Treating Depression in Patients with Diabetes

Date of Award

Spring 2025

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Kimberly Erikson, MSPAS, PA-C

Abstract

Diabetes is a life-changing diagnosis. Characterized by either insulin deficiency or resistance, diabetes is chronic and potentially debilitating. Affecting millions of people worldwide and associated with numerous, life-threatening complications, diabetes and its management has been extensively studied. However, the psychological consequences of the disorder have comparatively been less investigated despite clinical relevance. The prevalence of depression in adults with diabetes is nearly twice that of adults without diabetes. The pathophysiology and mechanism behind this association is undetermined, though recent evidence supports a bidirectional, interactive relationship. Additionally, comorbid diabetes and depression have a negative impact on each other. Though further investigation is necessary in elucidating the relationship between the two disorders, it is strongly recommended to routinely screen and treat for depression in adults with diabetes. However, regarding pharmacological treatment of diabetes, particularly Type 2 Diabetes Mellitus (T2DM), there has been some controversy due to potential effects of antidepressants on diabetic outcomes. Additionally, prolonged antidepressant has also been associated with the onset of T2DM. Consequently, there is a need to clarify treatment guidelines for depression in patients with diabetes. Though limited, current data suggests SSRIs and SNRIs to be preferred due to euglycemic and hypoglycemic effects. Contrarily, TCAs and MAOIs are to be avoided if possible due to associated hyperglycemic effects and weight gain. If TCAs or MAOIs are deemed necessary, close glucose monitoring is recommended.

Link to Full Text

Share

COinS
 

Treating Depression in Patients with Diabetes

Diabetes is a life-changing diagnosis. Characterized by either insulin deficiency or resistance, diabetes is chronic and potentially debilitating. Affecting millions of people worldwide and associated with numerous, life-threatening complications, diabetes and its management has been extensively studied. However, the psychological consequences of the disorder have comparatively been less investigated despite clinical relevance. The prevalence of depression in adults with diabetes is nearly twice that of adults without diabetes. The pathophysiology and mechanism behind this association is undetermined, though recent evidence supports a bidirectional, interactive relationship. Additionally, comorbid diabetes and depression have a negative impact on each other. Though further investigation is necessary in elucidating the relationship between the two disorders, it is strongly recommended to routinely screen and treat for depression in adults with diabetes. However, regarding pharmacological treatment of diabetes, particularly Type 2 Diabetes Mellitus (T2DM), there has been some controversy due to potential effects of antidepressants on diabetic outcomes. Additionally, prolonged antidepressant has also been associated with the onset of T2DM. Consequently, there is a need to clarify treatment guidelines for depression in patients with diabetes. Though limited, current data suggests SSRIs and SNRIs to be preferred due to euglycemic and hypoglycemic effects. Contrarily, TCAs and MAOIs are to be avoided if possible due to associated hyperglycemic effects and weight gain. If TCAs or MAOIs are deemed necessary, close glucose monitoring is recommended.