REVIEW OF THE ASSOCIATION BETWEEN DIABETIC PERIPHERAL NEUROPATHY AND DEPRESSIVE SYMPTOMS

Abstract

The diabetic peripheral neuropathy is present in approximately 50% of the diabetic patients, being a major health problem, frequently associated with physical, psychological and social “sequelae”. Its presence leads to a significant raise of the risk for the lower limbs ulcer and, consequently, of the amputation risk, which, in their turn, imply supplementary costs for treatment, disruption in employment and decrease the quality of life.1,2On the other hand, clinical studies have emphasized the fact that the diabetic patients present a high risk of depressive disorder, the stress of daily care, the social isolation feeling, the difficulties in the obtaining of an optimum glycemic control and in the management of complications and comorbidity (when they are present) being only a part of the factors that contribute to the decrease in the quality of life and to the appearance of the depressive symptoms.3,4In literature we find contradictory data regarding the association between diabetic neuropathy and depression, data that may be partially explained by the fact that in different studies different tests have been used in order to establish the diagnosis of peripheral nerves damage or to evaluate the relationship between the presence of the symptoms characteristic to neuropathy and to depression.Based on the current information regarding the pathogenetic mechanisms of the diabetic peripheral neuropathy, the research has focused on the development of drugs which would interfere in the perception of pain and modulate descending inhibitory pain pathways. Duloxetine is used both in the treatment of painful diabetic neuropathy and of major depressive disorder (it is a selective serotonin and nor epinephrine reuptake inhibitor at the synaptic level).