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Diabetes and co-morbid Depression
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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 [email protected]
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
m
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
![Depression, distress and self-efficacy: The impact …...depression [3]. Depression adds to the burden of managing diabetes, as those with depression perform poorer diabetes self-care](https://static.fdocuments.us/doc/165x107/5f1844074dbc4e10542f138e/depression-distress-and-self-efficacy-the-impact-depression-3-depression.jpg)
