In people with diabetes the comorbidity with depression is associated with micro- and macrovascular complications and increased mortality. Health-related quality of life is often reduced, and the adherence to treatment is generally low. Screening and diagnostic tools for depression are widely available. However, their use is only effective if subsequent treatment pathways are provided, which is often not the case. Meta-analyses on the treatment of depression in diabetes indicate that depression can be effectively treated with a variety of psychological and/or psychopharmacological interventions. However, results from the most frequently studied psychological treatment, cognitive behavioral therapy (CBT), have revealed decreasing effects ranging from large to low-grade, the longer the studies’ follow-up lasts. This may indicate CBT’s reduced long-term efficacy in diabetes patients with depression compared to depressive people without diabetes. As few data are available on the long-term effects of drug treatments, the studies’ conclusiveness is limited. Regarding the amelioration of glycemic control, the treatment results are heterogeneous, indicating a slight improvement by selective serotonin reuptake inhibitors and contradictory evidence for psychological interventions. This chapter concludes with a practice-oriented model of stepped care for depression treatment in people with diabetes. For complete coverage of this and all related areas of Endocrinology, please visit our FREE on-line web-textbook, www.endotext.org.
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