Depression+and+Diabetes

Diabetes and co-morbid Depression

"One plus one equals much more than two when you add diabetes and depression."

- Patrick Lustman professor of medical

psychology Washington University School of

Medicine 2 medicalquery@torrentpharma.com

3medicalquery@torrentpharma.com

Diabetes

• Is metabolic disorder • Body does not

produce or properly uses insulin

• blood glucose (sugar) becomes too high

• 3 main types of diabetes: – Type 1 Diabetes – Type 2 Diabetes – Gestational Diabetes

DepressionDSM-IV criteria• 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• Psychomotor Changes: Agitated or slower

than usual• Feelings of Worthlessness or Guilt• Impaired Concentration : difficulty making

decisions…• Thoughts of death /suicide

Prevalence• According to the International

Diabetes Federation, 189 million individuals have Diabetes world wide1

• Individuals with Diabetes have a two-fold increased risk for Depression, affecting approximately 1 in every five Diabetespatients 1

• According to the American Diabetic Association, While Depression affects may be 3 or 5% of the population at any given time, the rate with Diabetes is between 15% and 20%2

• Depression is under-recognized in patients with Diabetes

• When they co-exist, one may worsen the other

Outcome of Diabetes Mellitus and co-morbid

Depression1,3

• Greater risk for Heart disease 1,3 • Higher body mass indexes 1

• Hyperglycemia 1,3

• Worse diabetes self-care, reflected by a worse adherence to diet and exercise advice

• Increased mortality risk

Outcome of Diabetes Mellitus and co-morbid

Depression• Depression can influence physical

outcomes, such as:– Recovery from myocardial infarction – Survival with malignancy– Propensity to infection

• Synergistic interaction between diabetes and depression, result in 4

– Decreased metabolic control– Higher incidence of micro- and macro-

angiopathic diabetic late complications– Decreased quality of life

Comparison of Physical Health and Mental Health between Diabetic Individuals with and without Depressive symptoms1

Difference in physical and mental health between diabetic individuals with and without depressive symptoms in studies using physical and mental components summary scores of the Short Form. Significant difference between diabetic individuals with and without depressivesymptoms 1

Management

Cognitive Behavioral Therapy

Antidepressant pharmacotherapy

Compliance with both Diabetic and Anti-depressant medications

Good diet Sleep Exercise Avoidance of

stress

Choice of Antidepressants4

Antidepressant should have no influence on body weight

No interactions with the numerous medications that the patient is likely to be taking

Should not produce HepatotoxicityShould not produce cardiovascular or

blood pressure effectsminimal sedationMinimal (or no) sexual dysfunction

12medicalquery@torrentpharma.co

Treatment with Milnacipran4

Good overall tolerabilityWeight neutralFree of cytochrome P450 drug

interactionsNo cardiotoxicityNo sexual dysfunction Long-term treatment with Milnacipran

results in a clear improvement in both depressive symptoms and metabolic parameters

References1. Schram M. T. et. al; Depression and Quality of Life in

Patients with Diabetes: A Systematic Review from the European Depression in Diabetes (EDID) Research Consortium; Current Diabetes Reviews, 2009, 5, 112-119

2. McManamy J; DEPRESSION AND DIABETES; Health Administrator Vol: XXII Number 1& 2 - 2009 : 127-128

3.Jeffrey S. Gonzalez J. S. et.al; Depression, Self-Care, and Medication Adherence in Type 2 Diabetes ; Diabetes Care 30:2222–2227, 2007

4. Abrahamian et al; Diabetes mellitus and co-morbid depression: treatment with milnacipran results in significant improvement of both diseases (results from the Austrian MDDM study group); Neuropsychiatric Disease and Treatment 2009:5 261–266

medicalquery@torrentpharma.com15

Depression+and+Diabetes

Health & Medicine

Transcript of Depression+and+Diabetes

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