Home' Australian Pharmacist : Australian Pharmacist June 2014 Contents Australian Pharmacist June 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
diabetes and the development of major
Lastly, patients with diabetes
may be concerned about developing
disease complications (such as retinopathy,
neuropathy and nephropathy), causing
further distress and increasing the risk of
Patients who suffer from both diabetes
and depression are also at a higher risk
of developing diabetes complications.
These patients typically show inferior
disease management overall, namely
due to poor glycaemic control leading to
increased hypoglycaemic episodes.
Patients with depression may be less likely
to consume regular meals and perform the
daily tasks required to manage diabetes
(such as blood glucose monitoring,
moderation of alcohol consumption and
15 Additionally, depression
may cause certain physiological changes
in the body, such as; dysregulation of the
autonomic nervous system, increased
levels of cortisol and elevated inflammatory
These physiological changes can
affect glycaemic control.
You advise Brian to make an appointment
with his GP as soon as possible. You are
concerned that he may be suffering
from depression, which may be linked to
his recent diagnosis of type 2 diabetes.
Brian’s doctor will most likely perform a
comprehensive evaluation of his current
symptoms, and perhaps consider the
initiation of an antidepressant if required.
If Brian’s doctor was to initiate
antidepressant therapy, he would most
likely choose a selective serotonin reuptake
inhibitor (SSRI), as these agents are typically
considered first line for moderate-to-severe
SSRIs appear to have the
greatest patient acceptance, and are
associated with more tolerable adverse
effects on the whole.
it is unlikely that SSRIs will disturb control
Due to the fact that patients with diabetes
tend to have poorer blood glucose control,
Brian’s doctor may consider changing the
dose of his diabetes medicines, to reduce
the potential for glycaemic fluctuations.
Brian returns to the pharmacy after eight
weeks and would like to update you on his
progress. His doctor diagnosed him with
major depression and he commenced
taking sertraline 50 mg daily six weeks
ago. Brian’s doctor also referred him to
a psychologist and he is undertaking
cognitive-behavioural therapy for up to
16 weeks. His doctor mentioned that the
treatment of major depression involves
both medicines and counselling, so he is
willing to give both options a try.
Brian was also referred to a diabetes
educator who has been working closely
with him on managing his diabetes. He has
started monitoring his blood glucose more
regularly, and is sticking to a healthier diet
and exercise regime. Brian’s blood glucose
levels are now well maintained, and he has
not had to change his dose of metformin
or Lantus. With the support of the diabetes
educator, his doctor and psychologist, Brian
feels more confident that he can manage
his diabetes, and try to prevent long term
complications. He is starting to feel more
like his old self again, and would like to
thank you for your help with this matter.
KEY LEARNING POINTS
• Mood changes have several potential
causes. As such, the pharmacist must
ask a series of detailed questions to
ascertain additional symptoms and any
• There is a strong link between
diabetes and the development of
depression. Conversely, patients
with depression have a higher risk of
• Patients who suffer from both diabetes
and depression are at risk of; poorer
diabetes self-management, inferior
disease control, glycaemic fluctuations
and increased hypoglycaemic episodes.
• Patients with diabetes who are
experiencing the signs and symptoms
of depression should be referred to
their doctor. Prompt diagnosis and
treatment of depression (with drug
and non-drug treatment options) may
reduce the risk of long-term diabetes
complications, and improve the
patients’ health-related quality of life.
1. Avoidance and increased arousal are
common symptoms of:
a) Post-traumatic stress disorder.
b) Generalised anxiety disorder.
d) Major depression.
2. Patients with diabetes have an
increased risk of depression due to:
a) Decreased levels of cortisol.
b) Low levels of inflammatory factors.
c) Added stress and burden of managing a
d) Brain changes that occur due to
3. Symptoms of grief include:
c) Suicidal ideation.
d) Feelings of worthlessness.
4. Generalised anxiety disorder and
major depression share which of the
a) Depressed mood most of the time.
b) Difficulty concentrating.
c) Trouble sleeping.
d) Both b and c are correct.
5. Which class of antidepressant
medicines is most suitable for a
patient with diabetes?
a) Tricyclic antidepressants.
b) Monoamine oxidase inhibitors.
c) Selective serotonin reuptake inhibitors.
d) Serotonin and noradrenaline reuptake
References are located on page 54.
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