Subject: A multicentre, retrospective, observational survey study to analyse the role of Escitalopram in patients with depression and comorbid diabetes

Major depressive disorder (MDD) is a debilitating disease that is characterized by at least one discrete depressive episode lasting at least 2 weeks and involving clear-cut changes in mood, interests and pleasure, changes in cognition and vegetative symptoms.¹ Depression is a common mental health disorder that can affect both the mental and physical health. The number of incident cases of depression worldwide increased from 172 million in 1990 to 258 million in 2017, representing an increase of 49.86%.² In 2017, 197·3 million people had mental disorders in India, including 45·7 million with depressive disorders and 44·9 million with anxiety disorders.³

Large-scale longitudinal studies converge in their findings suggesting that MDD increases the risk of diabetes mellitus, heart disease, stroke, hypertension, obesity, cancer, cognitive impairment and Alzheimer disease.⁴ Clinically significant depression is present in one of every four people with type 2 diabetes mellitus (T2DM). The interaction of depression and diabetes is bidirectional, with depression adversely impacting the course of diabetes, and diabetes complications increasing the risk of, and worsening the course of, depression. Both diabetes and depression reduce the quality of life for an individual, but together they have a more negative impact.⁵

Treatment options for management of depression can be broadly be divided into antidepressants, electroconvulsive therapy (ECT) and psychosocial interventions. In general, because of the side effect and safety profile, selective serotonin reuptake inhibitors (SSRIs) are considered to be the first line antidepressants. Other preferred options include tricyclic antidepressants, mirtazapine, bupropion, and venlafaxine.⁶ CBT and antidepressants examined separately or in collaborative care approaches are effective in treating depression in patients with diabetes, but evidence for benefit in glycemic control is mixed.⁷

Escitalopram, the clinically active S-enantiomer of racemic citalopram, is currently approved in over 100 countries for treatment of social anxiety disorder, generalized anxiety disorder, obsessive- compulsive disorder and MDD. It is available as 5 mg, 10 mg and 20 mg tablets administered once daily orally. It potently inhibits the serotonin transporter protein (SERT) in comparison to citalopram. Escitalopram has a favourable safety profile and has been shown efficacious for both acute and long- term treatments for adolescents and adults⁸ Treatment with escitalopram showed a favourable glycemic profile in type 2 DM patients with depression.⁹

Nexito (Escitalopram) tablets are marketed by Sun Pharmaceutical Industries Ltd. Although every product is marketed only after regulatory approval, it is important to know how it performs in day-to- day practice of individual medical practitioners. For this purpose, we have planned to conduct a retrospective, observational survey study to analyse the role of Escitalopram in patients with depression.

We invite you to participate in this data collection activity. All you need to do is to report on a standard form your experience with Escitalopram in the normal course of your practice. If you agree to participate, you will need to fill data collection forms (which we call DCF).