Depression symptoms and antidepressant medicine use in Diabetes Prevention Program participants

George Washington University, Washington, Washington, D.C., United States
Diabetes Care (Impact Factor: 8.42). 04/2005; 28(4):830-7. DOI: 10.2337/diacare.28.4.830
Source: PubMed


To assess depression markers (symptoms and antidepressant medicine use) in Diabetes Prevention Program (DPP) participants and to determine whether changes in depression markers during the course of the study were associated with treatment arm, weight change, physical activity level, or participant demographic characteristics.
DPP participants (n = 3,187) in three treatment arms (intensive lifestyle, metformin, and placebo) completed the Beck Depression Inventory (BDI) and reported on use of antidepressant medicines at randomization and subsequently at each annual visit (average duration in study 3.2 years).
On study entry, 10.3% of participants had BDI scores > or =11, which was used as a threshold for mild depression, 5.7% took antidepressant medicines, and 0.9% had both depression markers. During the DPP, the proportion of participants with elevated BDI scores declined (from 10.3% at baseline to 8.4% at year 3), while the proportion taking antidepressant medicines increased (from 5.7% at baseline to 8.7% at year 3), leaving the proportion with either marker unchanged. These time trends were not significantly associated with the DPP treatment arm. Depression markers throughout the study were associated with some participant demographic factors, adjusted for other factors. Men were less likely to have elevated depression scores and less likely to use antidepressant medicine at baseline (9.0% of men and 17.9% of women had at least one marker of depression) and throughout the study (P <0.0001). Those with more education were less likely to have elevated symptom scores (P = 0.0007) but more likely to be taking antidepressant medicine (P = 0.002). Non-Hispanic white participants were less likely than African Americans to have BDI scores > or =11 (P = 0.03), but white participants were more likely to be taking antidepressant medicine than any other racial/ethnic group (P <0.0001).
DPP participation was not associated with changes in levels of depression. Countervailing trends in the proportion of DPP participants with elevated depression symptoms and the proportion taking antidepressant medicine resulted in no significant change in the proportion with either marker. The finding that those taking antidepressant medicine often do not have elevated depression symptoms indicates the value of assessing both markers when estimating overall depression rates.

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Available from: Edwin B Fisher, Oct 10, 2015
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    • "A history of cardiovascular disease was not included in the multiple logistic regression analyses since we did not know whether individuals had developed cardiovascular disease before or after they got diabetes or a DFU. Sensitivity analyses were performed with depression status alternatively defined as symptoms of depression (HADS-D score ≥ 8) and/or use of antidepressant medication to avoid misclassification of persons with medically treated depression in remission as non-depressed (Rubin et al., 2005). Analyses were also performed using HADS-D as a continuous variable. "
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    ABSTRACT: Aim To prospectively examine whether depressive symptoms increase the risk of diabetes and a diabetic foot ulcer. Methods The Nord-Trøndelag Health Study (HUNT) is a community-based longitudinal study. The Hospital Anxiety and Depression Scale (HADS-D subscale) assessed depressive symptoms. We followed individuals with complete HADS-D data from HUNT2 (1995–97) and assessed whether they reported diabetes with or without a history of diabetic foot ulcer (DFU) in HUNT3 (2006–08) (n = 36,031). Logistic regression was used to investigate the effect of depressive symptoms on subsequent development of diabetes and of DFU. Results Unadjusted odds for reporting diabetes at follow-up was higher among individuals who reported a HADS-D score ≥ 8 at baseline (OR 1.30 95% CI, 1.07 – 1.57) than among those reporting a lower score. After adjusting for age, gender and BMI, this association was no longer significant. The odds of developing a DFU was almost two-fold (OR = 1.95 95% CI, 1.02 – 3.74) for those reporting a HADS-D score of 8–10, and 3-fold (OR = 3.06 95% CI, 1.24 – 7.54) for HADS-D scores ≥ 11, compared to HADS-D scores < 8, after adjusting for age, gender and serum glucose. Conclusions Symptoms of depression at baseline is associated with an increased risk of a diabetic foot ulcer in a dose response manner during this 11-year follow-up.
    Journal of Diabetes and its Complications 09/2014; 29(1). DOI:10.1016/j.jdiacomp.2014.09.006 · 3.01 Impact Factor
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    • "Through review of titles and abstracts, we excluded 293 duplicate articles and 2,615 articles that did not satisfy the selection criteria. After the full text for the remaining 26 articles was reviewed, 14 articles were excluded, 8 demonstrated insufficient data,20-27) 3 were reviews or correspondences,28-30) and 3 were included totally or partially in another article.31-33) As a result, we included 12 observational studies (3 case-control studies, 9 cohort studies, no RCTs), which ultimately met our inclusion criteria. "
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    ABSTRACT: Epidemiologic studies have reported inconsistent findings regarding the association between the use of antidepressants and type 2 diabetes mellitus (DM) risk. We performed a meta-analysis to systematically assess the association between antidepressants and type 2 DM risk. We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library (through Dec 31, 2011), including references of qualifying articles. Studies concerning the use of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or other antidepressants and the associated risk of diabetes mellitus were included. Out of 2,934 screened articles, 3 case-control studies, 9 cohort studies, and no clinical trials were included in the final analyses. When all studies were pooled, use of antidepressants was significantly associated with an increased risk of DM in a random effect model (relative risk [RR], 1.49; 95% confidence interval [CI], 1.29 to 1.71). In subgroup analyses, the risk of DM increased among both SSRI users (RR, 1.35; 95% CI, 1.15 to 1.58) and TCA users (RR, 1.57; 95% CI, 1.26 to 1.96). The subgroup analyses were consistent with overall results regardless of study type, information source, country, duration of medication, or study quality. The subgroup results considering body weight, depression severity, and physical activity also showed a positive association (RR, 1.14; 95% CI, 1.01 to 1.28). A publication bias was observed in the selected studies (Egger's test, P for bias = 0.09). Our results suggest that the use of antidepressants is associated with an increased risk of DM.
    Korean Journal of Family Medicine 07/2013; 34(4):228-40. DOI:10.4082/kjfm.2013.34.4.228
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    • "In addition, screening for depression in adults at risk for T2D is indicated. Adults with prediabetes have a high prevalence of depression (Rubin et al., 2005) and depression may impede lifestyle change efforts (Lin et al., 2004). Treatment of depression in adults at risk for T2D may also improve insulin sensitivity (Wagner et al., 2009: Weber-Hamann et al., 2008). "
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    ABSTRACT: The purpose of this study is to describe the implementation process and participant satisfaction with a lifestyle program provided by nurse practitioners (NPs) in primary care to adults at risk for type 2 diabetes (T2D) compared to enhanced standard care. A mixed-method clinical trial design was used (n= 58). NPs were interviewed prior to beginning the program, at 3 months, and at completion of the program. NPs also completed a questionnaire on lifestyle counseling at baseline. Process data were collected on attendance, attrition, and intervention fidelity. Participants completed a satisfaction survey at completion of the program and a sub-sample were interviewed at the end of the program. NPs reported that they felt well-prepared and moderately effective in providing lifestyle change counseling. Participant attendance was high and in-person sessions were implemented with good success. Participants in the lifestyle program were more satisfied with the program, reporting that the program was a good experience. Implementation of a lifestyle program to prevent T2D in primary care is feasible and acceptable to NPs and participants. Developing a structured program may improve health outcomes.
    Journal of the American Academy of Nurse Practitioners 12/2010; 22(12):684-93. DOI:10.1111/j.1745-7599.2010.00562.x · 1.02 Impact Factor
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