9/15/2017. Behavioral Health/Depression Sheritta A. Strong, MD I HAVE NO FINANCIAL DISCLOSURES
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1 Behavioral Health/Depression Sheritta A. Strong, MD I HAVE NO FINANCIAL DISCLOSURES 1
2 Goal (Symposium Objective): Identify self-care behaviors in relation to being active, healthy eating, and healthy coping Objectives Discuss the bi-directional influence between diabetes and depression. Explain how the stress response is implicated in both conditions. Summarize strategies to help your patients improve their self-care behaviors. 2
3 What we know about the relationship? Many patients with depression have diabetes And, many patients with diabetes have depression Campayo et al. Diabetes and Depression. Curr Psychiatry Rep (2011) 12: The scope of the problem Nearly a 1/3 of persons with diabetes suffer from clinically relevant depressive disorders. Persons with depressive disorders are 2X as likely as the rest of the population to also suffer from diabetes The Dialogue on Diabetes and Depression - 3
4 INTERPRET DD A combination of screening for depression alongside monitoring of diabetes-related emotional distress during routine clinical care could optimize patient well-being and quality of life. Study Protocol of Diabetes and Depression (DAD): This is the first RCT comparing antidepressants to a psychological treatment in diabetes and depression. Psychological Well- Being in Outpatients With Diabetes The results support the recommendation to monitor psychological wellbeing in patients with diabetes. Campayo et al. Diabetes and. Depression Curr Psychiatry Rep (2011) 12:
5 Cost Mortality Morbidity Cost Mortality Morbidity 5
6 Screening is key! Holt, Richard and Christina M. van der Felz-Cornelis. Key Concepts in Screening for Depression in People with Diabetes. Journal of Affective Disorders. 2012:S72-S79; The ADA recommends: Regular screening of depression for people with diabetes Holt, Richard and Christina M. van der Felz-Cornelis. Key Concepts in Screening for Depression in People with Diabetes. Journal of Affective Disorders. 2012:S72-S79; 6
7 People with diabetes who are less likely to discuss their self-care issues Berry et al. Diabetes distress: understanding the hidden struggle of living with diabetes and exploring intervention strategies. Postgraduate Medicine Journal. 2015:91: People with diabetes who are less likely to discuss their self-care issues Report: Higher distress from diabetes Poor quality of life Less frequent self-management behaviors, and Less self-motivated coping strategies Therefore, ask: Which aspects are the most difficult? How can I help you manage you condition better? Berry et al. Diabetes distress: understanding the hidden struggle of living with diabetes and exploring intervention strategies. Postgraduate Medicine Journal. 2015:91:
8 Consequences of Depression in Diabetes Impairs QOL Adversely affects diabetes outcomes Poorer self-care behavior Diet and exercise advice followed less rigorously Less likely to monitor glucose Less likely to take medications are prescribed Holt, Richard and Christina M. van der Felz-Cornelis. Key Concepts in Screening for Depression in People with Diabetes. Journal of Affective Disorders. 2012:S72-S79; How are moods related to glucose levels? Lower A1C Levels Associated well-being and perceived health status Higher A1C Levels Vascular complications etc as well as development of depression Lustman, Patrick and Ray Clouse. Depression in diabetic patients: The relationship between mood and glycemic control. Journal of Diabetes and Its Complications. 19 (2005)
9 What is the association between diabetes and depression? 9
10 Stress & its Effects on Glucose Levels and Moods 10
11 Patient Provider Fiore et al. The association between diabetes and depression: a very disabling condition. Endocrine. 2015; 48: Goal (Symposium Objective): Identify self-care behaviors in relation to being active, healthy eating, and healthy coping 11
12 Hmmm Do you regulate the glucose or treat the depression first? Both???? 12
13 CBT AntiDs Glucose Control Best management of Depression in Diabetes 13
14 Self-Care Behaviors & Treatment Strategies of Depression - Pharmacotherapy SSRIs and SNRIs are helpful Sertraline may lower glucose levels Weight gain is variable DNRI Bupropion is also #2helpful Thought to have less weight gain Med trial #1 Med trial Referral to psychiatry Older ADs such as TCAs can increase HbA1C Remission and prevention of relapse is the goal Holt, Richard and Christina M. van der Felz-Cornelis. Key Concepts in Screening for Depression in People with Diabetes. Journal of Affective Disorders. 2012:S72-S79. 14
15 Self-Care Behaviors & Treatment Strategies of Depression - Therapies Cognitive Behavioral Therapy (CBT) Interpersonal Therapy (IPT) Motivational Interviewing (MI) In multiple trials, glycemic control improved with psychological interventions esp. CBT Example of CBT Sessions 15
16 Self-Care Behaviors & Treatment Strategies of Depression Diabetes Support CBT DM Education Improved wellbeing Dec glucose Lustman, Patrick and Ray Clouse. Depression in diabetic patients: The relationship between mood and glycemic control. Journal of Diabetes and Its Complications. 19 (2005)
17 In summary Depression should be managed effectively first before patients can muster up the energy to manage their diabetes. Attention to depression, emotional well-being, and healthy relationship is not a secondary consideration in chronic disease care but, based in the evidence, of central importance. References: Badescu et al. The association between Diabetes mellitus and Depression. Journal of Medicine and Life. Vol 9, Issue2; April-June Barnard, KD, TC Skinner, and R. Peveler. The Prevalence of co-morbid depression in adult with Type 1 diabetes: systematic literature review. Diabetic Medicine, 23: Berry et al. Diabetes distress: understanding the hidden struggle of living with diabetes and exploring intervention strategies. Postgraduate Medicine Journal. 2015:91: Campayo et al. Diabetes and Depression. Curr Psychiatry Rep (2011) 12: Fiore et al. The association between diabetes and depression: a very disabling condition. Endocrine. 2015; 48:14-24 Fisher et al. Co-occurrence of diabetes and depression: Conceptual considerations for an emerging global health challenge. Journal of Affective Disorders. 142S1 (2012)S56-S66. Francois Pouwer et al. Monitoring of Psychological Well-Being in Outpatients With Diabetes. Diabetes Care. Vol 24:11, Nov Gragnoli, Claudia. Depression and Type 2 Diabetes: Cortisol Pathway Implication and Investigational Needs. Journal of Cellular Physiology. Vol. 227: , Holt, Richard and Christina M. van der Felz-Cornelis. Key Concepts in Screening for Depression in People with Diabetes. Journal of Affective Disorders. 2012:S72-S79; Lustman, Patrick and Ray Clouse. Depression in diabetic patients: The relationship between mood and glycemic control. Journal of Diabetes and Its Complications. 19 (2005) Petrak et al. Study Protocol of Diabetes and Depression: a multi-center randomized controlled trial to compare the efficacy of a diabetes-specific cognitive behavioral group versus sertraline in patients with major depression and poorly controlled diabetes mellitus. BMC Psychiatry. 2013, 13:206. The Dialogue on Diabetes and Depression
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