Effects of Nortriptyline on Depression and Glycemic Control in Diabetes

Results of a Double-blind, Placebo-controlled Trial

Bibliographic Data

ID19306104
AuthorsPatrick J Lustman (Washington University in St. Louis), Linda S Griffith (Saint Louis University), Ray E Clouse (Saint Louis University), Kenneth E Freedland (0000-0002-3118-9913, Saint Louis University), Seth A Eisen (0000-0001-7746-6624, Saint Louis University), Eugene H Rubin (Saint Louis University), Robert M Carney (0000-0002-0737-6655, Saint Louis University), Janet B McGill (0000-0002-6228-6521, Saint Louis University)
Year1997
Volume59
Issue3
Pages241-250
Publication date1997-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenuePsychosomatic Medicine (JOURNAL)
Journal identifiersISSN: 0033-3174 • E-ISSN: 1534-7796
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00006842-199705000-00007
PMID9178335
OpenAlexW2094455081
LanguageEN
Citations received14
References cited41

OBJECTIVE: Depression is a prevalent and chronic condition in diabetes and is associated with poor glucose regulation and poor compliance with diabetes treatment. This investigation evaluated the effects of nortriptyline on depression and glycemic control to see whether depression in diabetes is treatable and whether restoring mental health contributes to improved medical outcome. METHOD: Sixty-eight diabetic patients with poor glycemic control, 28 of whom had active major depression (DSM-IIIR), completed a randomized, placebo-controlled, double-blind trial involving 8 weeks of treatment with nortriptyline targeted to therapeutic plasma levels (50-150 ng/ml). Depression improvement was determined with the Beck Depression Inventory; glucose control was measured by glycated hemoglobin levels. Compliance behavior was assessed using medication dispensing devices and glucometers equipped with electronic memory. RESULTS: The reduction in depression symptoms was significantly greater in depressed patients treated with nortriptyline compared with those receiving placebo (-10.2 vs -5.8, p = .03). Nortriptyline was not statistically superior to placebo in reducing glycated hemoglobin of the depressed subjects (p = .5). However, path analysis indicated that the direct effect of nortriptyline was to worsen glycemic control whereas depression improvement had an independent beneficial effect on glycated hemoglobin. These findings were not explained by the relationships of nortriptyline treatment to weight change (r = -0.21, p = .31) or depression improvement to compliance with the protocol for self-monitoring of blood glucose (r = 0.01, p = .97). CONCLUSIONS: Major depression in diabetic patients can be effectively treated with nortriptyline at the expense of a direct hyperglycemic effect. Path analysis demonstrated a treatment-independent effect of depression improvement on glycemic control, suggesting that a more ideal antidepressant agent may both restore mental health and improve medical outcome

Anxiety · Beck Depression Inventory · Depression (economics) · Diabetes mellitus · Glycated hemoglobin · Glycemic · Nortriptyline · Placebo · Psychiatry · Type 2 diabetes · Diabetes Management and Education · Diabetes Management and Research · Diabetes Treatment and Management · Endocrinology · Internal Medicine · Medicine

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