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15 October 1998 | Volume 129 Issue 8 | Pages 613-621
Background: Psychotherapy is the principal nonpharmacologic method for the management of depression, but its usefulness for depressed patients with diabetes remains unknown.
Objective: To assess the efficacy of cognitive behavior therapy (CBT) for depression in patients with diabetes.
Design: Randomized, controlled trial.
Setting: Referral-based academic medical center.
Patients: 51 patients with type 2 diabetes and major depression.
Intervention: Patients were assigned either to a group that received 10 weeks of individual CBT or to a control group that received no specific antidepressant treatment. All patients participated in a diabetes education program to control for the effects of supportive attention and the possible influence of enhanced diabetes control on mood.
Measurements: Degree of depression was measured by using the Beck Depression Inventory; glycemic control was measured by using glycosylated hemoglobin levels. Outcomes were assessed immediately after treatment and 6 months after treatment.
Results: The percentage of patients achieving remission of depression (Beck Depression Inventory score
Conclusions: The combination of CBT and supportive diabetes education is an effective nonpharmacologic treatment for major depression in patients with type 2 diabetes. It may also be associated with improved glycemic control.
Author and Article Information
From Washington University School of Medicine and the Veterans Affairs Medical Center, St. Louis, Missouri.
ARTICLE
Cognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus
A Randomized, Controlled Trial
9) was greater in the CBT group than in the control group: posttreatment, 85.0% of patients in the CBT group (17 of 20) compared with 27.3% of controls (6 of 22) achieved remission (difference, 57.7 percentage points [95% CI, 33 to 82 percentage points]) (P < 0.001); at follow-up, 70.0% of patients in the CBT group (14 of 20) compared with 33.3% of controls (7 of 21) achieved remission (difference, 36.7 percentage points [CI, 9 to 65 percentage points]) (P = 0.03). Post-treatment glycosylated hemoglobin levels were not different in the two groups, but follow-up mean glycosylated hemoglobin levels were significantly better in the CBT group than in the control group (9.5% compared with 10.9%; P = 0.03).
Acknowledgments: The authors thank Julio Santiago, MD, for support and technical assistance; Michael Province, PhD, for statistical advice; and Kathleen McAleenan, MSW, and Linda Lawrence, MEd, for assistance with data collection.
Grant Support: In part by a clinical research grant from the American Diabetes Association (Dr. Lustman) and grant R21 MH 52629 from the National Institute of Mental Health (Dr. Freedland).
Requests for Reprints: Patrick J. Lustman, PhD, Department of Psychiatry, Washington University School of Medicine, 4940 Children's Place, St. Louis, MO 63110.
Current Author Addresses: Drs. Lustman and Freedland and Ms. Griffith: Department of Psychiatry, Washington University School of Medicine, 4940 Children's Place, St. Louis, MO 63110.
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