their risk of death, largely by accelerating coronary heart disease, and their risk of diabetes complications, Dr. Lustman and his associates said (Arch. Gen. Psychiatry 2006;63:521–9).

Pharmacotherapy and psychotherapy improve both mood and glycemic control in depressed diabetic patients, but the benefits appear to be short-lived, with up to 60% of such patients developing a recurrence in the year following successful treatment. Maintenance therapy is known to reduce recurrences in 15%–30% of nondiabetic depressed patients but had not been assessed in diabetic patients until this study was done.

The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression.

The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred.

Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Both the Beck Depression Inventory and the Hamilton Depression Rating scale were used to measure depression symptoms.

Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote.

The interval until one-third of the subjects developed a recurrence was 226 days in those taking sertraline, compared with 57 days in those taking placebo. The median time to recurrence exceeded 365 days, the maximum duration of follow-up, for subjects taking sertraline, compared with 251 days for those taking placebo.

Nearly 77% of recurrences developed early, within 4 months of randomization.

Sertraline did not interfere with glycemic control. In fact, glycemic control improved as depression improved with initial therapy, and it was maintained at that improved level throughout the depression-free interval.

“Treatment with sertraline is relatively simple, safe, and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity, and burden associated with recurrent depression,” Dr. Lustman and his associates said.

This study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Improvements in glycemic control were maintained throughout the depression-free interval. DR. LUSTMAN