Patients with diabetes, as well as other people with
chronic diseases, commonly experience long-term
stress or depression. It often is a direct result of the disease
itself, because of all the emotional ups and downs
patients experience during chronic management. For example,
patients with diabetes often worry about lasting complications
of the disease, how to manage the cost of the disease,
and how it will affect their families or their jobs.
As many as 1 in every 3 persons with diabetes suffers from
depression. The disease itself can be overwhelming and
often leaves a patient wondering, "Why me?" Identifying
these patients and helping them with tips to manage stress
and depression effectively can have a positive impact, not
only on their emotional well-being, but on their long-term
clinical outcomes as well.
Sources of stress can be physical or mental. Examples of
physical stresses include infections, trauma, injuries, or sickness.
Mental stresses include relationship difficulties, financial
concerns, and pressure from a stressful job. Physiologically,
the body responds to stressors by secreting the counter-regulatory
hormones such as epinephrine, cortisol, and glucagon.
These hormones, although helpful in some circumstances,
certainly can add to the complications of a diabetic patient.
Their effects include increased heart rate, blood pressure,
and glucose levels.
Stress and depression also can affect patients' control of
their diabetes in indirect ways. For example, these patients
may have a lack of concern for taking care of themselves.
They often do not sleep well, or they sleep too much and are
not as attentive to their basic daily needs as they should be.
They also often are unconcerned about daily diabetic requirements,
such as eating properly, taking the proper medications,
or performing regular self-monitoring of blood glucose.
Recognizing the Signs
For pharmacists, recognizing the signs and symptoms of
depression can be the first step in assisting these patients to
find help. Pharmacists can generate conversations that identify
patients' specific issues: Are they losing interest in their
usual activities? Are they experiencing any changes in
weight? Are they having trouble sleeping?
Most patients will not seek help or make direct statements,
such as "I'm feeling very down and depressed." Yet,
paying attention to their usual habits and personalities and
noticing any changes can be the first step. For example, the
pharmacist should notice when a patient who has not been
known to seek medications for insomnia is asking about the
best OTC product to help him or her sleep. The pharmacist
also should take note of a patient recently diagnosed with
diabetes who is asking about alternative therapies to help
him or her feel better or have more energy.
Getting Help for Patients
One of the simplest yet most effective interventions is to
help these patients understand that what they are experiencing
is normal and that successful treatments are available.
Depression and stress can be treated effectively with psychotherapy
(counseling) and/or medication therapy. Most of
the time, health insurance plans will cover counseling for
diabetes-related depression. For patients without insurance,
there may be local health clinics that will offer counseling
services at a reduced fee or on sliding-scale payment options.
Local diabetes education centers also traditionally have support
personnel to assist with patient counseling. Counselors
often can teach patients various relaxation techniques.
Patients who lack the basic information or skills needed to
manage their disease will feel more stressed or depressed, simply
because they feel overwhelmed. Support from family and
friends is important, but sometimes the support of other
patients experiencing the same illness or problems can be
more therapeutic for a patient. Many communities have wellness
centers that offer diabetes support groups. For patients to
feel that they are not alone and to be able to express the fears
and difficulties, as well as successes, associated with their disease
can have a positive impact on their mental and physical
well-being. Diabetes centers also generally offer group or individual
For patients who are medically cleared by their physician,
suggesting a regular exercise regimen can be helpful, not
only for long-term stress management, but also for improving
glycemic and cardiovascular outcomes. Patients should
be encouraged to start a physical activity program slowly.
Dr. Brian is a clinical specialist with Cornerstone Health Care, High
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