depression and diabetes
TRANSCRIPT
Depression and Diabetes: An Overview
Prepared by Dalal AlotaibiClinical Psychologist
IntroductionDiabetes and psychology are not often thought of as being
complimentary but with the use of psychology the life of a
diabetic can be improved
To understand the role that psychology has to play it is important to
understand how it can affect the life of a diabetic
For example, depression is not generally listed as a complication of
diabetes, However, it can be one of the most common and
dangerous complications
Major Depressive Disorder
DefinitionMajor depressive disorder is a mental disorder characterized by
a pervasive low mood low self-esteem
loss of interest in normally enjoyable activities
Major depression is a disabling condition which affects a person's family, work or school life, sleeping and eating habits, and general health
Depression is common. It affects nearly one in 10 adults each year - nearly twice as many women as men
It’s also important to note that depression can strike at any time but, the peak age for depression onset is 20 to 40, with the highest risk occurring in those who have a family history of the disease
Causes Family history
Genetics play an important part in depression For example, if one identical twin has depression, the other has a
70% chance of having the illness sometime in life Personality
People with low self-esteem can be easily affected by depression
Environmental factors Continuous exposure to violence, neglect, abuse or poverty
may make people depressed Biochemistry
Abnormalities in two chemicals in the brain, serotonin and norepinephrine, might contribute to symptoms of depression
Trauma and stressThings like financial problems and the breakup of a relationship can bring on depression
You can become depressed after changes in your life, like starting a new job, graduating from school, or getting married
Medical conditions For example, a brain tumor or vitamin deficiency can cause depression
Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, because of the physical weakness and stress they bring on
Other psychological disorders Anxiety disorders, eating disorders, and schizophrenia
DiagnosisDepression affects 3% to 5% of the general population and 5% to 15% of the primary care population. Despite its pervasiveness research indicates that primary care clinicians fail to recognize as many as 50% of depression cases
Barriers to Diagnosis and Treatment of Depression
Patients may not accept a diagnosis of depression and may focus on the disease's physical manifestations rather than treatment
Patients or their families often underestimate the severity of depression or believe they can self-treat it which can delay treatment. So, patient education is essential in accepting the diagnosis Clinicians may lack the skills and information to handle the emotional aspects of depression
Psychological Evaluation The diagnosis of major depressive disorder is based on the patient's self-reported experiences
Diagnosis of depression may be conducted by a general practitioner or by a psychiatrist or psychologist, but psychologists will conduct a psychological evaluation
A complete psychological evaluation is needed to determine whether a person has a depressive illness. Consultation with a psychologist will include a review of one's physical health history
As a general rule, patients should never take antidepressant medication alone, without also beginning psychotherapy, or at least seeing a psychologist for an evaluation
A good psychological diagnostic evaluation includes A complete history of one's symptoms; that is
When they started How long they have lasted
How severe they are Whether you've had them before
Whether you were treated and what treatment you received
Family history of depression Lastly, the psychological diagnostic evaluation will include a
mental status examination to assess the full range of psychological symptoms and problems. This will help identify
any other psychological problems that might be present
Screening for Depression
Several questionnaires can help detect depressive symptoms such as
1 .The Beck Depression Inventory (BDI) 2 .Another approach is the Two-Question Case-Finding
Instrument. To use this method, ask the patient During the past month, have you often been depressed or hopeless? and During the past month have you often been bothered by having little interest or pleasure in doing things? If the answer to both questions is no, it's unlikely that the patient has depression. If the answer is yes, to one or both questions, follow up with the diagnostic criteria for a major depressive episode
Depression can be a chronic and recurrent disease requiring ongoing treatment
A single episode of depression isn't the norm, and the chance of having a second episode is 50% to 65%
Patients who have depression also frequently have another disorder such as anxiety
Diabetes and Depression: A Vicious Cycle
Depression and diabetes are two conditions that can sometimes go hand-in-hand
Diabetes can increase the risk of depression. In fact, having DM doubles the risk of depression, compared to people who don't have the disease (1) Depression has been found to be more common among diabetic patients than in the general population affecting 15 – 20% of patients (2, 3)
A study published in one of the major psychiatric journals (4) indicates that almost 5% of the patients (193 over 4400) who had diabetes also had panic and depression
1 .Debra Manzella, R.N., About.com Updated: January 16, 20082 .Gavard JA et al. Diabetic care 1993; 16:1167-1178 3. Kovacs M. Diabetic Care 1997; 20:45-51
4 .Journals (General Hospital Psychiatry, November 2006) 5. Debra M. Arch Int Med; April 23 2007
Conversely, depression also can increase the risk of Type 2 diabetes (1) A new study (2) suggested that chronic depression can increase the risk of developing diabetes in older adults independent of other risk factors like obesity
It looks due to cortisol hormone which is secreted in response to stress When someone is depressed, the cortisol level rises, and if depression is chronic, the cortisol level may stay consistently high
Depression can get worse as the complications of diabetes get worse, and being depressed can stop people from managing their diabetes as effectively as they need to, which can lead to increased incidence of long-term complications such as retinopathy, neuropathy or nephropathy
1 .Debra Manzella, R.N., About.com Updated: January 16, 20082 .Debra M. Archive of Internal Medicine; April 23 2007
A depressed person may not have the energy or motivation to maintain good diabetic management
Depression is also frequently associated with unhealthy appetite changes
There is some suggestion that the stress of depression itself may lead to hyperglycemia in diabetics Treatment of anxiety and depression may lead to a better medical prognosis and a better quality of life
Recent studies have suggested that effective treatment of depression can improve diabetic control
In a study by Lustman glucose levels were shown to improve as depression lifted
The better the improvement, the better the diabetic control. Lustman et al.1997
Stages of GriefMany newly diagnosed diabetics go through the typical stages of mourning. These are denial, anger, depression and acceptance
Denial: This can be one of the more dangerous stages of the grief process. It may not occur only once. Many individuals cycle back to this phase several times
Anger: It really does seem unfair. The type II diabetic, trying to lose weight, may envy heavier people who seem to enjoy good health One might erupt at someone who innocently offers a dessert
Stages of Grief
Depression: Mild depressive feelings are a normal part of grieving and adaptation. As long as they are not prolonged, they may not be harmful. However, when the depression lasts a long time, becomes severe or interferes with diabetic management, one should seek treatment
Acceptance
Signs Depressed mood for most of the day
Decreased pleasure in normal activities Difficulty sleeping or increased need to sleep
Weight loss or weight gain Feelings of guilt or worthlessness
Low energy level Difficulty making decisions of concentrating
Suicidal thoughts
Treatment Antidepressants
Psychotherapy: Cognitive psychotherapy is one of the methods that has demonstrated good results for depression
In this type of therapy, the individual identifies thought patterns associated with a depressive, hopeless outlook
Frequently these thought patterns are based on erroneous assumptions about self and others
The therapist helps the patient monitor such thoughts and to replace them with more effective positive ways of thinking
Cognitive therapy can also be helpful in non-depressed individuals who are having trouble with their diabetic management
Conclusion Good diabetic management is dependent
on the development of self-knowledge
Many of the things that other people's bodies do automatically, diabetics must do consciously
This includes closer monitoring of both one's blood glucose and one's emotional state
Thank you