All depressed patients met established DSM-IV criteria for MDD.27 Patients with MDD were screened using structured clinical psychiatric interviews and had Hamilton Depression Rating Scale Scores of 15 or greater on the 17-item scale.28 All patients were free of significant clinical brain disorders other than MDD in the depressed diabetic group. None of the depressed patients had any other major psychiatric disorder such as dementia, bipolar disorder, or substance abuse. All subjects had Folstein Mini-Mental State Examination scores of 24 or higher.29 Depressed patients had not taken psychotropic medication for at least 2 weeks prior to the study. Laboratory testing for all subjects included complete and differential blood counts, hepatic, renal, and thyroid screens, electrolyte levels, and hemoglobin A1C (HbA1C) levels. In addition, cerebrovascular risk factors were assessed using the American Heart Association's Stroke Risk Prediction Chart30 and overall medical comorbidity was ascertained using the Cumulative Illness Rating Scale, which provides an assessment of the degree of organ system dysfunction and overall medical burden.31 Three of the 16 subjects diagnosed with MDD reported the index (current) episode as their first. Seven patients reported 1 prior depressive episode, 1 patient reported 2, and 1 reported 3. In 4 cases, the information on prior episodes was considered unreliable. Twenty-one patients with diabetes (those with and without depression) were taking oral hypoglycemic agents alone for diabetes control. Two patients were taking insulin only and 13 patients were taking a combination of insulin and oral hypoglycemics for blood glucose control. Patients with diabetes were taking different forms of insulin (Humulin N [Eli Lilly & Co, Indianapolis, Indiana], Humalog [Eli Lilly & Co], Lantus [Sanofi Aventis, Bridgewater, New Jersey], Novolog [Novo Nordisk Pharmaceuticals Inc, Princeton, New Jersey], Insulin R&N [synonymous with Humulin R or N]), and oral hypoglycemic drugs including Glucovance combination (Bristol-Myers Squibb, New York, New York), Glucophage only (Bristol-Myers Squibb), glyburide, Prandin (Novo Nordisk), glipizide, Actos (Takeda Pharmaceuticals, Deerfield, Illinois), and Avandia (Glaxo SmithKline, Philadelphia, Pennsylvania).