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Treatment of patients with comorbid depression and diabetes with metformin and milnacipran

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ABSTRACT

Depression is twice as frequent in patients with diabetes as in the general population, and has a negative impact on self-care, adherence to treatment, and the general prognosis of diabetes. This underscores the importance of screening all diabetic patients for depression and, if necessary, treating it with an effective antidepressant drug in parallel with standard diabetes treatment. In a recent study, a simple two-question screening tool was used to screen diabetic patients for comorbid depression. The effects of the serotonin and norepinephrine reuptake inhibitor antidepressant, milnacipran, on metabolic parameters and depressive symptoms in 64 diabetic patients with comorbid depression detected by this screen were studied. Patients received milnacipran for 6 months, in addition to standard diabetes treatment with metformin. At the end of the study, 72% of patients had responded to antidepressant treatment (≥50% reduction of baseline Beck Depression Score). The proportion of patients with <8% glycosylated hemoglobin HbA1c (a common indication in diabetes of the need for intensive therapeutic intervention) had decreased significantly from 46.6% at baseline to 6.9%. HbA1c, fasting blood glucose, body mass index, total and low-density lipoprotein cholesterol, and serum triglyceride levels were all significantly decreased in patients with an antidepressant response, but not in patients whose depressive symptoms had not responded to milnacipran.

No MeSH data available.


Change in metabolic parameters during 6 months of milnacipran treatment.***P < 0.001 compared with baseline values. Values are medians for all 58 patients who completed the study.Abbreviations: FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; total chol, total cholesterol; triglyc, serum triglycerides.
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f3-ndt-6-009: Change in metabolic parameters during 6 months of milnacipran treatment.***P < 0.001 compared with baseline values. Values are medians for all 58 patients who completed the study.Abbreviations: FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; total chol, total cholesterol; triglyc, serum triglycerides.

Mentions: Over the 6 months of the study, FBG levels, HbA1c, body weight, BMI, total cholesterol, LDL-cholesterol, and serum triglycerides were all significantly improved (Figure 3) and the proportion of patients with HbA1c <8% decreased significantly from 47% to 7%. Interestingly, this improvement in diabetic symptoms was principally due to reductions in patients with a response in their depressive symptoms. As shown in Figure 4, depression-responsive patients had significant improvements in all of the metabolic and anthropometric parameters studied, while nonresponders showed no significant improvements. Interestingly, there was a significant weight loss during treatment of these overweight or obese patients (Figure 5).


Treatment of patients with comorbid depression and diabetes with metformin and milnacipran
Change in metabolic parameters during 6 months of milnacipran treatment.***P < 0.001 compared with baseline values. Values are medians for all 58 patients who completed the study.Abbreviations: FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; total chol, total cholesterol; triglyc, serum triglycerides.
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Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2819761&req=5

f3-ndt-6-009: Change in metabolic parameters during 6 months of milnacipran treatment.***P < 0.001 compared with baseline values. Values are medians for all 58 patients who completed the study.Abbreviations: FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; total chol, total cholesterol; triglyc, serum triglycerides.
Mentions: Over the 6 months of the study, FBG levels, HbA1c, body weight, BMI, total cholesterol, LDL-cholesterol, and serum triglycerides were all significantly improved (Figure 3) and the proportion of patients with HbA1c <8% decreased significantly from 47% to 7%. Interestingly, this improvement in diabetic symptoms was principally due to reductions in patients with a response in their depressive symptoms. As shown in Figure 4, depression-responsive patients had significant improvements in all of the metabolic and anthropometric parameters studied, while nonresponders showed no significant improvements. Interestingly, there was a significant weight loss during treatment of these overweight or obese patients (Figure 5).

View Article: PubMed Central

ABSTRACT

Depression is twice as frequent in patients with diabetes as in the general population, and has a negative impact on self-care, adherence to treatment, and the general prognosis of diabetes. This underscores the importance of screening all diabetic patients for depression and, if necessary, treating it with an effective antidepressant drug in parallel with standard diabetes treatment. In a recent study, a simple two-question screening tool was used to screen diabetic patients for comorbid depression. The effects of the serotonin and norepinephrine reuptake inhibitor antidepressant, milnacipran, on metabolic parameters and depressive symptoms in 64 diabetic patients with comorbid depression detected by this screen were studied. Patients received milnacipran for 6 months, in addition to standard diabetes treatment with metformin. At the end of the study, 72% of patients had responded to antidepressant treatment (&ge;50% reduction of baseline Beck Depression Score). The proportion of patients with &lt;8% glycosylated hemoglobin HbA1c (a common indication in diabetes of the need for intensive therapeutic intervention) had decreased significantly from 46.6% at baseline to 6.9%. HbA1c, fasting blood glucose, body mass index, total and low-density lipoprotein cholesterol, and serum triglyceride levels were all significantly decreased in patients with an antidepressant response, but not in patients whose depressive symptoms had not responded to milnacipran.

No MeSH data available.