School of Medicine investigators have found that a form of psychotherapy called cognitive behavior therapy (CBT) is an effective treatment for depression in patients with diabetes, restoring mental health and significantly improving control of blood sugar levels.
Cognitive behavior therapy treats depression by involving patients in social and physical activities, teaching problem-solving skills to resolve stressful situations, identifying distorted thought patterns that lead to depression and replacing them with more positive and useful views.
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The researchers report the findings of this first-ever controlled trial of CBT in diabetes in the Oct. 15, 1998 issue of Annals of Internal Medicine. They found that a 10-week program of therapy helped relieve depression in the majority of patients with diabetes. In the months after CBT, these patients also achieved better control of their blood glucose levels.
"In the past, we had shown that antidepressant medications could help alleviate depression in patients with diabetes," said Patrick J. Lustman, Ph.D., principal investigator and associate professor of psychiatry. "But not all are good candidates for drug therapy, so it's important to find other ways to treat them."
While depression affects about 5 percent of the general population, the rate of clinical depression is between 15 and 20 percent in patients with diabetes. However, approximately two-thirds of patients who have both diabetes and depression never receive any antidepressant treatment.
Depression can be particularly hard on patients with diabetes. Untreated depression is closely associated with poor glucose control. It also is linked to poor compliance with diabetes treatment and higher rates of heart and eye complications.
All subjects in this study had both clinical depression and diabetes. All received 10 weeks of education about diet, exercise and compliance with treatment. Half also received CBT.
After 10 weeks, depression was in remission for 17 of the 20 patients (85 percent) in the CBT group. In the group that received only diabetes education, six of the 22 patients (27 percent) went into remission.
The investigators also examined the subjects six months after psychotherapy treatment and found that 14 of the 20 patients (70 percent) in the CBT group were still in remission, while seven of 21 remaining patients (33 percent) in the control group were not depressed.
And while glucose control was similar in the two groups at the end of the 10-week study, glucose levels were significantly better in the CBT-treated patients when they were examined again six months after treatment.
"We measured glycosylated hemoglobin, and that gives us average glucose levels in the blood over the last 120 days, and it takes some time to change that measurement," Lustman said. "But it looks as if treating depression in these patients may have long-term benefits in controlling blood glucose."
The findings are welcome news for researchers looking at connections between the mind and body. A number of studies have suggested that depression has negative effects on diabetes and many other physical illnesses. This study is one of the few to suggest that these negative effects may be reversible and that treating depression may have beneficial effects on other aspects of diabetes.
