Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis☆☆☆★★★
Abstract
Background
Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown.
Objective
This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes.
Methods
Data sources: PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants, interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment by psychotherapy, pharmacotherapy or collaborative care of depression in persons with Type 1 and Type 2 diabetes mellitus. Study appraisal: risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis.
Results
Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective in terms of reduction of depressive symptoms: −0.512; 95% CI −0.633 to −0.390. The combined effect of all interventions on clinical impact is moderate, −0.370; 95% CI −0.470 to −0.271; it is large for psychotherapeutic interventions that are often combined with diabetes self management: −0.581; 95% CI −0.770 to −0.391, n=310 and moderate for pharmacological treatment: −0.467; 95% CI −0.665 to −0.270, n=281. Delivery of collaborative care, which provided a stepped care intervention with a choice of starting with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect size of −0.292; 95% CI −0.429 to −0.155, n=1133; indicating the effect size that can be attained on a population scale. Pharmacotherapy and collaborative care aimed at and succeeded in the reduction of depressive symptoms but, apart from sertraline, had no effect on glycemic control. Limitations: amongst others, the number of RCTs is small.
Conclusion
The treatment of depression in people with diabetes is a necessary step, but improvement of the general medical condition including glycemic control is likely to require simultaneous attention to both conditions. Further research is needed.
Keywords: Diabetes mellitus, Depression, Meta-analysis, Systematic review, Glycemic control, Treatment
To access this article, please choose from the options below
☆ Disclosures for the past three years: C.F.C.: Received royalties for books that she wrote on the subject of psychiatry. Her employer, Trimbos Instituut, was reimbursed for the following activities: honorariums for lectures, and investigator initiated research, by Eli Lilly and Wyeth. The funders had no influence on the content of these lectures, and on data assemblage and analysis, writing of the protocols, reports or other publications derived from these research projects. C.F.C. is involved in development of guidelines, funded by the Ministry of Health and/or the Dutch Psychiatric Association, in the Netherlands. She was a member of the Board of the Dutch Psychiatric Association. J.N.: None reported. C.S.: Involved in development of guidelines, funded by the Ministry of Health. J.C.: Received consultancy, lecture fees and grant support from Astra Zeneca, Bayer, Bristol Myers Squibb, Daiichi-Sankyo, GSK, Lilly, MSD, Novo-nordisk, Pfizer and Sanofi-Aventis. A.M.J.: None reported. WK: Honorariums for lectures: Lilly, Forest, Wyeth, Pfizer. Advisory Boards: Lilly, Wyeth. F.S.: Honorariums for lectures: Eli Lilly, Sanofi Aventis, Novo Nordisk, Roche. Advisory Boards: Eli Lilly, Novo Nordisk, Roche, Sanofi Aventis. N.S.: Served as consultant to Eli Lilly and Company, Servier, U.B.C., the Lundbeck Institute and participated as chairperson or speaker at scientific meetings and symposia organized by Akhelion, Lilly, Pfizer and U.B.C. On no occasion did N.S. talk about products of these companies. He also served as an advisor to the World Health Organization, The Open Society Institute and the American Psychiatric Research Institute.
☆☆ Ethics committee approval: was not needed for this study.
★ Contribution of authors: C.F.C. chose the selection criteria for the study, designed the objectives of the systematic review and meta analysis, discussed those with the DDD community, contributed to the selection of studies and risk of bias appraisal, contributed to data extraction, performed the meta analysis and wrote the article. C.F.C. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, J.N. contributed to the definition of selection criteria for the systematic review, to the selection of studies and risk of bias appraisal, and to writing the article. C.S. performed the systematic review, handled translation of non-English studies, contributed to the risk of bias appraisal and data extraction, and writing the article. Both J.N. and C.S. contributed equally to this review. J.C. helped with translation and interpretation of the Chinese articles, contributed to data extraction, and accorded the final version of the article. A.M.J. and F.S. contributed to writing the article. N.S. contributed to the design of the objectives of the systematic review and the discussion with the DDD, helped with the selection of articles and contributed to writing the article.
★★ Funding: This study was partly funded by Eli Lilly. The study sponsor did not play a role in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
PII: S0163-8343(10)00061-7
doi:10.1016/j.genhosppsych.2010.03.011
© 2010 Elsevier Inc. All rights reserved.
Refers to erratum:
- Erratum to “Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis” [General Hospital Psychiatry 32 (2010) 380–395] , 30 September 2010
