Published: 2017-11-23

A prospective comparative study to assess the efficacy and safety of sertraline and methylcobalin with pregabalin and methylcobalin in patients suffering with depression due to diabetic neuropathic pain

V. Sivasankari, E. Manivannan, S. P. Priyadarsini


Background: Diabetic neuropathic pain produces mood swings thereby creating emotional disturbances ranging from mild anxiety to severe depression when the disease progresses for 10 years or more. The existing treatment includes Tricyclic antidepressants, Selective Serotonin Reuptake Inhibitors, anticonvulsants, Dual Reuptake Inhibitor antidepressant, topical agents like capsaicin, lignocaine, gabapentin. Yet the psychological component has to be treated with the antidepressants. Even though SSRI’s like sertraline has shown some promising results as analgesic but could works better as an antidepressant. Hence, this work emphasizes some promising role of sertraline as an adjuvant to methylcobalin and other medications in the management of depression due to diabetic neuropathic pain.

Methods: A total of 100 consecutive patients of both sex between the age group of 18-65 years with painful diabetic neuropathic pain with signs and symptoms depression were recruited and randomized into two groups. Statistical methods: Data were tabulated, and results were analyzed. Chi-square test was used to analyze demographic data of the study population. Depressive score was analyzed at baseline and 12th week by using Student’s t-test and Analysis of Co variance. A p value of <0.05 was considered as statistically significant.

Results: Group I patients showed an improvement of symptomatology where the number of patients shifted from mild to minimal depression. This is critically less in Group II.

Conclusions: The combination of sertraline with methylcobalin showed a promising outcome with improvement of symptoms of painful diabetic neuropathic pain in Indian patients.


Antidepressants, Diabetes mellitus, Diabetic neuropathic pain, Depression, Methylcobalin, Sertraline

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Halawa MR, Karawagh A, Zeidan A, Mahmoud AE, Sakr M, Hegazy A, painful diabetic peripheral neuropathy study group. Prevalence of painful diabetic peripheral neuropathy among patients suffering from diabetes mellitus in Saudi Arabia. Current medical research and opinion. 2010 Feb 1;26(2):337-43.

Dongre TU, Swami OC. Sustained-release pregabalin with methylcobalamin in neuropathic pain: an Indian real-life experience, University of Michigan, International J of General Medicine. 2013;6:413-7.

Khan SE. Cooper ME, Del prato S. pathophysiology and treatment of type II Diabetes; prospectives on the past, present and future. Lancet. 2013;383:1068-83.

De Groot M, Kushnick M, Doyle T, Merrill J, McGlynn M, Shubrook J, et al. Depression among adults with diabetes: prevalence, impact, and treatment options. Diabetes Spectrum. 2010 Jan 21;23(1):15-8.

Tesfaye s. Selvarajah D. advances in epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabeto Metab Res. Rev 2012Feb;28(1):8-14.

Aaron IV, Casellini CM. Guidelines in the management of diabetic nerve pain: clinical utility of pregabalin. Diabetes Metab Syndr Obes. 2013;6:57-78.

Saxena AK, Nath S, Kapoor R. Diabetic Peripheral Neuropathy: Current Concepts and Future Perspectives. Journal of Endocrinology and Diabetes. 2015;2(5):1-8.

Snyder MJ, Gibbs LM, Lindsay TJ. Treating Painful Diabetic Peripheral Neuropathy: An Update. American family physician. 2016 Aug;94(3):227-34.

Ziegler D, Fonseca V. From guideline to patient: a review of recent recommendations for pharmacotherapy of painful diabetic neuropathy. J of Diabetes and its Complications. 2015 Feb 28;29(1):146-56.

Kiani J, Azizkhani H, Kosarifard S. The prevalence and associated risk factors of peripheral diabetic neuropathy in Hamedan, Iran. Archives of Iranian Medicine. 2013 Jan 1;16(1):17.

Barbosa AP, Medina JL, Ramos EP, Barros HP. Prevalence and risk factors of clinical diabetic polyneuropathy in a Portuguese primary health care population Diabetes metabolism. 2001 Sep;(4 pt 1):496-502.

Jawaid T, Shakya AK, Kamal M, Hussain S. Amitriptyline and sertraline in diabetic neuropathy: a comparative view. International J of Health Research. 2008;1(2):73-8.

Goodnick PJ, Jimenez I, Kumar A. Sertraline in diabetic neuropathy: preliminary results. Ann Clin Psychiatry. 1997 Dec; 9(4):255-7.

Casandra. J. Rosenberg treatment of painful diabetic peripheral neuropathy prosthetics and orthotics International. 2015;39(1):17-25.

Amy M. Barret Epidemiology, public health burden and treatment of diabetic peripheral Neuropathic pain: A Review, American Academy of Pain Medicine. 2006;8:50-62.

Torrance N, Ferguson JA, Afolabi E, Bennett MI, Serpell MG, Dunn KM, et al. Neuropathic pain in the community: more under-treated than refractory?. PAIN®. 2013 May 31;154(5):690-9.