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  1. 1. Diabetes and co-morbid Depression
  2. 2. "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_address]
  3. 3. [email_address]
  4. 4. Diabetes <ul><li>Is metabolic disorder </li></ul><ul><li>Body does not produce or properly uses insulin </li></ul><ul><li>blood glucose (sugar) becomes too high </li></ul><ul><li>3 main types of diabetes: </li></ul><ul><ul><li>Type 1 Diabetes </li></ul></ul><ul><ul><li>Type 2 Diabetes </li></ul></ul><ul><ul><li>Gestational Diabetes </li></ul></ul>[email_address]
  5. 5. Depression <ul><li>DSM-IV criteria </li></ul><ul><li>Depressed Mood: Sad, anxious or irritable feelings, flat affect </li></ul><ul><li>Anhedonia: loss of pleasure in most activities </li></ul><ul><li>Weight/appetite changes : Decreased weight without dieting, increased weight </li></ul><ul><li>Sleep Disturbance: Insomnia or hypersomnia </li></ul><ul><li>Fatigue or lack of energy </li></ul><ul><li>Psychomotor Changes: Agitated or slower than usual </li></ul><ul><li>Feelings of Worthlessness or Guilt </li></ul><ul><li>Impaired Concentration : difficulty making decisions… </li></ul><ul><li>Thoughts of death /suicide </li></ul>[email_address]
  6. 6. Prevalence <ul><li>According to the International Diabetes Federation, 189 million individuals have Diabetes world wide 1 </li></ul><ul><li>Individuals with Diabetes have a two-fold increased risk for Depression, affecting approximately 1 in every five Diabetes </li></ul><ul><li>patients 1 </li></ul><ul><li>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 </li></ul><ul><li>Depression is under-recognized in patients with Diabetes </li></ul><ul><li>When they co-exist, one may worsen the other </li></ul>[email_address]
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  8. 8. Outcome of Diabetes Mellitus and co-morbid Depression 1,3 <ul><li>Greater risk for Heart disease 1,3 </li></ul><ul><li>Higher body mass indexes 1 </li></ul><ul><li>Hyperglycemia 1,3 </li></ul><ul><li>Worse diabetes self-care, reflected by a worse adherence to diet and exercise advice </li></ul><ul><li>Increased mortality risk </li></ul>[email_address]
  9. 9. Outcome of Diabetes Mellitus and co-morbid Depression <ul><li>Depression can influence physical outcomes, such as: </li></ul><ul><ul><li>Recovery from myocardial infarction </li></ul></ul><ul><ul><li>Survival with malignancy </li></ul></ul><ul><ul><li>Propensity to infection </li></ul></ul><ul><li>Synergistic interaction between diabetes and depression, result in 4 </li></ul><ul><ul><li>Decreased metabolic control </li></ul></ul><ul><ul><li>Higher incidence of micro- and macro-angiopathic diabetic late complications </li></ul></ul><ul><ul><li>Decreased quality of life </li></ul></ul>[email_address]
  10. 10. Comparison of Physical Health and Mental Health between Diabetic Individuals with and without Depressive symptoms 1 <ul><li>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 depressive </li></ul><ul><li>symptoms 1 </li></ul>[email_address]
  11. 11. Management <ul><li>Cognitive Behavioral Therapy </li></ul><ul><li>Antidepressant pharmacotherapy </li></ul><ul><li>Compliance with both Diabetic and Anti-depressant medications </li></ul><ul><li>Good diet </li></ul><ul><li>Sleep </li></ul><ul><li>Exercise </li></ul><ul><li>Avoidance of </li></ul><ul><li>stress </li></ul>[email_address]
  12. 12. Choice of Antidepressants 4 <ul><li>Antidepressant should have no influence on body weight </li></ul><ul><li>No interactions with the numerous medications that the patient is likely to be taking </li></ul><ul><li>Should not produce Hepatotoxicity </li></ul><ul><li>Should not produce cardiovascular or blood pressure effects </li></ul><ul><li>minimal sedation </li></ul><ul><li>Minimal (or no) sexual dysfunction </li></ul>[email_address]
  13. 13. Treatment with Milnacipran 4 <ul><li>Good overall tolerability </li></ul><ul><li>Weight neutral </li></ul><ul><li>Free of cytochrome P450 drug interactions </li></ul><ul><li>No cardiotoxicity </li></ul><ul><li>No sexual dysfunction </li></ul><ul><li>Long-term treatment with Milnacipran results in a clear improvement in both depressive symptoms and metabolic parameters </li></ul>[email_address]
  14. 14. References <ul><li>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 </li></ul><ul><li>McManamy J; DEPRESSION AND DIABETES; Health Administrator Vol: XXII Number 1& 2 - 2009 : 127-128 </li></ul><ul><li>Jeffrey S. Gonzalez J. S.; Depression, Self-Care, and Medication Adherence in Type 2 Diabetes ; Diabetes Care 30:2222–2227, 2007 </li></ul><ul><li>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 </li></ul>[email_address]
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