Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis ★★★

BackgroundComorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown.ObjectiveThis systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes.MethodsData 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.ResultsMeta 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.ConclusionThe 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.