Pharmacotherapeutic strategies for managing comorbid depression and diabetes

ABSTRACT

Introduction: The increasing prevalence of comorbid depression and diabetes exerts a heavy burden on global health. Co-occurrence of depression and diabetes is common, affecting 14% to 35.8% of patients with diabetes, leading to a higher mortality and morbidity rate, more micro- and macro-vascular diseases and more cognitive decline.

Areas covered: In this paper, the authors address various areas from epidemiology, the association between depression and diabetes, treatment strategies and future directions based on the currently available literature to provide novel insight into the pharmacotherapeutic management of comorbid depression and diabetes.

Expert opinion: Pharmacotherapy can help patients with comorbid depression and diabetes by relieving depressive symptoms and improving glycemic control. When combined with psychological therapy, as a collaborative care effort, pharmacological therapy based on selective serotonin reuptake inhibitors (SSRIs) is recommended for comorbid depression with diabetes. Furthermore, studies with larger sample sizes that can help to define different subtypes of diabetes and severity of depression are needed so that clinicians can draw up a precise and applicable management guidelines for the personalized therapy of these diseases.

KEYWORDS:

• Depression
• diabetes
• pharmacotherapy
• SSRIs

Article highlights

• Comorbid depression in patients with diabetes presents twice as much as in the general population.

• The co-occurrence of depression and diabetes is associated with micro- and macro-vascular diseases, cognitive decline, and a higher morbidity and mortality rate.

• The relationship between depression and diabetes is bi-directional, suggesting that these two diseases may share common mechanisms.

• SSRIs combined with psychological therapy in collaborative pattern may be an effective treatment strategy for comorbid depression and diabetes.

• Future research should aim at exploring the underlying mechanisms of comorbid depression and diabetes and providing personalized therapy.

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Acknowledgments

The authors give a special thanks to Kevin Kuo for his advice about the revisions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.