Home' Australian Pharmacist : Australian Pharmacist June 2014 Contents Australian Pharmacist June 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
person’. As such, it does not appear
that Brian is suffering from grief on
Post-traumatic stress disorder (PTSD)
can occur after exposure to a traumatic life
event, and is associated with a number of
negative health effects.
which typically trigger PTSD include; life
threatening events and events which
threaten personal safety.3 There are
three characteristic symptoms of PTSD;
re-experiencing (i.e. recurrent dreams,
extreme distress), avoidance (i.e. reduced
interest in activities, sense of detachment)
and increased arousal (i.e. trouble sleeping,
irritability, lack of concentration).3,4
patient suffers from these symptoms for a
period of longer than one month post the
traumatic event, PTSD is usually diagnosed.
Brian assures you that he has not
experienced a significant or traumatic
life event. Despite the fact that Brian’s
symptoms do correlate with some of the
symptoms of PTSD, he does not appear to be
suffering from PTSD on this occasion.
Generalised anxiety disorder (GAD)
is a long-term condition which affects
approximately 5% of the Australian
It is a disabling condition,
where the patient experiences
symptoms such as; excessive anxiety
and uncontrollable worry about
common events, restlessness, difficultly
concentrating, insomnia, fatigue and
irritability for a period of six months or
1,5 Patients who suffer from GAD
generally experience reduced work
productivity and a lower health-related
quality of life.
Brian appears to be suffering from
some of the symptoms of GAD.
However, Brian’s main symptom is extreme
sadness, and he has not reported excessive
or uncontrollable worry about common
events. Brian’s extreme sadness cannot be
attributed to GAD in this instance.
Major depression is a chronic condition
which is highly prevalent in Australia.
The exact cause of major depression is not
well defined, however, it is known that a
combination of various factors, such as
genetic influences, stress, personality traits
and comorbid medical conditions, can
predispose an individual to this condition.
In addition, some medicines have
been implicated in causing depressive
symptoms, for example beta blockers,
oral contraceptives, corticosteroids and
The major symptoms of
depression are; a sad/depressed mood
and reduced pleasure/interest in usual
Further symptoms of
major depression are detailed in Box 1.
A diagnosis of depression is usually made
after a person experiences five or more
symptoms during the same two-week
period, with at least one symptom of
depressed mood, and one symptom of
reduced pleasure in daily activities.
Brian has been suffering from an
unusually sad mood, insomnia,
irritability, agitation, reduced energy levels,
lack of motivation, reduced interest in daily
activities and a reduced appetite. He has
experienced most of these symptoms for
the past six months. The symptoms Brian
describes are consistent with those of
Comorbid medical conditions and
Long-term medical conditions have been
shown to cause and trigger depression
in susceptible individuals.
illnesses, such as Parkinson’s disease,
diabetes and some forms of cancer
are often associated with ongoing
symptoms, such as; pain, discomfort,
or physical impairment and a reduced
ability to perform daily functions.
The added burden of such diseases
can be a cause of depression itself.
addition, current research suggests that
a compromised immune function (which
may be related to chronic diseases)
may play a role in the development
Brian suffers from type 2 diabetes
which was diagnosed approximately
12 months ago. He has experienced his
current symptoms for the past six months.
It is possible that his current mood changes
and myriad of symptoms may be linked to
diabetes. Upon further questioning, you
discover that Brian is finding it increasingly
difficult to manage this condition. He is ‘fed
up’ with the daily routines of blood glucose
testing, taking medication, injecting insulin
and eating a ‘special’ diet. As such, he has
become less methodical in his daily processes,
often forgetting to ‘check his sugars’ and
going for long periods of time without
food, leaving him feeling dizzy and faint.
In addition, Brian is becoming increasingly
worried that he will suffer from the serious
complications associated with diabetes, such
as eye, nerve and kidney damage.
Diabetes and depression
There is a two-fold link between depression
and diabetes; patients with diabetes
have an increased risk of developing new
depression, and those suffering from
depression are at a higher risk of developing
Recent evidence suggests
that patients with diagnosed diabetes have
more than double the risk of developing
Additionally, patients who
suffer from depression are also at double
the risk of developing type 2 diabetes.
The increased risk of depression in patients
with type 2 diabetes is likely to be associated
with; the intense nature of diabetes
self-management (especially for patients
with more complicated treatment regimens
that include insulin) and extreme lifestyle
changes that accompany a diagnosis of type
13 Interestingly, the risk of new
depression is not increased in patients with
undiagnosed diabetes, further supporting
the link between the chronic and
demanding self-management of type 2
1. Depressed/sad mood on a
2. Reduced interest or pleasure in
3. Changes in appetite or weight
4. Insomnia or hypersomnia
6. Fatigue and reduced energy levels
7. Feelings of guilt and worthlessness
8. Trouble with decision making and
9. Recurrent thoughts about death
Box 1. Symptoms of major depression1,6,9,10
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