Preventing diabetes-related depression -
The inclusion criteria were follows: 1 participants aged 18 and over with diagnosed or otherwise confirmed or established T2D; 2 experimental design such as randomized controlled trials as well as quasi-experimental designs including pre-post schemes , cohort studies, case control studies, and mixed-method studies; 3 any form of prevention approach or intervention strategy including educational programs or other seeking to prevent the onset of depression or prevent the worsening of non-clinical depressive symptoms; 4 a valid measure of depressive symptoms, for example, the Beck Depression Inventory BDI 30 , and the Center for Epidemiological Studies Depression Scale CES-D 31 ; 5 full-text articles available in English or French.
where the primary objective was remediating an existing i. Pertinent articles were identified by searching several databases, including Medline, Embase, Cochrane Database of Systematic Reviews, PsycINFO, PubMed, and Scopus.
A search strategy was developed and tested using a combination of terms Supplemental File 1. The number of publications increased significantly after , reflecting a growing interest in this area post The search was thus limited to publication dates between January and May Articles reporting secondary analyses of data were included.
The final search strategy was deemed satisfactory following independent screening by two evaluators EG, LA of the first excluded articles to confirm warranted removal.
Results of the database search were uploaded to Distiller Systematic Review DSR software to facilitate the process of article screening and selection as well as data extraction between the three reviewers EG, LA, HJ.
Screening forms were developed in DSR for each level of screening. These were pilot tested and refined accordingly by the evaluators. Independently and in duplicate, the three evaluators screened titles for relevance.
Titles deemed relevant by one or both evaluators were retained for abstract screening. Similarly, the evaluators subsequently examined the list of abstracts to identify those deemed worthy of full article screening. In the case of disagreement during abstract screening, discrepancies were discussed until agreement was reached regarding inclusion.
Lastly, the full-texts of the remaining articles were surveyed for final inclusion. As required, an impartial third evaluator CA provided their advice regarding the article's selection. For all studies included in the final review, data were extracted conforming to the PICO framework with the following variables:.
Sample size, location of study, sex or gender, ethnicity, age, and if available HbA1c levels, body mass index BMI , and duration of T2D months or years. Intervention target, intervention type and modality e.
individual , context e. if applicable number of comparators and type s of comparator s e. Primary depression measure instrument , list of all outcomes evaluated in the study i.
In regards to depression, as the goal of this study was not to systematically evaluate intervention effects quantitatively, a general synopsis of impact was extracted.
Specifically, the following information was pulled for each intervention study as available: a statistical change in depression over time from baseline i. As the goal of this scoping review was to identify and examine studies in which the main aim was preventing the onset or worsening of depressive symptoms, included studies were divided as follows: 1 depressive symptoms or levels as the primary or sole outcome; 2 depressive symptoms or levels as a secondary or unspecified intervention measure or outcome.
The reviewed studies were first described according to study and intervention characteristics Table 1 , participant characteristics Table 2 , and intervention effects on depression Table 3.
We conducted a narrative, descriptive synthesis of contextual delivery factors and active intervention ingredients. In a scoping review, experts recommend a qualitative content analysis be conducted in light of the emerging body of evidence on the topic as well as variability in study designs and participant samples.
In our study, we consider the similarities, differences, and implications of the included intervention strategies, including their design and implementation. Table 2. Participant characteristics for 12 included studies results provided for the full sample unless otherwise specified.
Consistent with scoping review recommendations and the Joanna Briggs Institute manual 28 , 29 , an appraisal of the quality of included sources and an assessment of risk of bias were not conducted The initial search identified 4, studies for triage after duplicate removal Figure 1.
After inspection of the titles, the reduced list consisted of entries for abstract screening. Filtering of the abstracts resulted in articles deemed relevant for full-text screening. The product of the full-text examination consisted in 12 eligible articles that focused specifically on preventing depression or improving non-clinical depressive symptoms as a primary objective, and 56 studies in which depression was considered a secondary aim i.
For the purposes of this study, we present a detailed synopsis of the 12 intervention studies that focused on preventing depression Tables 1 — 3. A tabular overview of the secondary studies is available as a Supplementary Table S1.
As shown in Table 3 , the most common measure of depression was the CES-D Four studies 33 , 35 , 36 , 39 were individual-based while five 34 , 37 , 42 — 44 used group formats and one study 40 reported a combination of individual and group approaches.
Two studies 32 , 41 did not specify the delivery format and at least one study 33 exploited an online delivery. Eight of the 12 studies 33 — 36 , 39 — 41 , 43 used a variant of a randomized design while three studies 37 , 42 , 44 followed a pre-post scheme and one 32 used a quasi-experimental design.
The duration of each intervention was variable, ranging from a few hours [e. Based on the findings presented in Table 3 , a significant positive effect on levels of depression was reported in six of the 12 studies 32 — 34 , 36 , 39 , In the sections that follow, key intervention components and delivery strategies are described for the 12 included studies.
We grouped the interventions on a spectrum from structured programs i. Fisher et al. Participants received instructions about how to identify problematic glycemic patterns. They recorded their SMBG profile during three consecutive days prior to scheduled study visits. During visits, forms were reviewed with a physician and suggestions for changes to exercise, nutrition, and medication were made.
Given positive results of the intervention on depressive symptoms, particularly among participants with more elevated depression scores, the authors concluded that this type of collaborative approach between patient and physician could help patients deal with the emotional strain of managing their T2D.
In itself, self-monitoring of glucose is a strongly advocated strategy among health professionals for facilitating treatment adherence The observational element is also thought to improve patient experiences and encourage more positive attitudes toward T2D, thereby increasing disease and treatment satisfaction This may in turn prevent the development of negative mood patterns in individuals with T2D.
Focused educational programs may be used in conjunction with specific diabetes management. In a cluster randomized RCT, Davies et al. The program was grounded in a philosophy of patient empowerment and based on several learning theories The design of the program was particularly suitable for preventing depression given its implementation within 12 weeks of T2D novo diagnosis.
Key process elements included its delivery in the community by registered health professionals and its integration into routine care. A non-didactic approach was favored to elicit learning with an emphasis on activating participants to move toward specific, achievable goals in self-management The content of the learning curriculum was broad, with a focus on risk and lifestyle factors.
Overall, participants who received the intervention experienced less depression at 12 months than those in the standard education control condition. Zagarins et al. Participants received four sessions over a 6-month period by trained instructors, two of whom also incorporated motivational interviewing, thus strengthening the patient-clinician relationship and empowering patients to improve their health.
This collaborative element is similar to the approach used by Fisher et al. Although levels of depression did not diminish significantly from baseline, Zagarins et al. Depressive symptoms were not specifically addressed in the DSME-based intervention despite their importance as an outcome of the study, therefore an intensified focus on depression may be required.
Developing skills to help individuals manage their T2D is a common goal among educational programs in diabetes care and this often includes problem-solving. Researchers in Iran 32 tested an intervention that was based on a model stipulating that solving psychosocial problems can mediate the impact of stressful events on well-being While intervention strategies by Davies et al.
In particular, an instruction-based intervention was delivered via eight sessions focused on recognizing problems, on key aspects of decision-making such as values and feelings, and on problem solving skills such as evaluating resources.
The positive influence of the intervention on depression levels of participants at endpoint provided evidence that improving daily decision-making can help participants improve their well-being in the face of problems related to managing T2D.
Effective problem solving can also help individuals with T2D build resilience. Steinhardt et al. The content of Transforming Lives Through Resilience Education was consistent with a resilience model based on previous work on the topic [e.
Examples of curriculum components in weeks 1 and 3 were problem- and emotion-focused coping strategies and an empowering interpretation model.
With nutrition education, the goal was to provide realistic, practical suggestions for improving diabetes care e. Bi-weekly support-group follow-up meetings were devoted to problem solving, reviewing course content, and providing social support.
Noted benefits in distal outcomes like HbA1c levels were not, however accompanied by decreases in depressive symptoms post-intervention. Akin to Zagarins et al. Another culturally sensitive intervention was delivered by Wagner et al.
In the Community Health Workers Assisting Latinos Manage Stress and Diabetes CALMS-D trial, diabetes education was paired with stress management training. The educational piece covered basic information about managing diabetes e. Most notably, the core components of the manualized intervention were group psychoeducational skills training and physiological relaxation skills training.
At each session, learning objectives were framed around a culturally relevant analogy or story. In session and at-home relaxation activities e.
Improvements in symptoms of depression with the intervention were significant, suggesting that interventions focused explicitly on managing stress and the psychological symptoms of diabetes are justified.
A subset of interventions focused on individuals' emotional health in lieu of diabetes-specific content. Mansour et al. The researchers were attentive to creating an optimal environment in which to develop of an effective therapeutic relationship. Specifically, their intervention rested on principles of trust and attentive listening and on therapist qualities such as demonstrating interest, concern, and friendliness, which naturally require a higher level of training and competencies from counselors and resources time.
Intensive counseling interventions stand in stark contrast with the approach taken by Dennick et al. The team implemented Written Emotional Disclosure WED , a theoretically grounded, self-administered low-intensity technique that has the potential to respond to low-level psychological needs.
Backed by the premise that WED is comparatively inexpensive and more widely available for widespread dissemination, participants were instructed to engage in 20 min writing sessions at home in private on 3 days over 1 week.
Participants were incited to write their thoughts and feelings regarding any stressful experience over the last month or a current, non-diabetes concern. Results showed a worsening effect for the WED group, notably depressive symptoms were significantly more severe at 3-month follow-up.
Coupled with feasibility issues, there were important limitations in the potential effectiveness of the WED intervention for use in primary care in its current form. The authors proposed a better evaluation of the appropriateness of WED based on individual characteristics and readiness, to which can be added the need for more proactive psychological skills training.
In this regard, Developing Affective HeaLth to Improve Adherence DAHLIA was an online, self-paced intervention that taught positive affect skills in order to improve daily positive emotions and adaptation as well as general coping abilities and well-being Grounded in the Stress and Coping Theory 50 , 51 and the Broaden-and-Build theory of positive emotion 52 , targeted skills included positive reappraisal, setting attainable goals, performing acts of kindness, and mindfulness.
Participants learned to practice one or more of these skills every day via weekly lessons and home assignments. Participants were encouraged to keep a learning journal and to apply acquired skills to manage their T2D and in other life domains.
A mindfulness practice i. Results showed a significant reduction in symptoms of depression with the intervention, regardless of baseline levels The authors reported good adherence and argued that an online format offers a low-cost alternative intervention to prevent depression among individuals with T2D who have more limited options for face-to-face care.
Mindfulness can be used as an adjunct strategy in multicomponent interventions like DAHLIA or it may be a worthy approach in and of itself.
As demonstrated by Cohn et al. In an effectiveness study among individuals with T2D who demonstrated a need for psychological support, Pearson and colleagues 39 examined a novel delivery approach for mindfulness practice. Over an 8 week period, patients used an audio compact disc CD to engage in a daily 30 min mindfulness intervention.
The CD was developed by a trainer with over 25 years of mindfulness practice. Participants in the intervention group showed an overall reduction in depression scores at 12 weeks. Mindfulness is one of several alternative practices that teach awareness regarding the interplay between movement, breath and thoughts.
Putiri et al. Qigong is a traditional Chinese practice designed to maintain health and cultivate spiritual well-being. Exercises are performed with a heighted sense of feeling and focus which cultivates self-awareness of internal energy conditions.
Although weekly YRMQ delivered by a certified instructor lowered participants' BDI scores by Since developing a regular Qigong practice may take time, an intervention period longer than 12 weeks may be necessary to achieve success.
Interestingly, participants in the progressive resistance-training physical activity PA group showed significant reductions in depression. Conversely, the results of another study that targeted aerobic PA behavior specifically were not consistent in regards to depression.
In Sardar et al. Unfortunately, a detailed description of the context in which the exercise training was delivered and what strategies were used to ensure adherence throughout were lacking. Although the intervention was consistent with recommendations for aerobic training in diabetes, it did not result in significant changes in depression in this all-male sample.
It is likely that the duration, intensity, and type of exercise training may need to be considered, particularly given that enjoyment of the activity may have particular relevance in regards to depression. Nonetheless, various forms of PA and lifestyle change have been the focus of many intervention studies to date, including those considered in the current review in which depression was presented as a secondary or auxiliary outcome 53 — Descriptive information and main findings of these studies are available as a Supplementary Table S1.
These tables can be consulted to extract learning points and relevant strategies for developing future intervention studies. Over four thousand titles met our initial search strategy but only 12 studies satisfied our inclusion criteria. We determined that the volume of research studies that have developed and tested intervention strategies focusing specifically on preventing depression in individuals with T2D is limited.
Interestingly, in the initial exclusion stages of our review we identified several studies relating to the treatment of depression. This suggests that research to date has overwhelmingly emphasized alleviating depressive symptoms once they develop rather than preventing the development or progression of depressive symptoms.
Still, our narrative review allowed us to hone in on the general success, limitations, and key elements of preventative approaches that have been tested, namely educational interventions incorporating diabetes self-management, problem-solving and resilience-focused approaches, emotion-targeted techniques as well as alternative interventions.
Overall, six studies with a primary focus on depression showed a significant positive effect while six studies showed inconsistent or non-significant findings.
However, given that study quality was not assessed e. Nonetheless, we were able to extract specific components that can be integrated in revised interventions and tested over longer periods, in larger samples and including both sex. Self-management education and support SMES has a long history in diabetes care.
Consistent with National Standards for SMES 60 and studies we presented, interventions can take on many forms and include components of nutritional and lifestyle counseling, safe medication practices, monitoring of glucose and other parameters, and the development of personal strategies to deal with psychosocial problems.
In the larger context of chronic disease, programs that include a psychotherapeutic component behavioral or psychosocial tend to demonstrate better results as they allow patients to modify negative perspectives about their illness, which can be a principal factor in developing comorbid mental disorders such as depression 61 , One review showed a large combined effect of psychotherapy and self-management education in treating depression among individuals with T2D In the CALMS-D trial 43 , a specific focus on stress management in facing diabetes and on building psychoeducational skills yielded superior improvements compared to education only.
Thus, even if levels of personal responsibility for T2D increase with an intervention, participants may feel better equipped to manage it Therefore, we suggest that incorporating a defined psychological element to patient education might be valuable for preventing the development or the exacerbation of depressive symptoms.
Moreover, studies have shown that T2D self-management programs that are adapted to the age, language, and culture of individuals are more effective compared to generic programs 63 — This may be particularly true in the context of addressing depression given different risk factors between racial and ethnic groups as well as cultural values and expectations about mental disorders Cultural adaptation can take many forms that extent beyond translation, including the integration of culturally salient values and an understanding of stigma related to living with depression.
Apart from Steinhardt et al. A unique characteristic of T2D management interventions is that they are typically patient-centered and adapted to patient needs, which should include evaluating multiple parameters such as beliefs and attitudes Therefore, future studies could strive to consider the ethno-linguistic background and diversity of targeted participants and the appropriateness of activities and messages.
The capacity to adapt or individualize an intervention may vary as a function of delivery. Online interventions can offer flexible options that address individual preferences and needs 33 , In addition, online interventions can be delivered anonymously, at lower cost, and at convenient locations and times, which may increase efficacy 33 , While at least six secondary studies used a computer-based or online delivery 57 , 70 — 73 and another four tested mobile phone applications 74 — 77 , only one of the primary studies reported using a web-based format Specifically, the DAHLIA positive affect intervention lead to lower levels of depression compared to an emotion-reporting waitlist control condition Other mediums for self-directed or home-based interventions such as the audio for a mindfulness practice 39 have also shown promise, although issues regarding how to measure and address compliance and adherence may compromise their potential In the context of depression, a meta-analysis demonstrated the potential for web-based interventions to significantly improve well-being outcomes in individuals with T2D, but not depression specifically Yet, given RCT evidence that web-based self-help intervention can reduce the incidence of major depressive disorder over 12 months in participants not affected by T2D 78 , further testing is warranted.
On the other hand, research has shown that group-based in-person diabetes education programs are particularly effective for improving clinical, lifestyle, and psychosocial outcomes in individuals with T2D 79 — Our findings in the context of reducing depressive symptoms strengthen the efficacy of group approaches.
Allowing participants to share their thoughts and insights may be particularly pertinent to problem-solving interventions, where skills, advice and strategies can be learned and integrated among group participants with similar experiences 32 , 42 , It is noteworthy that some interventions herein emphasized not only problem solving and coping skills in relation to diabetes, but also general psychosocial preparedness, competencies, and resilience.
Thus, when considering the mental health risks that accompany the demands of a disease like T2D, it may be beneficial to integrate an awareness of an individual's life and emotional experiences beyond the disease itself In particular, we saw the emergence of interventions that were more holistic in nature.
Two studies 33 , 39 suggested a distinct mindfulness component to complement their programs, with the DAHLIA intervention 33 also targeting patients' general cognitions and emotions. The practice of mindfulness helps people take a nonjudgmental and observing stance on their thoughts, leading to less worry and rumination, which are important correlates of depression Regarding implementation, mindfulness is a unique approach in that unlike mainstream or other diabetes-orientated interventions, it can be delivered as an adjunct therapy by non-specialists and can be a cheaper and more accessible long-term alternative It has shown promise for preventing symptoms of depression in patients with type 1 and 2 diabetes Given that the incidence of T2D and depression are increasing at alarming rates, further research is needed to develop low-cost approaches and alternative means of delivery that will be available to a more diverse population of individuals with T2D.
While the strengths of this review include a comprehensive search of multiple databases, a rigorous screening process for inclusion, and an explicit focus on prevention, the findings should be interpreted within the scope of a few limitations.
Firstly, this review does not provide a quantitative summary of effect size. Thus, we cannot objectively discuss efficacy or compare efficacy across the different intervention delivery formats.
Consequently, a direct effect of depression on IR could importantly mediate the depression-hyperglycemia association, but the above studies have not established this causal relationship.
Consideration also should be given to the possibility that depression and IR have a common underlying etiology,e. Chiba et al. Further work establishing the correct relationships is essential in positioning depression as the modifiable risk factor.
Outcomes from short- and long-term treatment trials already are available, however, to suggest that depression treatment can reduce depression-associated metabolic derangements. Proper depression management is hindered by several barriers, and nearly two-thirds of depressed diabetic patients do not receive antidepressant treatment.
Criteria for diagnosis of MDD are provided in the Diagnostic and Statistical Manual of Mental Disorders 4th ed. and summarized in Table 2. One of the symptoms must be depressed mood or anhedonia. Minor depression involves symptoms below criteria for MDD and impairs function and quality of life.
Dysthymia is defined as the presence of less than five symptoms lasting at least 2 years. A patient may have multiple symptoms of a depressive disorder, but the symptoms may not be revealed if the clinician fails to ask appropriate or sufficient questions.
Brief paper-and- pencil screening instruments for detecting depression, such as the item Beck Depression Inventory BDI 48 or the 9-item Patient Health Questionnaire PHQ , 49 can help with this problem Table 3.
Hyperglycemia, reflected as elevated hemoglobin A 1c A1C levels, and IR are principal independent determinants of diabetes complications.
Accordingly, interventions directed at these end points are the mainstays of diabetes therapy. Treatment of major depression provides an example of such interventions. To monitor effects of depression treatment on glucose regulation, treatment studies have measured changes in A1C and markers of IR in relation to intervention and to depression response.
In an early study, therapeutic doses of nortriptyline were administered to depressed and nondepressed patients in a double-blind placebo-controlled manner.
Path analysis indicated that the direct effect of nortriptyline was to worsen glycemic control, whereas the treatment-independent effect of depression remission was a reduction of 0. In a subsequent study, fluoxetine-treated diabetic patients showed a trend toward greater reduction in A1C results after 8 weeks of therapy In both investigations, effects on A1C were unrelated to changes in weight.
Weight loss and depression improvement accompanying treatment independently predicted improvement in A1C results. A study of cognitive behavior therapy CBT removed potential for medication effects and assessed depression and A1C end points after 10 weeks of treatment and again after 6 months.
However, at 6-month follow-up when CBT effects on depression appeared sustained, covariate-adjusted A1C results were lower in the active therapy group 9. Okamura et al. S i , the index of insulin sensitivity determined from FSIGTT expressed as 10 -5 ·min -1 · pmol -1 · l , was significantly lower in depressed than in nondepressed subjects 6.
This confirmed the association of depression with increased IR in nondiabetic individuals. Depressed subjects also were compared before and after depression treatment. Each patient was prescribed a tri-cyclic antidepressant TCA ,allowed a food intake of 1,, kcal per day, and underwent no exercise therapy.
A significant increase in S i was observed after treatment to Overall, the changes observed in these trials suggest that successful depression treatment may have favorable effects on glucose regulation, effects that might improve the course of diabetes and, if generalized to people with pre-diabetes, delay development of diabetes.
The mechanism behind these improvements is not fully elucidated. Remission of depression may have beneficial effects on health-related behaviors, such as physical activity,medication adherence, and dietary habits, or via effects on physiology involved in glucose metabolism.
Acute relief of MDD typically requires specific therapeutic intervention;the rate of improvement in response to nonspecific supportive measures is not different from placebo. As described in the previous section, both pharmacological and psychotherapeutic interventions are effective for depression in diabetic patients.
Having a more favorable adverse effect profile and efficacy equal to or better than TCAs, the selective serotonin reuptake inhibitors buproprion,mirtazapine, and venlafaxine are recommended as first-line treatment of depression in diabetes.
Pharmacological management of depression in patients with diabetes demands awareness of common comorbid conditions, potential drug-drug interactions, and adverse effects. Because of these concerns, medications such as monoamine oxidase inhibitors and TCAs are not commonly used to treat diabetic patients.
TCAs are associated with orthostatic hypotension, urinary retention, and prolongation of cardiac repolarization leading to QT interval prolongation.
TCAs should be avoided in patients with cardiac conduction defects and cardiovascular disease. Thus, a significant proportion of diabetic patients are excluded from TCA use because of presumed or diagnosed cardiovascular disease.
An integral component of evaluation of depression in patients with diabetes is a review of medications to assess for drugs that can contribute to depression e. Electroconvulsive therapy ECT is safe and efficacious in people with and without diabetes. It is most commonly performed on an outpatient basis and frequently provides rapid symptom improvement.
With CBT, patients are taught to recognize and remove patterns of thinking that characterize and perpetuate depression e. The short-term treatment approaches discussed thus far are effective in bringing depression under control. At that point, treatment often is discontinued in practice, possibly because the patient or provider desires to relegate the problem to the past or to simplify what typically is a complicated medical management regimen.
Maintenance pharmacotherapy refers to the practice of keeping patients on antidepressant medication beyond the point of depression remission to prevent or delay recurrence. The depression-free interval during follow-up was significantly three to four times longer in the group maintained on sertraline.
Glycemic control improved during open-label treatment and remained so in both treatment groups during the depression-free interval of maintenance.
Other approaches to maintenance currently are being investigated. Without alteration in weight or body composition, physical activity improves insulin sensitivity, glycemic control, and compliance and provides useful adjunctive treatment for depression.
Our understanding of optimal treatment for depression in diabetic patients is evolving. At present, it is best understood as a process requiring simultaneous comprehensive care of both medical and psychiatric illness aspects. We reviewed here evidence in support of a hypothesis that relief of depression may improve the medical prognosis, delaying development or slowing progression of diabetes.
We think it important that both patients and providers recognize the implications of the hypothesis for individuals and for society: the genuine possibility that treatment of depression may promote health, even extend life.
At the same time we recognize the limited nature of the evidence presented and the somewhat speculative character of our argument. Apart from its effects on specific diabetes end points, depression remains an important focus of clinical care because of its beneficial effects on mood,functioning, and quality of life.
Williams, MD, is an instructor, and Ray E. Clouse, MD, is a professor in the Departments of Psychiatry and Medicine at Washington University School of Medicine in St.
Louis, Mo. Patrick J. Lustman, PhD, is a professor in the Department of Psychiatry at Washington University School of Medicine and a counseling psychologist at the Department of Veterans Affairs Medical Center in St.
Clouse and Dr. Lustman have received research funding from GlaxoSmithKline to study the use of its bupropion hydrochloride extended-release tablet product for the treatment of depression in patients with diabetes. The writing of this article was supported in part by grants DK and DK from the National Institutes of Health, including the Alan A.
and Edith L. Wolff charitable trust fund in support of P50AG, and by a grant from the Sidney R. Baer, Jr. Williams is a recipient of the Alene and Meyer Kopolow award. Sign In or Create an Account.
Search Dropdown Menu. header search search input Search input auto suggest. For example, people with diabetes and mild depression may find that regular physical activity improves depressed moods and also helps control blood glucose levels.
The most effective treatments combine psychological and medical care. Talk to your doctor about how you are feeling and discuss whether a referral for psychological support is appropriate.
Support is vital and can come from a number of sources such as friends, family, community groups and your Credentialled Diabetes Educator. Your doctor or health professional will take into account several factors when suggesting the most suitable treatment for you.
Regular contact with, and ongoing assessment by your doctor to check that your treatments are working effectively is an important part of becoming and, staying well. Medicare may provide a rebate on psychologist fees if you have chronic condition and are referred by your doctor.
Discuss this with your doctor if you would like to seek counselling. If you or someone you know needs help, talk to your doctor or other health professional about getting the right advice and support.
For further information contact:. Depression is a very real condition and is becoming increasingly common in the general population; approximately one in four people will experience depression some time in their adult life.
Mayo Clinic offers appointments in Arizona, Florida and Minnesota and Prevenring Mayo Clinic Health Preventing diabetes-related depression locations. If Subcutaneous fat appearance diabetes-telated diabetes — either type Obesity and education or type 2 — you have a higher risk of developing depression. And if you're depressed, you may have a greater chance of developing type 2 diabetes. The good news is that diabetes and depression can be treated together. And effectively managing one can help with the other. Depression is not Caffeine pills for improved performance low mood but a Preventing diabetes-related depression illness. People with depression Subcutaneous fat appearance it hard to do normal activities and Diabetew-related from deppression to day. Depression has serious effects on derpession as diabetes-relatee as mental health. Research shows that having diabetes more than doubles the risk of developing depression. Living with a chronic condition like diabetes, coping with biological and hormonal factors plus needing to manage the condition on a daily basis may increase the risk of depression. Depression can increase the likelihood of developing diabetes complications. People with depression may find it harder to deal with everyday tasks.
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