In a small study of low-income, diabetic African American and Hispanic adults diagnosed with depression, a popular antidepressant not only significantly improved hemoglobin A1c, but also significantly decreased systolic blood pressure.
In the double blind, randomized trial conducted by Dr. Diana Echeverry and her colleagues at Charles Drew University, Los Angeles, 75 patients in an L.A. County diabetes clinic who were diagnosed with depression and had HbA1c levels of at least 8% were randomized to receive 50–100 mg sertraline or placebo for 6 months.
HbA1c levels fell significantly in both groups, but the decrease in the sertraline group was more than twice that of the placebo group, at −2.0% and −0.9%, respectively. Systolic blood pressure also fell significantly in both groups, but once again, more so in the sertraline group (−15 mm Hg) than in the placebo group (−6 mm Hg), the researchers wrote.
Hamilton Depression Scale (HAM-D) scores fell significantly in both groups, but no difference was seen between them, the researchers reported. A very significant correlation of 0.45 (P less than 10doi:10.2337/dc09-0785
Dr. Echeverry and her colleagues wrote that the results suggested “an effective approach to the time constraints hindering primary care physicians caring for patients in poor glycemic control in whom depression is suspected, especially in low income, minority populations,” they wrote, adding that although these patients may traditionally be more difficult to treat successfully, the researchers wrote, “in this manner, both depression and uncontrolled diabetes and systolic blood pressure may be improved.”
The robust effect of sertraline in lowering HbA1c levels differs from most other studies of depression in diabetes, they wrote. The similar improvements in depression, quality of life, and pain scores observed within the two groups might be explained by the frequent interaction with the study coordinator, i.e., a placebo effect in the control group.
The study was funded by the University of California, Los Angeles, and the National Institutes of Health. The researchers reported that they had no conflicts of interest.