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DEPRESSION AND DIABETES A synopsis based on the WPA volume “Depression and Diabetes” (Katon W, Maj M, Sartorius N, eds.

DEPRESSION AND DIABETES A synopsis based on the WPA volume “Depression and Diabetes” (Katon W, Maj M, Sartorius N, eds. – Chichester: Wiley, 2010). Epidemiology of depression and diabetes.

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DEPRESSION AND DIABETES A synopsis based on the WPA volume “Depression and Diabetes” (Katon W, Maj M, Sartorius N, eds.

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  1. DEPRESSION AND DIABETES A synopsis based on the WPA volume “Depression and Diabetes” (Katon W, Maj M, Sartorius N, eds. – Chichester: Wiley, 2010)

  2. Epidemiology of depression and diabetes • In people with diabetes, the prevalence of clinically relevant depressive symptoms is 31% and that of major depression is 11% (Anderson et al., 2001). • People with depressive disorders have a 65% increased risk of developing diabetes (Campayo et al., 2010). • The prognosis of both diabetes and depression (in terms of complications, treatment resistance and mortality) is worse when the two diseases are comorbid than when they occur separately. • From Lloyd CE et al. The epidemiology of depression and diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  3. People with both depression and diabetes have a greater decrement in self-reported health than those with depression and any other chronic disease (Moussavi et al., Lancet 2007;370:851-858). From Lloyd CE et al. The epidemiology of depression and diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  4. Health care utilization is significantly higher among depressed compared with non-depressed diabetes patients (US 1996 data). From Egede LE. Medical costs of depression and diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  5. Health care expenditures are significantly higher in depressed than in non-depressed diabetes patients (US 1996 data). From Egede LE. Medical costs of depression and diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  6. Depression and diabetes complications • A prospective association has been documented between prior depressive symptoms and the onset of coronary artery disease in people with diabetes (Orchard et al., 2003). • A prospective association has been found between depression and the onset of retinopathy in children with diabetes (Kovacs et al., 1995). • Depressive symptoms are more common in diabetes patients with macro- and micro-vascular problems, such as erectile dysfunction and diabetic foot disease, although the causal direction of the relationship is unclear (Thomas et al., 2004). • From Lloyd CE et al. The epidemiology of depression and diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  7. Diabeticpopulation Non-diabeticpopulation A strong association has been found between depressive symptoms (as assessed by the Center for Epidemiological Studies - Depression Scale, CES-D) and increased mortality in people with diabetes, but not in those without diabetes, after adjusting for socio-demographic and lifestyle factors (Zhang et al., Am. J. Epidemiol. 2005;161:652-660). From Lloyd CE et al. The epidemiology of depression and diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  8. The depression-diabetes link: behavioural factors • Depression is associated with reduced physical activity, which increases the risk for obesity and consequently for type 2 diabetes. • Depression is associated with poor diabetes self-care (including oral medication taking, dietary modifications, exercising and monitoring of blood glucose). • Emotional problems related to diabetes may lead to the development of depression. • From Lloyd CE et al. The epidemiology of depression and diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  9. The depression-diabetes link: biological factors • Depression is a phenotype for a range of stress-related disorders which lead to an activation of the hypothalamic-pituitary-adrenal axis, a dysregulation of the autonomic nervous system and a release of pro-inflammatory cytokines, ultimately resulting in insulin resistance. • Metabolic programming at the genetic level and undernutrition (in utero and childhood) may predispose to both diabetes and depression. • From Ismail K. Unravelling the pathogenesis of the depression-diabetes link. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  10. Practical problems arising from depression-diabetes comorbidity - I From Hellman R, Ciechanowski P. Diabetes and depression: management in ordinary clinical conditions. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  11. Practical problems arising from depression-diabetes comorbidity - II From Hellman R, Ciechanowski P. Diabetes and depression: management in ordinary clinical conditions. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  12. Practical problems arising from depression-diabetes comorbidity - III From Hellman R, Ciechanowski P. Diabetes and depression: management in ordinary clinical conditions. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  13. Efficacy trials of psychotherapies for depression in diabetes From Katon W, van der Felz-Cornelis C. Treatment of depression in patients with diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  14. Efficacy trials of medications for depression in diabetes From Katon W, van der Felz-Cornelis C. Treatment of depression in patients with diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  15. Depression care in patients with diabetes: Step 1 • Screen for: • Depression with the Patient Health Questionnaire - 9 (PHQ-9) • Helplessness/”giving up” or sense of being overwhelmed about disease self-management • Comorbid panic attacks and post-traumatic stress disorder • Inability to differentiate anxiety symptoms from diabetes symptoms (e.g., hypoglycemia) • Associated eating concerns • Emotional eating in response to sadness/loneliness/anger • Binge eating/purging • Night eating From Katon W, van der Felz-Cornelis C. Treatment of depression in patients with diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  16. Depression care in patients with diabetes: Step 2 • Improve self-management: • Explore “loss of control” of disease self-management • Explore understanding of bidirectional link between stress and suboptimal disease self- • management and outcomes • Define depression and how it overlaps with and is distinct from “stress” • Review symptoms of depression and how these symptoms overlap with or mimic diabetes • symptoms • Discuss depression-related medical symptom amplification • Break down tasks in self-management of diabetes, depression, other illnesses • Help patient prioritize order of importance of specific tasks From Katon W, van der Felz-Cornelis C. Treatment of depression in patients with diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  17. Depression care in patients with diabetes: Step 3 • Support: • Consider adjunctive brief psychotherapy for: • emotional eating (cognitive-behavioural therapy) • breaking down problems (problem-solving therapy) • improving treatment adherence (motivational interviewing) From Katon W, van der Felz-Cornelis C. Treatment of depression in patients with diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  18. Depression care in patients with diabetes: Step 4 • Consider medication: • Comorbid depression and anxiety: SSRI or SNRI • Sexual dysfunction: use bupropion or, if already responding to SSRI, add buspirone • Significant neuropathy: choose bupropion, venlafaxine or duloxetine due to effectiveness • in treating neuropathic pain From Katon W, van der Felz-Cornelis C. Treatment of depression in patients with diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  19. Enhanced treatment of depression in patients with diabetes is associated with lower health care costs over a 2-year period. From Katon W, van der Felz-Cornelis C. Treatment of depression in patients with diabetes. In: Depression and Diabetes. Katon W, Maj M, Sartorius N (eds). Chichester: Wiley, 2010.

  20. Acknowledgements This synopsis is part of the WPA programme aiming to raise the awareness of the prevalence and prognostic implications of depression in persons with physical diseases. The support to the programme of the Lugli Foundation, the Italian Society of Biological Psychiatry, Eli-Lilly and Bristol-Myers Squibb is gratefully acknowledged. The WPA is grateful to Dr. Andrea Fiorillo, Naples, Italy for his help in the preparation of this synopsis.

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