On May 1st, the Samepage team participated in this year’s highly successful Diabetes Expo at the Washington State Convention & Trade Center in Seattle. The Expo drew over 5,400 participants – a 6% increase over last year’s attendance! Congratulations to the American Diabetes Associationand the hard-working Expo organizers who showed, once again, that they are masters at running a practical and highly relevant program that helps individuals with diabetes and their families in dealing with the daily challenges of living with diabetes.
At the Samepage exhibit booth, Marianne, Ben, Emma, and Sabine did a terrific job demonstrating freely available on-line tools, including VisitPrep and Ask and Tell Gallery, while I took a few breaks to give a couple of scheduled presentations. Here are the main points from one of my talks entitled ‘Diapression’.
What is diapression?
Based on clinical and research work, I coined the term ‘diapression’ as a way of better understanding the lived experience of people with both a medical and behavioral condition – like diabetes and depression.
One of the main ideas behind diapression is to help patients and healthcare providers communicate better. Clinicians can get a clearer understanding of the daily experience of patients who have both conditions. Patients can better understand and accept the questions and clinical tasks of the healthcare provider trying to diagnose and/or treat a behavioral and medical condition.
Which comes first, depression or diabetes?
Diabetes leads to a greater likelihood of having depression. In fact, depression is twice as common in people with diabetes compared to the general population.
On the other hand, research is showing that untreated depression is associated with onset of diabetes. In people already diagnosed with diabetes, depression leads to worse clinical outcomes.
Some key features of diapression:
Individuals with diabetes and depression can have confusing symptoms.
- Depression can worsen diabetes symptoms like neuropathy pain and fatigue.
- Persisting diabetes symptoms can make people with depression feel even more down and can lead to difficulties with concentration and motivation.
- People with both conditions can experience bewilderment and frustration about a decreasing ability to control diabetes, often leading to a mounting sense of giving up.
- At healthcare visits patients often don’t know what is going on and they may feel they are doing something wrong as their diabetes spirals more and more out of control.
In individuals with diabetes and depression, emotions can seem to temporarily take charge of daily behaviors.
- Almost weekly in my clinical work, I hear patients who are struggling with depression say something like this about their diabetes self-care:
“I know what I am supposed to do and I know what I am not supposed to do, but I still do the wrong things and I don’t know why.”
- I often say that some of my patients could write a best-selling book about what to do to effectively manage diabetes. Yet, when they are depressed they may be barely able to manage their weight, glucose numbers, blood pressure or make regular healthcare visits.
Depression “turns up the volume” on physical symptoms!
For years, clinicians and researchers have recognized that depression is a “symptom amplifier” of emotional and physical symptoms.- This was shown most recently in a study of 4,000 primary care patients with diabetes at Group Health in Seattle. Ludman and colleagues showed that, compared to patients without depression, those who were depressed were:
- Twice as likely to report neuropathy pain
- Three times as likely to report excessive hunger or thirst
- Almost four times as likely to report shakiness, blurred vision or feeling faint
- Five times as likely to report daytime sleepiness
Depression can lead to difficulties with diabetes self-management, with taking medications, and with glucose control.
- Symptoms of depression – like lower motivation, poorer concentration, difficulties with sleep and less hope for the future – can all lead to challenges in taking care of oneself.
- Stress and depression can also increase glucose levels and blood pressure through biological mechanisms.
Depression can lead to isolation and reduce one’s ability to trust or to be satisfied with healthcare.
In a prior study, we followed individuals with diabetes for 10 months and showed that those whose depression worsened over time were less able to trust others in their social environment while those whose depression improved were more able to reach out and trust others.- In other words, depression can have a negative impact on the ability of individuals with diabetes to reach out to family, friends and healthcare providers in taking care of their condition.
The good news
There are effective treatments for depression, including psychotherapy and antidepressant medications. Effective treatments for depression and diabetes also include “collaborative care” models where nurse care managers, primary care providers, behavioral health and internal medicine specialists all work together in an efficient way to deliver tailored, evidence-based care for depression.
Regardless of type of care one receives for depression, treatment can start by understanding and discussing “diapression” challenges such as having confusing symptoms, symptom amplification, difficulties with self-management, and reductions in trust level. For more on diapression, go to diapression.com.
Dr. Paul