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Cognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus
A Randomized, Controlled Trial
- Patrick J. Lustman, PhD;
- Linda S. Griffith, MSW;
- Kenneth E. Freedland, PhD;
- Sarah S. Kissel, RN, CDE; and
- Ray E. Clouse, MD
- From Washington University School of Medicine and the Veterans Affairs Medical Center, St. Louis, Missouri. 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.
Abstract
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 ≤ 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).
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.
- Copyright ©2004 by the American College of Physicians
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