DIABETES AND DEPRESSION

CONTENTS OBJECTIVES WHAT IS DIABETES WHAT IS DEPRESSION CAUSES OF DEPRESSION EFFECTS OF DEPRESSION DEPRESSION & DIABETES IDENTIFYING DEPRESSION TREATMENT SUGGESTION

OBJECTIVES Become cognizant of the relationship between diabetes and depression. Become familiar with treatment options for Diabetes.

WHAT IS DIABETES? Chronic disease of carbohydrate metabolism characterized by hyperglycemia. Insufficient insulin production and release.

WHAT IS DIABETES? (Patient view) Dietary changes Insulin shots ( cure?) Can’t eat sweets A big bother

WHAT IS DIABETES? Diabetes is a Life Partner Regular Diet Routine Healthy Life Style Regular Health Checkup

WHAT IS DEPRESSION? Depressed Mood: Sad, anxious or irritable feelings, flat affect Anhedonia: loss of pleasure in most activities Weight/appetite changes : Decreased weight without dieting, increased weight Sleep Disturbance: Insomnia or hypersomnia

Fatigue or lack of energy continued……. Fatigue or lack of energy Psychomotor Changes: Agitated or slower than usual Feelings of Worthlessness or Guilt Impaired Concentration : difficulty making decisions… Thoughts of death /suicide

CAUSES OF DEPRESSION Family History Personality Traits Childhood Trauma Environmental Some Illnesses Some Medications

EFFECTS OF DEPRESSION Decreased Self-Esteem Unmotivated Appearance Poor Hygiene Loss of Strategies

DIABETES AND DEPRESSION

DEPRESSION POPULATIONS

WHY WORRY ? Depressed diabetics have earlier, more severe prevalence of physical problems. Diabetics report earlier onset than general population

CAUSES OF DEPRESSION IN DIABETES Diabetes treatment plan changes Response of family / friends Undergoing a major life event like moving, getting married Not achieved diabetes control Diagnosis of some other chronic illness or disability.

EFFECT OF DEPRESSION IN DIABETES Decreased adherence to treatment plan Worse glucose control Increased complications Decreased overall functional well-being Sub-optimal self-care

REASONS FOR SUB-OPTIMAL SELF-CARE Lack of motivation & energy Negative thought patterns Self blame for negative events Believe negative events will repeat in future Expect same negative results

DEPRESSION AS A CONTRIBUTOR TO DIABETIC MORBIDITY AND MORTALITY Significantly associated with hyperglycemia especially using standardized interviews. (Lustman 2000) Associated with retinopathy, nephropathy, macrovascular complications & sexual dysfunction (deGroot 2001) Coronary heart disease more rapid in depressed women (Clouse 2003)

IDENTIFYING DEPRESSION WHO ( World Health Organization) has published a tool for screening DEPRESSION

  How much of the time... All of the time Most of the time More than half of the time Less than half of the time Some of the time At no time 1 Have you felt in low spirits or sad? 5 4 3 2 Have you lost interest in your daily activities? Have you felt lacking in energy and strength? Have you felt less self-confident? Have you had a bad conscience or feelings of guilt? 6 Have you felt that life wasn't worth living? 7 Have you had difficulty in concentrating, e.g. when reading the newspaper or watching television? 8a Have you felt very restless? 8b Have you felt subdued? 9 Have you had trouble sleeping at night?

HOW CAN WE HELP ? Assessment Talk with Patient –MOST IMPORTANT

BRIEF SELF-ASSESSMENT Diabetes History Medical History Family & friends support Dietary changes Life style Work place

TREATMENT Medication Stress Management Problem Solving Refer for Counseling Support Group Cognitive behavioral therapy

COGNITIVE BEHAVIORAL THERAPY Works with patients on their cognitions or thoughts to interrupt self-perpetuating cycles Negative thoughts Low mood Decreased motivation Inactivity

SUGGESTION Acceptance Talk with other diabetic people. Make a mental list of all the things you enjoy. Develop healthy lifestyle Exploring goals and values Imagine extremes Review personal strength and support Supportive relationship