Treat depression to control blood sugar.

The Diabetes Control and Complications Trial, the landmark study completed in 1994, concluded unequivocally that keeping a close rein on blood sugar can prevent or delay the kidney, eye, and nerve complications that affect patients with diabetes. For some, though, that goal is nearly impossible. Diabetics with depression have a very difficult time managing their blood sugar levels.

Investigators at Washington University School of Medicine in St. Louis have found that treating clinical depression with the anti-depressant drug nortriptyline helps patients control their blood sugar, even though it tends to raise blood glucose levels. In depressed diabetics, treating depression more than made up for those increases in blood sugar.

"The drug had two opposing effects," explains Patrick J. Lustman, associate professor of psychiatry. "It improved depression significantly, but it worsened glucose control in patients who were not depressed. Yet, even in the face of this opposing effect, we found that as depression improved, glucose control did, too."

Depression has a negative influence on quality of life for anyone, but...