Roopan Subethini, Larsen Erik Roj
1Psychiatric Department Kolding-Vejle,Region of Southern Denmark,Denmark.
2Department of Affective Disorders Q,Mood Disorders Research Unit,Aarhus University Hospital,Risskov,Denmark.
Acta Neuropsychiatr. 2017 Jun;29(3):127-139. doi: 10.1017/neu.2016.54. Epub 2016 Oct 25.
Depression may be difficult to treat and with comorbid diabetes mellitus (DM) it is an even bigger challenge. This article aims to evaluate antidepressants most suitable for patients with depression and comorbid DM. Design and methods Initially we searched for randomised, controlled double-blind trials of treatment with antidepressants in depressed with DM but there were only a few studies and many of them were small trials. Thus, we decided to include studies that were not only randomised-controlled trials. In total, we ended up with 18 articles for our purposes.
The combination of depression and DM may be harmful as depression has a strong impact on psychosocial and medical outcomes in patients with DM. Almost all of the trials in this review showed a reduction in depressive symptoms after treatment with an antidepressant in the acute as well as during maintenance phase. It showed that depression improvement had a favourable effect on glycaemic control that was weight independent. Some studies included only subjects with minor depression or with suboptimal-controlled diabetes making it difficult to show an effect.
From these data, we will recommend choosing an selective serotonin reuptake inhibitor (SSRI) if possible to treat a depression among patients with diabetes. If treatment with a tricyclic antidepressant is needed, closer glycaemic monitoring is recommended. Bear in mind that there is a possible risk of hypoglycemia when using SSRIs. Agomelatine and bupropion have shown promising results, but need to be investigated in more trials.
抑郁症可能难以治疗，而合并糖尿病（DM）时更是一项巨大挑战。本文旨在评估最适合抑郁症合并糖尿病患者的抗抑郁药。设计与方法：最初，我们搜索了抑郁症合并糖尿病患者使用抗抑郁药治疗的随机对照双盲试验，但此类研究较少，且许多是小型试验。因此，我们决定纳入不仅是随机对照试验的研究。最终，我们共筛选出18篇符合我们研究目的的文章。
抑郁症与糖尿病并存可能有害，因为抑郁症对糖尿病患者的心理社会和医疗结局有重大影响。本综述中的几乎所有试验均表明，在急性期和维持期使用抗抑郁药治疗后，抑郁症状有所减轻。结果显示，抑郁症状的改善对血糖控制有有益影响，且与体重无关。一些研究仅纳入轻度抑郁症患者或糖尿病控制不佳的患者，因此难以显示出治疗效果。
根据这些数据，我们建议在治疗糖尿病患者的抑郁症时，尽可能选择选择性5-羟色胺再摄取抑制剂（SSRI）。如果需要使用三环类抗抑郁药进行治疗，建议加强血糖监测。请记住，使用SSRI时可能存在低血糖风险。阿戈美拉汀和安非他酮已显示出有前景的结果，但还需要更多试验进行研究。
