Depressive disorders in patients with diabetes mellitus and the effect of the combined herbal phytopreparation of Hypericum perforatum with Valeriana on the car bohydrate metabolism and psychoemotional state of patients with anxiety-depressive syndrome

Abstract

Abstract. Depressive disorders are quite common in patients with diabetes mellitus (DM). Depression is associated with worsening glycemic control. Attempts to improve it through the use of synthetic antidepressants in complex therapy had mixed results. The aim: to evaluate the prevalence of anxiety-depressive disorders in patients with diabetes mellitus treated in diabetology department and to assess the effect of a combined medicine containing standardized extracts of Hypericum perforatum (St John’s Wort or hypericin or hyperforin or johanniskraut) (100 mg) with Valeriana (50 mg) on carbohydrate metabolism and psychoemotional state of patients with anxiety-depressive syndrome (ADS). Material and methods. The study included 122 patients with type 1 and 2 DM, 103 women and 19 men, aged 18 to 75 years. 33 of them with ADS participated in a 3-month study, 16 of whom additionally took combined medicine of Hypericum perforatum with Valeriana 2 capsules twice a day for 2 months. The remaining 17 patients formed the control group. At the beginning of the study, as well as after 2 weeks, 1, 2, 3 months from the beginning of the observation, the psychoemotional state was assessed, determining the severity of depressive syndrome according to the Beck Depression Inventory (BDI), the Patient Health Questionnaire-9 (PHQ-9), as well as the state of personal and reactive anxiety according to the Spielberger-Hanin scale. Glycated hemoglobin was determined before and 3 months after the start of monitoring. Results. Depressive disorders were identified in 80.3% and 67.2%, respectively, according to the PHQ-9 and the BDI-II. Most patients had mild to moderate depression. High personal anxiety was found in 66.4%, high reactive anxiety – in 50.8% of patients. In patients of the main group who took medicine of Hypericum perforatum with Valeriana a significant improvement in depressive symptoms was noted with a decrease in points on PHQ-9 scale from 13.7±1.6 to 9.3±1.4 (mean±SE) (p<0.05) after the first month of treatment, and on the BDI-II from 23.9±1.8 to 18.2±1.9 points (p<0.05) after the second months of treatment, in contrast to patients in the control group: 11.9±1.2 and 10.8±1.1 points (p>0.1) on the PHQ-9 scale and 19.7±1.7 and 18.9±2.3 points (p>0.1) on the BDI-II, respectively. The achieved improvement of psychoemotional state of patients after the end of treatment with combined medicine of Hypericum perforatum with Valeriana was maintained after 3 months after the start of monitoring: 7.1±1.3 points on the PHQ-9 scale and 16.1±2.1 points on the BDI-II, respectively (p<0.01). After 2 months of therapy with the herbal medicine of Hypericum perforatum with Valeriana, in the group of patients with anxiety-depressive syndrome, in contrast to patients in the control group, personal anxiety decreased from 59.5±2.2 to 53.5±1.9 points (p<0.05) and reactive anxiety from 57.4±2.5 to 49.3±2.7 points (p<0.05). Against the background of positive dynamics of depressive symptoms in patients taking herbal medicine of Hypericum perforatum with Valeriana 3 months after the start of therapy, 3 months after the start of therapy, there was a significant decrease in glycated hemoglobin: from 9.4±0.5% to 8.1±0.2% (p<0.05), in contrast to patients of the control group. Conclusions. An ADS was defined in 63.1% of patients of the diabetology department, with depressive disorders mainly of mild and moderate severity, high personality and reactive anxieties. The herbal medicine of Hypericum perforatum with Valeriana in the complex therapy of patients with DM, in addition to a positive and prolonged effect on ADS, improves carbohydrate metabolism, with a 1.3% decrease in glycated hemoglobin over 3 months. This indicates the advisability of using the herbal medicine both for the treatment of anxiety-depressive disorders and for improving carbohydrate metabolism in patients with DM and ADS.