1. DIABETES AND DEPRESSION

2. CONTENTS OBJECTIVES WHAT IS DIABETES WHAT IS DEPRESSION
CAUSES OF DEPRESSION
EFFECTS OF DEPRESSION
DEPRESSION & DIABETES
IDENTIFYING DEPRESSION
TREATMENT
SUGGESTION

3. OBJECTIVES
Become cognizant of the relationship between diabetes and depression.
Become familiar with treatment options for Diabetes.

4. WHAT IS DIABETES?
Chronic disease of carbohydrate metabolism characterized by hyperglycemia.
Insufficient insulin production and release.

5. WHAT IS DIABETES? (Patient view)
Dietary changes
Insulin shots ( cure?)
Can’t eat sweets
A big bother

6. WHAT IS DIABETES? Diabetes is a Life Partner Regular Diet Routine
Healthy Life Style
Regular Health Checkup

7. WHAT IS DEPRESSION?
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

8. Fatigue or lack of energy
continued…….
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

9. CAUSES OF DEPRESSION Family History Personality Traits
Childhood Trauma
Environmental
Some Illnesses
Some Medications

10. EFFECTS OF DEPRESSION Decreased Self-Esteem Unmotivated Appearance
Poor Hygiene
Loss of Strategies

11. DIABETES AND DEPRESSION

12. DEPRESSION POPULATIONS

13. WHY WORRY ?
Depressed diabetics have earlier, more severe prevalence of physical problems.
Diabetics report earlier onset than general population

14. CAUSES OF DEPRESSION IN DIABETES
Diabetes treatment plan changes
Response of family / friends
Undergoing a major life event like moving, getting married
Not achieved diabetes control
Diagnosis of some other chronic illness or disability.

15. EFFECT OF DEPRESSION IN DIABETES
Decreased adherence to treatment plan
Worse glucose control
Increased complications
Decreased overall functional well-being
Sub-optimal self-care

16. REASONS FOR SUB-OPTIMAL SELF-CARE
Lack of motivation & energy
Negative thought patterns
Self blame for negative events
Believe negative events will repeat in
future
Expect same negative results

17. DEPRESSION AS A CONTRIBUTOR TO DIABETIC MORBIDITY AND MORTALITY
Significantly associated with hyperglycemia especially using standardized interviews. (Lustman 2000)
Associated with retinopathy, nephropathy,
macrovascular complications & sexual dysfunction (deGroot 2001)
Coronary heart disease more rapid in
depressed women (Clouse 2003)

18. IDENTIFYING DEPRESSION
WHO ( World Health Organization) has published a tool for screening DEPRESSION

19. How much of the time...
All of the time
Most of the time
More than half of the time
Less than half of the time
Some of the time
At no time 1
Have you felt in low spirits or sad? 5 4 3 2
Have you lost interest in your daily activities?
Have you felt lacking in energy and strength?
Have you felt less self-confident?
Have you had a bad conscience or feelings of guilt? 6
Have you felt that life wasn't worth living? 7
Have you had difficulty in concentrating, e.g. when reading the newspaper or watching television? 8a
Have you felt very restless? 8b
Have you felt subdued? 9
Have you had trouble sleeping at night?

20. HOW CAN WE HELP ?
Assessment
Talk with Patient –MOST IMPORTANT

21. BRIEF SELF-ASSESSMENT
Diabetes History
Medical History
Family & friends support
Dietary changes
Life style
Work place

22. TREATMENT Medication Stress Management Problem Solving
Refer for Counseling
Support Group
Cognitive behavioral therapy

23. COGNITIVE BEHAVIORAL THERAPY
Works with patients on their cognitions or
thoughts to interrupt self-perpetuating
cycles
Negative thoughts
Low mood
Decreased motivation
Inactivity

24. SUGGESTION Acceptance Talk with other diabetic people.
Make a mental list of all the things you enjoy.
Develop healthy lifestyle
Exploring goals and values
Imagine extremes
Review personal strength and support
Supportive relationship