February 18, 2015

Do You Understand Depression - Part 2

Many people will not come right out and state that they are depressed or feel depressed. Normally, the doctor should know the signs as they can accompany other real problems the person goes to the doctor to resolve.

Because of how depression can affect people diagnosed with diabetes, I would propose that the following be made mandatory for all adult people with diabetes and all parents of children with diabetes. Once a diagnosis has been made, the diagnosing doctor should schedule a session with a psychiatrist. And yes, this should be mandatory with penalties for not keeping the appointment. Insurance should be required to pay for this.

This would not be the normal visit, but an educational appointment to learn about depression, the warning signs of depression, and maybe some tests as described in this blog. Many people with diabetes (about two-thirds) do develop some depression because of the daily chores with diabetes. No stigmatism should be attached to this appointment and questions should be allowed. The psychiatrist should build a file for future assistance and learn what medications you might be willing to take. This should also build a doctor patient relationship that can be used later if needed and allow for open communications in the future.

Understand that this does not lock you in with this doctor. If you don't have a rapport with the doctor, you should be able to get a referral in the future to another psychiatrist. Some even use telemedicine to chat with you later to answer questions about depression. Don't forget the problem with burnout and these doctors may be able to assist during this and help shorten the length of the burnout.

Back to the information about depression. People that are depressed can have trouble falling and staying asleep, or conversely, they will find they want to sleep all the time. Interest in things commonly enjoyed can disappear. Feelings of guilt and hopelessness can be intense and constant. Concentration is often impaired, and appetite can be minimal or, conversely, voracious. This is when a visit with a psychiatrist could be important. The American Psychiatric Association provides a screening tool for depression that could be of help.

While about 19 percent of depression can become severe, it is better to ask for help when you recognize some of the early symptoms than say I will get better and then not get better, but worse.

When the depression gets worse, this is when thoughts often happen such as I'd be better off dead, or turn to killing oneself or others. Depression is dangerous when it distorts thinking, judgment, and decision-making. The disease of depression can make it hard to remember the last time you felt "normal" and hard to believe you will ever feel "normal" again. It can be hard to believe someone we have known as a happy, well-adjusted, and successful friend, neighbor, family member, or colleague would want to kill himself or herself. However, depression is extremely powerful.

Without this information, patients can feel lost or, worse, defeated if their symptoms progress. It is very important to become educated to get help right away if their mood worsens or if they have any of these additional symptoms.

It is important to provide crisis numbers, including the national suicide hotline (1-800-273-8255), which is available 24/7. I would advise everyone that if they are feeling dangerous to themselves, they should not wait to see a psychiatrist in the community; they should go to the nearest emergency department or call 911.

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