Treating Depression in Diabetic Patients: Is There an Alternative to Medications?

In the general population, depression is exceedingly common, sometimes difficult to diagnose, and undertreated but remediable [1, 2]. In patients with chronic conditions such as diabetes, depressive disorders seem to occur even more frequently [3], have a high rate of recurrence [4], and seem to be associated with worsened medical outcomes [5]. The high prevalence of depression in diabetes [3], the frequency of depression onset before diabetes complications [6, 7], the similarity in the hypothalamic-pituitary axis changes found in depression and poorly controlled diabetes mellitus [8], indications that diabetic rats are more susceptible to neurochemical and behavioral changes similar to those found in depression [9], and mood shifts often associated with glycemic changes [10] all raise interesting questions about the direction of causality and biological mechanisms linking depression and diabetes. However, there is very little evidence to provide clear guidance on either issue.

Of practical clinical importance, growing evidence shows that depressive disorders in adults are associated with one of the key markers of medical outcome: worsened glycemic control [4, 6, 11, 12]. Depressive disorders may …