 Diabetes is a major health problem affecting approximately 18 million Americans. It is a growing crisis that has devastating complications including heart disease, peripheral neuropathy and renal failure. According to a literature review by Gavard et al, the prevalence of major depression in a sample diabetic population in controlled studies was 8.5 to 27.3 mean prevalence of 14.0. This was estimated to be up to three times the prevalence of major depression in the general U.S. adult population. Diabetes and major depression are mutual risk factors, with diabetic patients more likely to develop major depression with an odds ratio of 2.5 and depressed patients being more likely to develop type 2 diabetes with an estimated relative risk of 2.2. Depression also has a significant impact on the course of diabetes, leading to higher rates of hyperglycemia and diabetic complications. Depression in patients with diabetes is also associated with poor compliance, decreased quality of life, increased disability and greater health care utilization. A recent 8-year follow-up study of patients with diabetes and depression concluded that the coexistence of these illnesses is associated with a significantly increased risk of death from all causes beyond that due to either depression or diabetes alone. In this study, patients with diabetes and depression had a 1.3-fold increased risk of death from all causes when compared with patients with diabetes alone and a 2-fold increased risk of death when compared with patients with only depression. Reports from a prospective, community-based study in western Australia suggest that the behavioral consequences of depression, including non-compliance with medication and exercise regimens, contribute to increased mortality in these patients. 