Depression-Diabetes Mechanisms: Urban African Americans
Condition: Diabetes; Depression
MeSH terms: Diabetes Mellitus; Depression; Depressive Disorder
Intervention: Beating the Blues; Escitalopram; Placebo
Intervention description: Beating the Blues is a computerized cognitive behavioral therapy.; Escitalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It's a 10 mg pill taken once or twice daily for 6 months.; A sugar pill taken as one to two tablets daily for 6 months.
Intervention MeSH terms: Escitalopram
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 20.0
Sex: All
Minimum age: 18 Years
Maximum age: 81 Years
Healthy volunteers: Accepts Healthy Volunteers

Summary:

      African-Americans suffer from increased prevalence of both type 2 diabetes and diabetes
      complications, reflecting a combination of psychobehavioral factors as well as metabolic
      dysfunction. In this process, depression may contribute to both the genesis of type 2
      diabetes (through impact on neurohormonal activation, inflammatory mediators, and insulin
      resistance), and difficulties in management (through decreased adherence to diet plans,
      medication, and scheduled appointments). The preliminary data from the Grady Diabetes Clinic
      indicates that depression may be common in African-Americans with diabetes, that depression
      is a factor in non-adherence, and that non-adherence leads to poor glycemic control - a
      direct cause of diabetes complications. What is not known is: how treatment of depression
      could lead to both neurohormonal and psychobiological improvement, with improved patient
      adherence and glycemic control.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Subjects must be English-speaking

          -  African American

          -  Have type 2 diabetes per American Diabetes Association criteria

          -  Patient's receiving care at Grady Hospital

        Exclusion Criteria:

          -  Severely depressed (Hamilton Depression Rating Scale (HAM-D) ≥ 34

          -  Non - English speaking

          -  Women who are pregnant, women who will be breastfeeding during the study, and women of
             childbearing potential who are not practicing a reliable method of birth control.

          -  currently meet Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV)
             criteria for:

               1. Bipolar Disorder

               2. Schizophrenia or any Psychotic Disorder

               3. Obsessive Compulsive Disorder

               4. Mental Retardation or any Pervasive Developmental Disorder or Cognitive Disorder.

               5. Personality Disorder of sufficient severity to interfere with their participation
                  in the study

               6. Psychotic features or with history of Psychotic Disorder, as defined by DSM-IV

          -  Suicide risk, or have made serious suicide attempt in the past year

          -  Substance Abuse or Dependence (other than nicotine) during the six months preceding
             the first dose of double blind study medication

          -  Any malignancy (other than excised basal cell carcinoma), or any clinically
             significant hematological, endocrine, cardiovascular (including any rhythm disorder),
             renal, hepatic, gastrointestinal, or neurological disease. History of syndrome of
             inappropriate anti-diuretic hormone secretion.

          -  Diabetes due to: glucagonoma, pheochromocytoma or other endocrine neoplasm, drug
             induced diabetes, gestational diabetes, or those with established genetic defects of
             beta cell function.

          -  Medical conditions that will interfere with the HbA1c assay or if hospitalization is
             likely within two months (sickle cell anemia, hypersplenism)

          -  A history of diabetic ketoacidosis episode during the 6 months preceding the first
             dose of double-blind study medication.

          -  Uncontrolled diabetes as judged by the investigator defined as blood glucose greater
             than 400 on last two visits or patients whom suffered from diabetic ketoacidosis in
             the last month or have had 2 episodes in the last year.

          -  Autonomic or peripheral neuropathy that requires treatment

          -  At the first follow-up visit - Patients with systolic blood pressure greater than 180
             mm Hg or less than 90 mm Hg or diastolic blood pressure greater than 105 mm Hg or less
             than 50 mm Hg

          -  Treatment with a depot neuroleptic during the last 6 months

          -  Patients who have been treated with any neuroleptic, antidepressant, or anxiolytic
             medication

          -  Participation in an investigational drug study within 1 month prior to study entry or
             who have received treatment with an investigational drug within 1 month or five
             half-lives, whichever is longer.

          -  Previous investigational study of escitalopram or previously treated with escitalopram
             in a dose and duration sufficient for therapeutic trial.

          -  History of hypersensitivity reaction to escitalopram or citalopram.

          -  Electroconvulsive therapy during the past 3 months

          -  Initiation or termination of behavior therapy or psychotherapy in the 3 months.

          -  Positive urine screening for alcohol, illicit drugs, or any prohibited medication