Effects of nortriptyline on depression and glycemic control in diabetes: Results of a double-blind, placebo-controlled trial
Effects of nortriptyline on depression and glycemic control in diabetes: Results of a double-blind, placebo-controlled trial
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DOI：
10.1097/00006842-199705000-00007
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发表时间：
1997-05-01
影响因子：
3.3
通讯作者：
McGill, JB
中科院分区：
文献类型：
--
作者：
Lustman, PJ;Griffith, LS;McGill, JB
抑郁症是糖尿病患者的一种常见慢性疾病，与血糖调节不良和糖尿病治疗依从性差有关。这项研究评估了去甲替林对抑郁症和血糖控制的影响，以了解糖尿病抑郁症是否可以治疗，以及恢复心理健康是否有助于改善医疗结果。方法：68例血糖控制不佳的糖尿病患者，其中28例患有活动性重性抑郁症（DSM-IIIR），完成了一项随机、安慰剂对照、双盲试验，包括8周的去甲替林治疗，靶向治疗血浆水平（50-150 ng/ml）。抑郁的改善与贝克抑郁量表确定;血糖控制是衡量糖化血红蛋白水平。使用药物分配装置和配备电子存储器的血糖仪评估依从性行为。结果如下：去甲替林治疗的抑郁症患者抑郁症状的减轻程度显著高于安慰剂治疗的患者（-10.2 vs-5.8，p = 0.03）。去甲替林在降低抑郁症受试者糖化血红蛋白方面没有统计学上级（p = .5）。然而，通径分析表明去甲替林的直接作用是使血糖控制恶化，而抑郁改善对糖化血红蛋白有独立的有益作用。去甲替林治疗与体重变化（r =-10.21，p = 0.31）或抑郁改善与血糖自我监测方案依从性（r = 0.01，p = 0.97）的关系不能解释这些结果。结论：去甲替林可有效治疗糖尿病患者的抑郁症，但其直接的高血糖效应是不可忽视的。通径分析表明，抑郁症改善对血糖控制的作用不依赖于治疗，这表明更理想的抗抑郁药既可以恢复心理健康，又可以改善医疗结果。
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 = -10.21, 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.