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ABSTRACT
Approximately 30% of patients with diabetes experience comorbid depression. There is a significant association between depression and hyperglycemia in type 1 and type 2 diabetes. Also, the adverse consequences of depression in diabetics are the increased risk of the macro- and microvascular complications of diabetes. On the other hand , results from the studies suggest that effective management of depression improves glycemic control. Many newly diagnosed diabetics go through the typical stages of mourning. These are denial, anger, depression and acceptance. They may also show rebellion, anxiety, pathological dependency and regression. Often, individuals with depression do not realize that they are depressed. It is easy to attribute the symptoms of depression to the diabetes. On the basis of Beck Depression Inventory scores, cognitive symptoms are the most reliable means to separate diabetic depressed from diabetic non-depressed patients. In the diagnosis of depression; one should look for affective and cognitive symptoms, rather than the somatic-vegetative signs. Panic attacks may resemble hypoglycemic episodes and vice-versa. Physicians generally select among TCAs, SSRIs, and other newer antidepressant agents to treat depression, reserving monoamine oxidase inhibitors and electroconvulsive therapy largely for severe , unresponsive cases. Factors affecting the selection of an antidepressant for patients with diabetes include presenting symptoms, coexisting medical conditions, drug interactions and side-effect profiles.
Approximately 30% of patients with diabetes experience comorbid depression. There is a significant association between depression and hyperglycemia in type 1 and type 2 diabetes. Also, the adverse consequences of depression in diabetics are the increased risk of the macro- and microvascular complications of diabetes. On the other hand , results from the studies suggest that effective management of depression improves glycemic control. Many newly diagnosed diabetics go through the typical stages of mourning. These are denial, anger, depression and acceptance. They may also show rebellion, anxiety, pathological dependency and regression. Often, individuals with depression do not realize that they are depressed. It is easy to attribute the symptoms of depression to the diabetes. On the basis of Beck Depression Inventory scores, cognitive symptoms are the most reliable means to separate diabetic depressed from diabetic non-depressed patients. In the diagnosis of depression; one should look for affective and cognitive symptoms, rather than the somatic-vegetative signs. Panic attacks may resemble hypoglycemic episodes and vice-versa. Physicians generally select among TCAs, SSRIs, and other newer antidepressant agents to treat depression, reserving monoamine oxidase inhibitors and electroconvulsive therapy largely for severe , unresponsive cases. Factors affecting the selection of an antidepressant for patients with diabetes include presenting symptoms, coexisting medical conditions, drug interactions and side-effect profiles.