Abstract
Background: Depression incidence is higher in diabetic patients when compared to the non-diabetic individuals and there exist a two-directional relationship between depression and the development of type 2 diabetes mellitus.
 Objectives: This study aimed to estimate the frequency of depression and the effect of antidepressant on glycemic control in type 2 diabetes mellitus patients.
 Methods: This prospective interventional study was conducted in type 2 diabetes mellitus patients with a sample size of 100. These patients were diagnosed with depression using WHO-ICD10 criteria. All study patients had uncontrolled blood glucose levels and were on an optimized maximal dose of combination oral hypoglycemic agents with stable glycoregulation (HbA1c 8.4 ±0.5) were taken up for the intervention with antidepressant. These patients were started on with antidepressant after enrollment and followed up for fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and HbA1c at the end of 3 months and 6 months. And also Hamilton depression rating scale scores were estimated at the beginning of the study and at the end of 6 months.
 Results: The frequency of depression among the type 2 diabetes mellitus patients was found to be 42%. There were reduction of mean FBS levels from baseline value of 177 mg/dl to follow-up value of 160 mg/dl (p<0.001), mean PPBS levels from 251.16 mg/dl to 217.84 mg/dl (p<0.001), and mean HbA1c dropped from 8.41 to 7.57 (p<0.001) after the treatment with antidepressant.
 Conclusion: Our study concluded that patient started on antidepressant showed a reduction in the blood sugar levels and HbA1c levels from their baseline values, which was clinically and statistically significant.
Highlights
Diabetes mellitus is one of the most serious chronic illnesses due to its negative effect on the quality of life of the affected individuals [1]
Depression incidence is higher in diabetic patients when compared to the non-diabetic individuals and there exist a two-directional relationship between depression and the development of type 2 diabetes mellitus [4]
Patients were excluded from the study if they were on insulin therapy, type 1 diabetic patients, age was more than 60 years of age, diabetes patients having a history of prior psychiatric illness, and/or prior treatment with psychiatric medicines and the patients who were not willing to give the informed consent
Summary
Diabetes mellitus is one of the most serious chronic illnesses due to its negative effect on the quality of life of the affected individuals [1]. The first hypothesis showed that depression increases the risk of developing diabetes. The physiological alterations like rising in levels of glucocorticoids, catecholamines, growth hormones, modification in the glucose transport function, and secretion of inflammatory cytokines in depression contribute to insulin resistance and abnormal beta islet cell functioning and become the causal factors for the development of diabetes as well as its complications. The second hypothesis states that psychosocial stressors of having a chronic medical condition (type 1 and type 2 diabetes mellitus) lead to depression [5]. The rise in the diabetic population in our country and the existence of a significant causative connection between depression and poor glycemic control necessitate the need for studying the effect of antidepressant use on glycemic control of diabetes patients
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