DON’T LET DEPRESSION GET YOU DOWN

A presentation by

Gwen K. Weber, Ph.D.

Why is the topic of depression important for those with diabetes?

• “In the United States, people with diabetes are twice as likely as the average person to have depression.” NIMH source.

• Symptoms of depression may reduce overall physical and mental health, not only increasing your risk for diabetes but making diabetes symptoms worse. “Studies have shown that individuals with diabetes and depression have more severe diabetes symptoms than individual who have diabetes alone.” NIMH source.

• The importance of realizing your response to having Diabetes.

FREQUENCY OF DEPRESSION IN THOSE WITH DIABETES

• DISTNGUISHING THE NORMAL LOWS/DEPRESSION VS A CLINICAL DEPRESSION THAT IMPACTS HEALTH.

• DEPRESSION IS MORE COMMON AND OCCURRS MORE FREQUENTLY AND LASTS LONGER THAN AMONG THOSE INDIVIDUALS WITHOUT DIABETES.

• ERATIC BLOOD GLUCOSE LEVELS MAY CAUSE FEELINGS OF DEPRESSION. HIGH BLOOD GLUCOSE CREATES FATIGUE, SLEEPLESSNESS, SAP ENERGY, AND KEEP INDIVIDUAL FROM DAILY ACTIVITIES.

THE CHALLENGING DELIMMA--DEPRESSION

• DEPRESSION MAY “CREEP UP” ON YOU WITHOUT YOUR AWARENES.. IT OFTEN DEVELOPS SLOWLY AND YOU AREN’T AWARE IS HAS OCCURRED.

• YOU DON’T REALIZE/THINK IT IS A PROBLEM.. DENIAL OF IT’S IMPACT ON YOU.

• EVEN IF/WHEN YOU ARE AWARE, YOU DON’T HAVE THE ENERGY TO RESPOND OR “ATTACK IT” IN ORDER TO RECOVER.

• DISTINGUISHING THE DIFFERENCE FROM NORMAL TIMES OF FEELING LOW AND/OR STRESS.

WHY THE INTERELATIONSHIP?

• Vulnerability: Who wanted to have Diabetes? NO ONE!

• Common emotional responses include: These effect self-worth

• Guilt and shame: “I should have…”

• Denial: “I feel ok.. I’ll pretend it isn’t a problem, don’t tell..” Can’t see it

• Anger: “Why me? I’ve always tried my best, etc”

• Overwhelming sense of responsibility: “I can’t do it all the time.”

• Fear: “I only need to think about the future and complications”

“Others don’t accept me, understand, I just can’t do it the way I’m supposed to”

• Failure, Sad: “I’m never going to be good enough according to me or others.”

• Anxiety, “I just can’t handle this now.”

IMPACT OF STRESSORS/STRESS ON DIABETES

• STRESS EFFECTS HORMONE BALANCE AND ALTERS BLOOD GLUCOSE, THE FLIGHT OR FIGHT RESPONSE.

• THE PHYSICAL EFFECTS OF STRESS IMPACTS THE BLOOD SUGAR LEVELS, TYPICALLY INCREASES THE BLOOD SUGAR IN THE BODY.

• STRESS IS FOUND TO IMPACT THE ONSET OF DIABETES IN AN INDIVIDUAL

• STRESS IS DIFFERENT FOR EACH INDIVIDUAL- KNOW YOUR STRESSORS

ASSESSING DEPRESSION: CHARACTERISTICS

• FEELINGS

• THOUGHTS/INTELLECTUAL

• BEHAVIORS

• PHYSICAL SYMPTONS

• ENVIRONMENTAL INFLUENCES

• FINANCIAL CHANGES

• SPIRITUAL

• SOCIAL INTERACTIONS AND CONTEXT

EXPRESSIONS OF FEELINGS IN DEPRESSION

• HAVING LITTLE ENERGY COMPARED TO PREVIOUS AFFECT

• MOODY AND APPEARS OR EXPRESSES SADNESS, TEARFUL

• IRRITABLE, “I DON’T CARE OR GIVE UP, I CAN’T DO IT

• PERSISTENT SADNESS OR FEELING EMPTY, BORED, OR EMPTY

• HOPELESSNESS, GIVING UP

• DEPENDENT ON ANOTHER OR OTHERS TO MANAGE PERSONAL NEEDS

• ANGER, IMPATIENT, NEGATIVE EMOTIONAL EXPRESSIONS

• AGITATION AND IRRISPONSIBLE

AGITATED DEPRESSION/ ANGER

• THERE IS AN ASSOCIATION BETWEEN ANGER, DIABETES MANAGEMENT, AND OTHER HEALTH PROBLEMS

• THE RUSH OF HORMONES ADRENALINE, CORTISOL CREATES GREATER HEART RATE, BLOOD PRESSURE, AND SUGAR METABOLISM (THE FIGHT OF FLIGHT RESPONSES)

• HIGH LEVELS OF HOSTILITY ARE MORE LIKELY TO HAVE INSULIN RESISTANCE AND LEAD TO DIABETES OR INSULIN RESISTANCE

• INTERNAL ANGER INCREASES THE RISK OF HEART ATTACK EIGHT FOLD

• wsj 3/24/15

THOUGHTS REFLECTING DEPRESSION

• NEGATIVE THINKING OR PERCEIVING A CAPACITY TO CHANGE

• DIFFICULTY FOCUSING, MAKING DECISIONS, CONCENTRATING

• DISTRUSTING YOURSELF TO MAKE A DECISION OR ACHIEVE A GOAL

• RACING THOUGHTS, IMPATIENT WITH SELF OR OTHERS

• DIFFICULTY BEING COMMITTED TO A GOAL.

• DISBELIEF IN PERSONAL ABILITIES OR OTHERS CAPACITIES TO HELP

• VIEWING SELF AS A BURDEN TO OTHERS

• QUITING AN EFFORT, I CAN’T DO IT..

BEHAVIORS EXHIBITING DEPRESSION

• LACK OF PERSONAL CARE HABITS

• CRYING, EASILY TEARING, BURSTING INTO TEARS

• STATING BEING A BURDEN TO ANOTHER OR OTHERS

• DECREASED INTEREST IN USUAL ACTIVITIES OR OTHERS

• CHANGE IN SLEEP PATTERNS, MORE OR LESS, INSOMMIA

• WITHDRAWAL FROM OTHERS, DISTRUST SELF

• IMPATIENT WITH SELF OR ANOTHER, OTHERS

• EATING HABITS CHANGE, EATING LESS OR MORE

• USING ALCOHOL OR DRUGS TO ESCAPE PROBLEMS

OR CONCERNS

ADDITIONAL EXACERBATING FACTORS

• GENETIC VULNARABILITY

• PROLONGED STRESSORS OR TENSIONS, EXPECTATIONS

• ILLNESS, SURGERY, PHYSICAL TRUAMA

• INTERPERSONAL RELATIONSHIP STRESSES OR DISSONANCE

• UNRESOLVED EMOTIONAL EXPERIENCES OR PREVIOUS EXPERIENCE

• LACK OF POSITIVE REINFORCEMENT IN ENVIRONMENT OR OTHERS

• LET DOWN AFTER ANTICIPATING OR HAVING AN EXCITING REWARDING EXPERIENCE.. “WHAT’S LEFT?”

SKILLS TO RESPOND TO DEPRESSION-CHANGE

• ACKNOWLEDGE THE CONCERN, ACQUIRE OJBECTIVE INFORMATION

• CONSIDER THE ETIOLOGY, SOURCES OF YOUR DEPRESSION

• IDENTIFY HOW YOUR LIFE WOULD IMPROVE WITH CHANGES

• CONSIDER YOUR STYLE OR MANNER IN WHICH YOU MAKE CHANGES

• IDENTIFY YOUR STRENGTHS THAT YOU HAVE TO MAKE CHANGES.

• ACQUIRE SUPPORT OF OTHERS AS NEEDED.

• BECOME YOUR OWN MOTIVATIONAL COACH.

DECIDING TO CHANGE: TREATMENT

• “INDIVIDUALS WITH DIABETES AND DEPRESSION WHEN

TREATED FOR DEPRESSION RAISE MOOD LEVELS AND

INCREASE BLOOD GLUCOSE CONTROL” (NIMH SOURCE)

A GOOD REASON TO IMPROVE

• SEEK INFORMATION FROM OTHER INDIVIDUAL’S PERCEPTIONS

• ACCURATE ASSESSMENTS ASSISTS DECISIONS FOR TREATMENT

• COGNITIVE, BEHAVIORAL, EMOTIONAL, SPIRITUAL, PHYSICAL, SPIRITUAL, AND ENVIRONMENTAL CHANGES- etiological factors

• MEDICATIONS

MONITORING AND ALTERING SELF WORTH

• TALK TO YOUR DIABETES: WHAT WOULD YOU SAY? CONFRONT YOUR FEELINGS AND VIEWS ABOUT HAVING DIABETES.

• CHALLENGE YOURSELF TO TACKLE WHAT DIABETES DOES TO YOU.• TAKE ON THE TASK OF WINNING OVER IT.. “I’LL SHOW YOU!” VIEW. • ASSERT YOURSELF FOR THE RIGHT TO BE HEALTHY..

• ACKNOWLEDGE YOUR FEARS AND CONSIDER OPTIONS TO HELP OVERCOME THEM.. WHAT NEEDS TO HAPPEN?

• INTEGRATE A HEALTHFUL SELF-VIEW OF YOURSELF WITH DIABETES.

• ASSERT TO OTHERS TO ASSURE THE TASKS YOU NEED TO MANGE IT.

• DEVELOP RESPONSES FOR OTHERS IF NEEDED. (HUMOR ETC.)

PHYSICAL INTERVENTIONS

• IMPROVING DIABETES MANAGEMENT/ CONTROL A1C

• EXERCISE AND ACTIVITY LEVEL. HABITUALLY DO WHAT YOU ENJOY

• STRESS MANAGEMENT SKILLS, DEEP BREATHING/RELAXATION

• CONSIDER HOW GOOD YOU FEEL HEALTHY-IT’S WORTH THE EFFORT

• MEDICATIONS TO IMPROVE SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITOR LEVELS-ANTIDEPRESSANT MEDICATIONS

• OTHER RELATED MEDICATIONS: TRICYCLICS ETC.

• THE MEDICATION OPTIONS TODAY ARE NUMEROUS, HAVE A SKILLED PROFESSIONAL DETERMINE THE BEST ONE FOR YOU

COGNITIVE INTERVENTIONS

• CBT PARADIGM: COGNITIVE, BEHAVIOR, FEELINGS INTERACTIONS

• MAKE A CLEAR DECISION TO MAKE SOME CHANGES. YOU ARE THE ONE!!

• INCREASE YOUR MOTIVATION, DETERMINATION, TRUST IN SELF

• CHANGE YOUR THOUGHTS ABOUT YOURSELF- SELF TALK

• DEVELOP HABITS OF POSITIVE INTERPRETATIONS OF EXPERIENCES

• SELF MONITOR RELAPSE AND CHANGE IN POSITIVE VIEW VS NEGATIVE

• PROBLEM SOLVING SKILLS AND END DICHOTOMOUS THINKING

• REALITY TESTING, CHALLENGE BELIEFS

• IDENTIFY REASONALBE GOALS YOU CAN DO. TRY AGAIN IF NEEDED

• DEVELOP ASSERTIVE SKILLS TO PROMOTE YOUR NEEDS FOR GOOD MANAGEMENT

• SPIRITUAL AWARENESS AND BELIEFS

BEHAVIORAL INTERVENTIONS

• INCREASE INTERACTIONS WITH OTHERS WHO ARE

POSITIVE AND SUPPORTIVE, CHANGE YOUR

ENVIRONMENTAL CONTEXT

• ACTIVITY SCHEDULING: BEGIN TO BE DISCIPLINED TO DO IT!

• TELL OTHERS WHAT YOU HAVE ACCOMPLISHED-SEEK PRAISE

• GRADUAL GOAL, OR TASK ASSIGNMENT TO PROGRESS

• DO BEHAVIORAL EXPERIMENTS AND REHERSAL = CONFIDENCE

• PRETEND - PRACTICE EXPERIENCING WHAT YOU WANT TO ACHIEVE

• ASSERT YOURSELF, SEEK OTHER’S ASSISTANCE TO HELP YOU

UTILIZE THE SMART MODEL FOR CHANGE

• SPECIFIC OBJECTIVE OR GOALS POSSIBLE FOR YOU TO ACHIEVE

• MEASURABLE MONITOR OF PROGRESS

• ACTION ORIENTED PLAN: SPECIFY THE TASK YOU WILL DO

• REALISTIC OUTCOMES IDENTIFIED. EVEN SMALL CHANGE COUNTS.

• TIME BOUND. ESTABLISH A TARGET TIME FOR ACHIEVEMENT

• BEGIN A DAY AT THE TIME OR ONE TASKS AT A TIME IF NEEDED.

• REWARD/PRAISE YOUR SELF FOR ANY CHANGE… I DID IT!!!

YOU CAN DO IT: CHANGE VS DEPRESSION

ACKNOWLEDGE DEPRESSED FEELINGS ARE OFTEN PRESENT AS AN INDIVIUAL WITH DIABETES

REALIZE THE IMPACT OF YOUR FEELINGS ON YOUR EFFORTS TO MANAGE CONTROL OVER YOUR DIABETES

IDENTIFY POSITIVE WAYS TO REINFORCE YOUR MANGEMENT OF DIABETES

YOU ARE NOT ALONE.. BUT ONLY YOU CAN BE THE ONE TO DO IT.

CHALLENGING QUESTIONS/DISCUSSION?

WHAT CONCERNS, QUESTIONS, EXAMPLES WOULD YOU LIKE TO SHARE THAT WOULD BE HELPFUL OR OF INTEREST TO OTHERS PRESENT?

THANK YOU, DR. GWEN WEBER