DIABETES AND DIABETES AND DEPRESSIONDEPRESSION

CONTENTSCONTENTS OBJECTIVESOBJECTIVES WHAT IS DIABETESWHAT IS DIABETES WHAT IS DEPRESSIONWHAT IS DEPRESSION CAUSES OF DEPRESSIONCAUSES OF DEPRESSION EFFECTS OF DEPRESSIONEFFECTS OF DEPRESSION DEPRESSION & DIABETESDEPRESSION & DIABETES IDENTIFYING DEPRESSIONIDENTIFYING DEPRESSION TREATMENTTREATMENT SUGGESTIONSUGGESTION

OBJECTIVESOBJECTIVES

Become cognizant of the Become cognizant of the relationship between diabetes relationship between diabetes and depression.and depression.

Become familiar with treatment Become familiar with treatment options for Diabetes.options for Diabetes.

WHAT IS DIABETES?WHAT IS DIABETES?

Chronic disease of carbohydrate Chronic disease of carbohydrate metabolism characterized by metabolism characterized by hyperglycemia. hyperglycemia.

Insufficient insulin production Insufficient insulin production and release.and release.

WHAT IS DIABETES?WHAT IS DIABETES?(Patient view)(Patient view)

Dietary changes Dietary changes

Insulin shots ( cure?)Insulin shots ( cure?)

Can’t eat sweetsCan’t eat sweets

A big botherA big bother

WHAT IS DIABETES?WHAT IS DIABETES?

Diabetes is a Life PartnerDiabetes is a Life Partner

Regular Diet RoutineRegular Diet Routine

Healthy Life StyleHealthy Life Style

Regular Health CheckupRegular Health Checkup

WHAT IS DEPRESSION?WHAT IS DEPRESSION?

Depressed Mood: Sad, anxious or irritable Depressed Mood: Sad, anxious or irritable feelings, flat affect feelings, flat affect

Anhedonia: loss of pleasure in most activitiesAnhedonia: loss of pleasure in most activities

Weight/appetite changes : Decreased weight Weight/appetite changes : Decreased weight without dieting, increased weight without dieting, increased weight

Sleep Disturbance: Insomnia or hypersomniaSleep Disturbance: Insomnia or hypersomnia

continued…….continued…….

Fatigue or lack of energyFatigue or lack of energy

Psychomotor Changes: Agitated or slower than Psychomotor Changes: Agitated or slower than usualusual

Feelings of Worthlessness or GuiltFeelings of Worthlessness or Guilt

Impaired Concentration : difficulty making Impaired Concentration : difficulty making decisions…decisions…

Thoughts of death /suicideThoughts of death /suicide

CAUSES OF DEPRESSIONCAUSES OF DEPRESSION

Family HistoryFamily History

Personality TraitsPersonality Traits

Childhood TraumaChildhood Trauma

EnvironmentalEnvironmental

Some IllnessesSome Illnesses

Some MedicationsSome Medications

EFFECTS OF DEPRESSIONEFFECTS OF DEPRESSION

Decreased Self-EsteemDecreased Self-Esteem

UnmotivatedUnmotivated

AppearanceAppearance

Poor HygienePoor Hygiene

Loss of StrategiesLoss of Strategies

DIABETES AND DEPRESSIONDIABETES AND DEPRESSION

DEPRESSION POPULATIONSDEPRESSION POPULATIONS

WHY WORRY WHY WORRY ??

Depressed diabetics have earlier, more Depressed diabetics have earlier, more severe prevalence of physical problems.severe prevalence of physical problems.

Diabetics report earlier onset than general Diabetics report earlier onset than general populationpopulation

CAUSES OF DEPRESSION IN CAUSES OF DEPRESSION IN DIABETESDIABETES

Diabetes treatment plan changesDiabetes treatment plan changes Response of family / friendsResponse of family / friends Undergoing a major life event like moving, Undergoing a major life event like moving,

getting marriedgetting married Not achieved diabetes controlNot achieved diabetes control Diagnosis of some other chronic illness or Diagnosis of some other chronic illness or

disability.disability.

EFFECT OF DEPRESSION IN EFFECT OF DEPRESSION IN DIABETESDIABETES

Decreased adherence to treatment planDecreased adherence to treatment plan Worse glucose controlWorse glucose control Increased complicationsIncreased complications Decreased overall functional well-beingDecreased overall functional well-being Sub-optimal self-careSub-optimal self-care

REASONS FOR SUB-REASONS FOR SUB-OPTIMAL SELF-CAREOPTIMAL SELF-CARE

Lack of motivation & energyLack of motivation & energy Negative thought patternsNegative thought patterns Self blame for negative eventsSelf blame for negative events Believe negative events will repeat inBelieve negative events will repeat in

futurefuture Expect same negative resultsExpect same negative results

DEPRESSION AS A CONTRIBUTOR TODEPRESSION AS A CONTRIBUTOR TODIABETIC MORBIDITY AND DIABETIC MORBIDITY AND

MORTALITYMORTALITY

Significantly associated with hyperglycemia Significantly associated with hyperglycemia especially using standardized interviews. especially using standardized interviews. (Lustman 2000)(Lustman 2000)

Associated with retinopathy, nephropathy,Associated with retinopathy, nephropathy, macrovascular complications & sexual macrovascular complications & sexual

dysfunction (deGroot 2001)dysfunction (deGroot 2001) Coronary heart disease more rapid inCoronary heart disease more rapid in depressed women (Clouse 2003)depressed women (Clouse 2003)

IDENTIFYING DEPRESSIONIDENTIFYING DEPRESSION

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

DEPRESSIONDEPRESSION

   How much of the How much of the time...time...

All of the timeAll of the time Most of the timeMost of the time More than half of More than half of the timethe time

Less than half of Less than half of the timethe time

Some of the timeSome of the time At no timeAt no time

11 Have you felt in Have you felt in low spirits or sad?low spirits or sad?

55 44 33 22 11 00

22 Have you lost Have you lost interest in your interest in your daily activities?daily activities?

55 44 33 22 11 00

33 Have you felt Have you felt lacking in energy lacking in energy and strength?and strength?

55 44 33 22 11 00

44 Have you felt less Have you felt less self-confident?self-confident?

55 44 33 22 11 00

55 Have you had a Have you had a bad conscience or bad conscience or feelings of guilt?feelings of guilt?

55 44 33 22 11 00

66 Have you felt that Have you felt that life wasn't worth life wasn't worth living?living?

55 44 33 22 11 00

77 Have you had Have you had difficulty in difficulty in concentrating, e.g. concentrating, e.g. when reading the when reading the newspaper or newspaper or watching watching television?television?

55 44 33 22 11 00

8a8a Have you felt very Have you felt very restless?restless?

55 44 33 22 11 00

8b8b Have you felt Have you felt subdued?subdued?

55 44 33 22 11 00

99 Have you had Have you had trouble sleeping at trouble sleeping at night?night?

55 44 33 22 11 00

HOW CAN WE HELP ?HOW CAN WE HELP ?

AssessmentAssessment

Talk with Patient –MOST IMPORTANTTalk with Patient –MOST IMPORTANT

BRIEF SELF-ASSESSMENT BRIEF SELF-ASSESSMENT

Diabetes HistoryDiabetes History Medical HistoryMedical History Family & friends supportFamily & friends support Dietary changesDietary changes Life styleLife style Work placeWork place

TREATMENT

Medication

Stress Management

Problem Solving

Refer for Counseling

Support Group

Cognitive behavioral therapy

COGNITIVE BEHAVIORAL COGNITIVE BEHAVIORAL THERAPYTHERAPY

Works with patients on their cognitions orWorks with patients on their cognitions or

thoughts to interrupt self-perpetuatingthoughts to interrupt self-perpetuating

cyclescycles Negative thoughtsNegative thoughts Low moodLow mood Decreased motivationDecreased motivation InactivityInactivity

SUGGESTIONSUGGESTION

AcceptanceAcceptance Talk with other diabetic people.Talk with other diabetic people. Make a mental list of all the things you Make a mental list of all the things you

enjoy.enjoy. Develop healthy lifestyleDevelop healthy lifestyle Exploring goals and valuesExploring goals and values Imagine extremesImagine extremes Review personal strength and supportReview personal strength and support Supportive relationshipSupportive relationship