Biobehavioral and Health Sciences Division, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
Gen Hosp Psychiatry. 2010 Jan-Feb;32(1):33-41. doi: 10.1016/j.genhosppsych.2009.07.009. Epub 2009 Aug 27.
Individuals with diabetes mellitus (DM) are two to four times more likely to be diagnosed with major depressive disorder (MDD). However, few controlled studies have examined the impact of DM on the treatment of MDD. Understanding the effect of DM on depressed patients could provide valuable clinical information toward adjusting current treatment modalities to produce a more effective treatment for depressed patients with DM.
This study was conducted using an evaluable sample of 2876 outpatient participants enrolled in the Sequenced Treatment Alternatives to Relieve Depression study. Sociodemographic and clinical characteristics and treatment characteristics with the selective serotonin reuptake inhibitor (SSRI) citalopram, as well as remission rates for MDD and time to remission, were compared between participants with DM and participants without DM.
The odds of remission were lower in participants with DM than in those without DM prior to adjustment [odds ratio (OR)=0.68; 95% confidence interval (95% CI)=(0.49, 0.94); P=.0184]. These differences were no longer present after adjustment [OR=0.92; 95% CI=(0.64, 1.32); P=.6399]. Participants with DM reported fewer side effects than participants without DM despite similar dosing.
Depressed patients with DM and depressed patients without DM appear to have similar rates of MDD remission, indicating that a diagnosis of DM per se has no impact on MDD remission. The findings of fewer side effects and psychiatric serious adverse events in participants with DM imply that depressed patients with DM may be excellent candidates for more aggressive SSRI dosing. This lower prevalence of side effects reported by depressed participants with DM warrants further exploration.
患有糖尿病（DM）的个体被诊断出患有重度抑郁症（MDD）的可能性是没有 DM 的个体的两到四倍。然而，很少有对照研究检查 DM 对 MDD 治疗的影响。了解 DM 对抑郁患者的影响可以为调整当前治疗方式提供有价值的临床信息，以产生对患有 DM 的抑郁患者更有效的治疗方法。
本研究使用了参加 Sequenced Treatment Alternatives to Relieve Depression 研究的 2876 名门诊参与者的可评估样本。比较了患有 DM 和不患有 DM 的参与者之间的人口统计学和临床特征以及选择性 5-羟色胺再摄取抑制剂（SSRI）西酞普兰的治疗特征，以及 MDD 的缓解率和缓解时间。
在调整之前，患有 DM 的参与者缓解的可能性低于没有 DM 的参与者[优势比（OR）=0.68；95%置信区间（95%CI）=（0.49，0.94）；P=0.0184]。调整后，这些差异不再存在[OR=0.92；95%CI=（0.64，1.32）；P=0.6399]。尽管剂量相似，但患有 DM 的参与者报告的副作用少于没有 DM 的参与者。
患有 DM 的抑郁患者和没有 DM 的抑郁患者似乎具有相似的 MDD 缓解率，这表明 DM 的诊断本身对 MDD 的缓解没有影响。患有 DM 的抑郁患者报告的副作用和精神科严重不良事件较少的发现表明，患有 DM 的抑郁患者可能是更积极的 SSRI 剂量的理想人选。患有 DM 的抑郁参与者报告的副作用发生率较低，这需要进一步探讨。
