Major Depression is a serious mental illness which if left untreated can lead to severe mental and physical debilitation. Major depression often occurs concurrently with many, serious, medical co-morbidities, e.g. diabetes mellitus. Primary care physicians now have to treat more medically complex patients due to the increasing incidence of diabetes mellitus and the increase of screening for major depression in the primary clinic settings. There are little data available about the impact of diabetes mellitus on depression treatment and this report will provide some of this data to the treating clinician.
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) was the largest study of major depression in the U.S. to date, with an enrollment of 4041. STAR*D offered a unique opportunity to examine the impact of diabetes on depression and antidepressant treatment. This report focused on the presenting characteristics and treatment outcomes of diabetics from the first STAR*D treatment level.
At study entry, diabetics differed on key socio-demographic variables, e.g. race/ethnicity and reported lower physical functioning at baseline across measures of quality of life and depression severity. Diabetics had poorer outcomes, although after adjustment for potential confounders, there was no statistically significant difference in these outcomes. Diabetics received similar treatment regimens as non-diabetic participants and reported fewer side effects at the conclusion of the first treatment level with citalopram. Diabetics also reported a lesser overall impact of side effects than non-diabetics, although these results were limited by a lack of available baseline side effect data for comparison.
These findings are of some importance to clinicians. The lack of an independent association of diabetes with major depression treatment response after adjustment for confounding factors implies that clinicians can treat diabetic patients similarly to those without diabetes mellitus for major depression. This is of some public health significance as untreated or poorly treated major depression adversely impacts diabetes disease management, which in turn can lead to the development of life-threatening diabetes complications. The importance of developing MDD treatment modalities that result in sustained remission for individuals with major depression and diabetes mellitus cannot be over-stated.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12082006-175048 |
| Date | 15 February 2007 |
| Creators | Bryan, Charlene Joanne |
| Contributors | Maria Mori Brooks, Ph.D., Stephen R. Wisniewski, Ph.D., Thomas J. Songer, Michael E. Thase, M.D. |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12082006-175048/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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