turners babe

I know it's an old study but what do you lot think?? As you know I've got depression again
(well "Pure-O" from OCD) which is kind of like depression. I've been put on Prozac again for a
month (only 20mg a day), so I'm reading up about the connection between the Big D and
depression....... came across this:

http://www.pslgroup.com/dg/2bf96.htm
"Treating Depression In Diabetics Helps Control Blood Sugar

ST. LOUIS, MO -- June 6, 1997 -- For patients with diabetes, the goal is tight control. The
Diabetes Control and Complications Trial, the landmark diabetes study completed four years ago,
concluded unequivocally that keeping a close reign on blood sugar can prevent or delay the
kidney, eye and nerve complications that affect patients with diabetes.

But for some people with the disease, that goal is nearly impossible. Diabetics with depression
have a very difficult time managing their blood sugar levels.

Now, investigators at Washington University School of Medicine in St. Louis have found that
treating clinical depression can help diabetic patients better control their blood sugar levels.
Reporting in the May 22, 1997, issue of Psychosomatic Medicine, the researchers say the
anti-depressant drug nortriptyline helps patients control their blood glucose, even though the
drug itself tends to raise blood glucose levels. It appears that in depressed diabetics,
treating depression more than made up for those increases in blood sugar.

"The drug had two opposing effects," explains Patrick J. Lustman, Ph.D., principal investigator
and associate professor of psychiatry. "It improved depression significantly, but it worsened
glucose control in patients who were not depressed. Yet, even in the face of this opposing
effect, we found that as depression improved, glucose control did too."

While depression affects about 5 percent of the general population at a given time, the rate is
between 15 and 20 percent in patients with diabetes.

Lustman and colleagues studied 68 patients with diabetes. All had poor glucose control.
Twenty-eight of them also were clinically depressed.

Study participants were divided into four groups. Half of the patients with depression received
the drug nortriptyline, a tricyclic anti-depressant. The rest received an inactive substance.
Patients who were not depressed also were divided into nortriptyline and placebo groups. Then
the patients were followed for eight weeks.

This was the first placebo-controlled study to establish that it is possible to treat depression
in diabetic patients. "The drug therapy helped bring almost 60 percent of the depressed patients
into remission," Lustman says. The study was supported by a grant from the National Institute of
Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, and in part by
the Sandoz Corp., which provided the nortriptyline.

Depression has a negative influence on quality of life for anyone, but it can cause additional
problems for patients with diabetes because it is closely associated with poor glucose control.
Depression also is linked to poor compliance with diabetes treatment.

"There are several theories about why depression has such a negative effect on patients with
diabetes," Lustman says. "Depressed patients may not comply with their treatment regimens, or
perhaps depression may cause changes in neuroendocrine function, making blood sugar especially
difficult to control."

Because depression makes it hard for a person to get anything done, it makes sense that the
disorder might interfere with measuring blood glucose levels and exercising, watching one's diet
or taking insulin. Therefore, treating depression could enable a diabetic patient to better
manage diabetes. But Lustman says the study showed that better compliance alone did not explain
the better blood sugar control.

The researchers used electronic monitoring devices to determine whether the subjects took their
medication. And they used memory glucometers to automatically record the dates and times that
patients tested their blood glucose levels. They found that all of the participants followed
their prescribed treatment regimens with little fluctuation during the eight weeks of the study.

In patients who were depressed and who were given nortriptyline, blood glucose levels improved
along with psychiatric health. "Each one-point drop in the index that we use to measure
depression correlated with a small reduction in blood sugar levels," Lustman says.

He says the new study demonstrates that improvement in depression can translate into a
clinically meaningful improvement in glucose control.

"Though the point-by-point change is small, the benefits could be substantial because many
depressed patients drop more than 20 points in their depression index with effective treatment,"
he explains.

Because the drug was administered to diabetic patients who were not depressed, it was possible
to measure the direct effects of nortriptyline on glucose regulation. "We found that taking
nortriptyline increased glucose levels in patients who took the drug but were not depressed,"
Lustman explains.

Other anti-depressants or non-drug interventions such as cognitive psychotherapy that do not
have this opposing effect on glucose control may be more effective in diabetes management.
Currently, Lustman is studying other treatment methods to see whether he can improve on his
recent results."

Can't find any new studies on it, but what do you think???

Jackie T

turners babe

Found this too:

http://pub49.ezboard.com/fvetbenefitsfrm19.showMessage?topicID=97.topic

So if this is the case, why can't they treat the depression first then the diabetes??? And does
tight glucose control stop depression??? Has the fact that my doc took me off medication, and
my bg's went up contributed to my reoccuring depression?? If I get them under control will it
go away?? I read that majority of people get depression before diabetes........ could this be a
warning sign???

al hardy

on Prozac again for a

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eight weeks of the study.

substantial because many

effective treatment,"

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found that taking

were not depressed,"

psychotherapy that do not

diabetes management.

can improve on his


Hi Jackie,
It is unfortunately only a fairly small study, and needs further
investigation. Sounds pretty spot-on to me, though, when all is said and
done. Not that old, really ( well it might be for young folk like
yourself ).

I think I shall do some searching myself in the wee small hours of the night
when normal ppl are asleep.

Al.

al hardy

Hi again,
Found these:

http://www.defeatdiabetes.org/Articles/depression020917.htm

http://www.iddtinternational.org/depressionanddiabetes.html

http://endocrinologist.com/depression.html

http://biopsychiatry.com/diabetes.htm

http://www.diabetes.org.uk/update/winter01/fact%20with20%20refs.htm

hth

Al.