Solutions for Depression

I had hoped that I would not have depression again, but after radiation for prostate cancer, depression comes and goes. This article keeps reminding me of my depression and why I dislike some doctors. Exercise, magnets, therapy, antidepressants, diets, herbs, music, and several other activities have all been tried and have shown success in the treatment of depression.

A recent study published in JAMA Internal Medicine reveals that that one out of every six people in the US has taken psychiatric drugs, and the great preponderance of those prescriptions are for antidepressants or anti-anxiety pills. The study found a significant increase in the use of antidepressants since 2009, when we wrote a blog post revealing that one in 10 people had taken antidepressants, a fact that we found alarming at that time. Now that statistic has risen to one out of every 8.5 individuals, with another one out of every 12 on sister drugs for anxiety. The majority of such prescriptions (85%) were refilled at least three times in the study year, meaning that these depressive crises and anxious states are not short-lived, one-shot deals.

As extraordinary as these numbers appear, they probably underestimate the actual numbers of people on antidepressant and anti-anxiety drugs, since the data relies on self-reporting from the 37,421 respondents, and you can bet that many were reluctant to reveal that they took such medications. It’s also interesting to note that the one in six figure represents an average for all subgroups, with twice as many women as men taking such drugs, and twice as many whites as other races. Among those over the age of 65, nearly one in every four people is on an antidepressant or anti-anxiety medication.

Exercise works just as well or even better than pharmaceuticals for alleviating depression and anxiety. So why on earth don’t doctors just prescribe exercise instead of prescribing the pills with dangerous side effects? Maybe it’s not just because they’re lazy or indoctrinated, but because they don’t want to encourage noncompliance. The sad truth is that when depression is severe, patients often can’t muster the energy to start exercising, or to take a class, or to even call a friend. One of the symptoms of depression can be a kind of catatonia where doing anything that requires energy feels overwhelming. Depression famously takes to bed and wants to stay there.

Depression is famous for seeking short-term comfort, and for many depressed people, the thought of avoiding chocolate, wine, coffee, cupcakes and so on is just too much to bear.

In other words, depression and anxiety crave short-term, no-sweat solutions and pharmaceuticals seem to suit the bill. Patients are willing to deal with side effects and with health risks in hope of finding some fast relief. And while the efficacy of antidepressant pills may be dismal for many patients, some do find they get a significant mood lift from them. Likewise, anti-anxiety medications often work fast, fueling continuing demand for them. Theoretically, prescription drugs might work as a short-term bridge until the patient is stabilized enough to switch to something that actually enhances health (like exercise), instead of continuing on medications that could potentially destroy it. (The problem, of course, is that the switch over doesn’t happen. Rather, the doctor writes out another prescription refill, leaving the patient to continue the same old unhealthy routines.)

I have been fortunate to avoid antidepressants and my depression does not last for long periods of time. I have only had one doctor try to prescribe an antidepressant and when I refused, he insisted. I told him that I would not fill the prescription as I had other ways to help my depression and prevent myself from developing severe depression. I did tell him that if that did happen, I would let him know and consider taking an antidepressant.

Seven Neglected Areas That Sabotage Healthy Aging – P4

People with type 2 diabetes are more susceptible to depression. Although healthy older adults have lower rates of depression than the general public, depression is still a common problem that is easily missed. It’s more common in those who are struggling with illness, involved in caregiving, or socially isolated. It’s important to spot and treat depression, as this is key to better quality of life and greater involvement in social activities. It can also enable older adults to better manage any health problems they have, such as chronic diseases, type 2 diabetes, or pain.

One important sign of depression in seniors is “anhedonia,” which means one stops enjoying activities that used to bring pleasure. If you notice this in an older person, or yourself, it’s important to get help. Studies show that medication and psychotherapy are generally equally effective in mild-moderate depression, but non-drug treatment often isn’t offered unless you ask. Among medications, the selective serotonin reuptake inhibitors (SSRIs) sertraline and escitalopram tend to have fewer side effects and drug interactions. Avoid paroxetine (Paxil) as it is anticholinergic, which means it dampens brain function.

For more information:

• Depression in Older Adults and the Elderly
• Pharmacological Treatment of Depression in the Elderly (review article written for family physicians; walks the reader through a nice real-life example)

My blogs:

http://bobsdiabetes.blogspot.com/2015/02/do-you-understand-depression-part-1.html

http://bobsdiabetes.blogspot.com/2015/02/do-you-understand-depression-part-2.html

http://bobsdiabetes.blogspot.com/2015/02/do-you-understand-depression-part-3.html

http://bobsdiabetes.blogspot.com/2014/11/lessons-for-people-new-to-type-2_30.html

http://bobsdiabetes.blogspot.com/2014/05/five-distinct-types-of-depression.html

http://bobsdiabetes.blogspot.com/2012/01/some-blogger-suggestions-for-handling.html

http://bobsdiabetes.blogspot.com/2012/01/depression-and-diabetes-cycle.html

http://bobsdiabetes.blogspot.com/2012/01/types-of-depression.html

http://bobsdiabetes.blogspot.com/2011/08/depression-under-diagnosed.html

Number 4 of 8 blogs.

Manage Depression and Manage Diabetes

Among people with diabetes, depression is a fact of life. Some have severe depression, but for most, it is mild depression. It is also a fact that many people with diabetes do not seek the help they need because of the stigma that is attached to depression.

Depression has been linked to increased hyperglycemia, morbidity, and mortality. The treatments for the symptoms as well as for depression can lead to improvement in quality of life. Depression is feeling blue or sad, which can interfere with daily life and be a burden on the patient and those around them.

There are many symptoms of depression. This list is just a few:

• feeling of depressed or sad mood
• diminished interest in activities, which used to be pleasurable
• weight gain or loss
• psychomotor agitation or retardation
• feeling of guilt
• difficulty concentrating
• recurrent suicidal thoughts

There are many causes of depression such as genetics, environmental factor, or psychological factors. This is also a reason that the stigma should not be put on people with depression as often it is not something that they can control. Progress is being made in finding other causes for depression and I have a blog about five of these.

It my understanding, about 67 percent of people with diabetes do suffer from some type of depression; however, most of the time you will see this listed as just depression with no definitive definition. Then about 19 percent of people with diabetes suffer from serious depression and again no accurate definition accompanies this statement.

Some depression tends to run in families and scientists are investigating certain genes that make an individual more prone to depression. However, while genetics do play a big part in depression, many would agree that it is the combination with environmental or other factors that would bring on depression. The loss of a loved one, trauma, difficult relationship, or any stressful situation may trigger a depressive episode in a patient. These are debilitating symptoms for a patient and can prevent them from taking proper care of themselves.

A retrospective cohort study looked at 1,399 patients diagnosed with both depression and type 2 diabetes, and compared their glycemic control using their A1c levels. The study found that 50.9% of depressed patients who are on antidepressants have good glycemic control as compared to only 34.6% of depressed patients without antidepressants. After adjusting for covariates, the study found that those on antidepressants are twice as likely to attain their glycemic goals as compared to those not receiving antidepressants.

Do You Understand Depression - Part 3

The causes of depression are many and varied. Some people are genetically predisposed to have a higher chance of having episodes of depression throughout their lifetime. If you have a parent or a sibling that has experienced depression, then you are at a higher risk for depression. Once you have depression, this is a predictor of future episodes.

Your environment is another cause of depression. Stressors and triggers can come from your home, work, and even memories can negatively affect your thoughts. Negative thoughts can affect not only mood and feelings, but also behavior and daily living. Depression can lead to self-isolation, poor nutrition, and little exercise. From my reading, I have learned that the brain and its neurotransmitters change during an episode of depression and all these factors negatively affect biology.

This is why when you have mild depression, you need to take steps to stop it there. If you have someone that understands you and can be a sounding board, make use of him or her and let him or her help you. If this does not work, then seek counseling and don't let depression get the better of you.

Depression negatively affects behavior by decreasing engagement in recreational activities and making chores and hygiene more likely to be deferred. Not being able to keep up with responsibilities at work and at home can lead to additional negative thoughts. Ever-increasingly negative thoughts, biology, and behavior all then enhance the feeling of depression. This can become a vicious cycle. What starts as something minimal can quickly snowball into severe and debilitating depression that negatively affects the biological, psychological, and social aspects of your life.

The first paragraph above says a lot and there are the people with diabetes that I am concerned about. Because some people are at higher risk for depression than others, the rest of the people around this person need to be aware that depression can negatively affect all areas of a person's life. The feelings of hopelessness and distorted thoughts and judgment can lead to self-harm and suicide. As with any disease, the symptoms and causes of depression for people with diabetes can be problems with unknown magnitude.

Like most diseases that go untreated, depression negatively affects quality of life and has complications, the most serious of which is suicide. This why I blog and our support group is working to do interventions. If anyone you know is suffering from depression, please assist them in obtaining treatment immediately.

Warning, leave certified diabetes educators (CDEs) out of this, as they avoid being in the room with anyone with diabetes that talks about depression. I have blogs up over the years where CDEs have done just this and I have been able to help a few of their victims. They can't seem even to pass this information to the person's doctor for follow-up.

Some blogs that I have found helpful include this about why are your missing work, this blog about restoring happiness, and this blog about other bloggers writing about handling depression. The last link is this on about some depression drugs causing hypoglycemia and this should be known before accepting some depression drugs.

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.

Lessons for People New to Type 2 Diabetes, Part 12

Do you know and understand depression. If you are new to diabetes, this should be on your list of topics to learn about. Since diabetes is a 24/7/365 disease, depression will eventually catch up with you. Yes, a few people can avoid this, but even one person I know finally admitted that depression had caught her off guard and it took a few days for her to realize what had happened. She has had diabetes for over 12 years and was not happy about having even this mild case of depression especially the way it happened.

A.J said that my blog here on interventions – understanding depression helped him and recently he needed to have Jerry read it and several other blogs to help him conquer his minor depression. Those of us in our support group have been excellent learners and we work with each other to help when we have depression. We know we can count on our members to talk about it and this talking helps us through the tough times and gets us back to the positive and happy side.

This is one reason I have been able to do the blogs in this series. A.J, Allen, Barry, and Ben have been exploring the topics and pulling other blogs together for me to write about. Often they suggest thoughts and ideas to include. Even Barry and Ben's sister, Sue, has asked that I include certain women's issues, but would understand if I did not feel like writing about them. She said having diabetes when entering menopause can make some women more susceptible to depression. She said that their cousin was having these problems and was thankful for all the information we had supplied her for her cousin to read and talk about with her. She had been diagnosed with type 2 diabetes shortly after she started menopause. She had depression and her blood glucose readings were difficult the manage at the same time.

Mild depression is often not even paid attention to as a health problem. Many doctors just prescribe an antidepressant and often for too long a period. Depression and diabetes seem to feed on each other and many doctors treat both at the same time and do not follow up to be sure that both are managed properly. A good doctor will treat each separately and make sure that both are properly treated. Some will even recommend seeing a therapist to make sure that the depression is handled properly.

If not treated properly, mild depression can become severe depression and this will lead to unmanaged diabetes. Yes, I am aware of the resistance people have to therapists – they don't like this because they are all wrapped up in the myth that people that say this imply that the disease is “all in your head.” The fact that people with diabetes get depression and often suffer from stress, makes this even more important. Both can make diabetes more difficult to manage and by talking to a therapist can often help reduce stress and make depression more recognizable and easier to get past mild to moderate episodes of depression.

Approximately 67 percent of people with diabetes develop mild to moderate depression and about 19 percent develop severe depression. If this does not give you concern, it should. Depression that lasts for several weeks can undo good diabetes management and encourage the development of some complications. Please get depression taken care of and don't let it ruin you diabetes health.

First Blood Test for Depression May Be Available Soon

Things are looking up for people with depression. In my previous blog on tests for depression this came to light - if depression could be detected via a blood test or urine test, it would clearly be in the realm of ‘medical illness’ and therefore a real problem that is not due to individual weakness or other equally stigmatizing reasons. Now we have a blood test for diagnosing severe or major depression and it has been developed by Northwestern Medicine® scientists.

This they claim is a breakthrough that provides the first objective, scientific diagnosis for depression. Apparently, they have not followed the information from my blog link above. The test identifies depression by measuring the levels of nine RNA blood markers. RNA molecules are the messengers that interpret the DNA genetic code and carry out its instructions.

Besides helping diagnosis of depression, the blood test will also predict who will benefit from cognitive behavioral therapy based on the behavior of some of the markers. Individualized therapy for people with depression will become more effective and individualized.

The research also showed that the test showed the biological effects of cognitive behavioral therapy, the first measurable, blood-based evidence of the therapy’s success. The levels of markers changed in patients who had the therapy for 18 weeks and were no longer depressed.

Eva Redei, co-lead author of the study, had previously developed a blood test that diagnosed depression in adolescents. Most of the markers she identified in the adult depression panel are different from those in depressed adolescents. Redei developed the test and is a professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.

Co-lead author David Mohr, a professor of preventive medicine and director of the Center for Behavioral Intervention Technologies at Feinberg says, “This study brings us much closer to having laboratory tests that can be used in diagnosis and treatment selection.”

The current method of diagnosing depression is subjective and based on non-specific symptoms such as poor mood, fatigue, and change in appetite, all of which can apply to a large number of mental or physical problems. A diagnosis also relies on the patient’s ability to report his symptoms and the physician’s ability to interpret them. But depressed patients frequently under report or inadequately describe their symptoms.

Eva Redei says, “This test brings mental health diagnosis into the 21st century and offers the first personalized medicine approach to people suffering from depression.”

It is time for science to catch up with all forms of depression and provide scientific evidence to blunt the stigmatism often attached to depression.

Interventions, Understanding Depression

I don't know what happened for the month of May, but with several of the members helping others and others visiting friends and members in the hospital and then the nursing home, we had no reason for a meeting, as we were busy enough. Then Dr. Tom advised us that the speaker for the June session on interventions asked to be excused until September or October.

For now, we have no plans for meetings until at least September. Allen and Tim have been working with James and report that he is finally doing much better and that his last A1c was 7.9% which is a great improvement and even Dr. Tom is pleased as he hopes to have it under 6.5% when it will be checked again in August.

A.J. asked me to do this blog and thanked me for the previous depression blog. He knew about this and admitted that he had intended to ask me earlier, but when he read the blog, he felt that he should wait so it would be later. Thank you A.J. as I had intended on having it for our May meeting, which did not happen.

The blog referred to is about depression and when you should get help. The Centers on Disease Control and Prevention reports that depression many affect as many as 1 in 10 adults. They list the following as possible symptoms:

1. Have little interest or pleasure in doing things
2. Can't work or have trouble with doing routine activities
3. Feel down, very sad, or hopeless
4. Have trouble falling asleep, staying asleep, or find you are sleeping too much
5. Feel tired or have little energy
6. Can't eat or are overeating
7. Feel bad about yourself, feel that you are a failure, or that you have let yourself or your family down
8. Have trouble concentrating on things, such as reading the newspaper or watching television
9. Find that you are moving or speaking so slowly that other people have noticed, or the opposite, you are so fidgety or restless that you can't be still

Many people fear seeking mental health care. Seeking professional help is often the best way to get well. Mental health is just like physical health, sometimes we need to get treatment and care to get better.

Depression is often associated with other chronic diseases, like arthritis, heart disease, or diabetes, and can make managing those conditions more difficult. For many people, physical conditions can contribute to problems with their mental health, problems that are often ignored and not treated.

Even though the author recommends that you start with your primary care physician, I have found that most try to laugh it off and say you are not depressed if you have enough fortitude to bring it up. At least my endocrinologist knew what I was saying and after looking at my A1c and a few other tests, asked a couple of questions and then advised me to stay in touch. My depression was minor and he felt that I could handle it, but I was to call if I could not.

Medication and talk therapies are about equally effective. Sometimes it is best to use both together and for some people it does not work. I know from experience that if you have a major depression, you need to see a therapist sooner rather than later. If you have depression multiple times, a combination of therapy and medication is the usual treatment. Talk therapy for the first few times of minor depression can often be the best, especially if the doctor helps train you in how to overcome minor depression.

Depression May Be Linked to Low Zinc Levels

Because soils in the United States are generally low in levels of zinc, this may well be factual and part of the depression problem. Granted this is the determination of a meta-analysis and not a large controlled study. In addition, the authors list some weaknesses of the studies they used. Association studies cannot determine the direction of causation, a causal association between zinc status and depression is biologically plausible.

Zinc does have antioxidant properties, it helps to maintain endocrine homeostasis and immune function, and zinc plays multiple roles in regulating the hippocampal and cortical glutamatergic circuits that sub serve regulation and cognitive function. Thus, changes in zinc homeostasis might compromise neuroplasticity and contribute to long-term neuropsychological and psychiatric decline. Homeostasis is the tendency of a system, especially the physiological system of higher animals, to maintain internal stability, owing to the coordinated response of its parts to any situation or stimulus that would tend to disturb its normal condition or function.

People who are depressed were found to have lower concentrations of zinc in their peripheral blood compared with nondepressed individuals, a meta-analysis suggests.  The pathophysiological relationships between zinc status and depression, and the potential benefits of zinc supplementation in depressed patients, does warrant further investigation. This is the conclusion of author Walter Swardfager, PhD, from the Sunnybrook Research Institute, University of Toronto, Canada, and colleagues. Their findings were published in the December 15 issue of Biological Psychiatry.

The analysis included 17 studies that measured peripheral blood–zinc concentrations in 1643 depressed patients and 804 control participants. Ten of these studies reported on psychiatric inpatients, and seven reported on community samples. Of the participants, 34.4% were male; the mean age was 37.7 years.

I found no mention in the study about whether the following vitamins, B12 and B6, which can also influence depression were even considered. From my research, I know that vitamin B12 and vitamin B6 can influence depression. From the Oregon State University the following is quoted from depression - “Because a key enzyme in the synthesis of the neurotransmitters serotonin and norepinephrine is PLP-dependent, it has been suggested that vitamin B6 deficiency may lead to depression. However, clinical trials have not provided convincing evidence that vitamin B6 supplementation is an effective treatment for depression, though vitamin B6 may have therapeutic efficacy in premenopausal women.”

Also from the Oregon State University, this is quoted from the vitamin B12 - “Observational studies have found as many as 30% of patients hospitalized for depression are deficient in vitamin B12. A cross-sectional study of 700 community-living, physically disabled women over the age of 65 found that vitamin B12 deficient women were twice as likely to be severely depressed as non-deficient women. A population-based study in 3,884 elderly men and women with depressive disorders found that those with vitamin B12 deficiency were almost 70% more likely to experience depression than those with normal vitamin B12 status.”

Rather than purchasing and taking zinc supplements, I would suggest that you talk this over with your doctor and have the doctor test for serum zinc deficiency. Be careful, as many doctors will declare that this is “all in your head.” A member of our support group had a relative with depression and this was the answer she received. The doctor also said the same for B12 and B6 and refused to test for them.

We are thankful that our local doctor, Dr. Tom, as we have nicknamed him, that knows our group fairly well now, did the tests for Sue's relative and discovered she was severely deficient for zinc, iron, and vitamin B12. He gave a series of shots for the B12 and started her on iron supplements immediately. He said because iron could prevent the uptake of zinc, he wanted her iron levels in the normal range before she took any zinc supplements. Sue's relative recovered from her depression before she started on the zinc supplement. There were other vitamins that the doctor discovered she was in the low range for and they started tackling them with food to start, and when one still tested low, he prescribed a supplement for it.

We have invited him to speak to a joint meeting of his support group and our group in January. He has accepted this.

Caregiver Care Done Right

Most people enter caregiving as amateurs and forget about what they may need to be quality caregivers. Some continue and become embroiled in the fight for their own health and often develop major depression. The better caregivers have realized that things happen beyond their control, consult with others early, accept help from friends and neighbors, and develop a relaxed but vigilant style of caregiving. These are the people that make great caregivers.


This article in WebMD covers caregiver stress and depression, both of which are real problems for caregivers. If you are providing near end of life care, or care for someone with a chronic painful condition, be aware that the rewards for this caregiving are real and can vary greatly.


Stephen Zarit, PhD, professor of human development at Pennsylvania State University, has been studying caregivers for more than 30 years. He finds that 40% to 70% of caregivers are significantly stressed. Zarit also says that about half of these seriously stressed caregivers “meet the diagnostic criteria for major depression.”


Psychologist Michael Williams, senior program associate at Wellness House, a caregiver support center in the Chicago area says caregivers seldom realize they are becoming depressed. He also states, "Depression builds over time due to the physical and emotional symptoms the caregiver experiences,"


I appreciate what Philip Higgins, MSW, director of palliative care outreach at Boston's Dana Farber Cancer Center has to say. He says, "You don't become depressed because of the symptoms; you become depressed because they are extreme and persistent,"


Symptoms of major depression include:

• Sad, anxious, or "empty" feelings
  
• Feelings of hopelessness or pessimism
  
• Irritability, restlessness, and anxiety
  
• Feelings of guilt, worthlessness, or helplessness
  
• Loss of interest in once pleasurable hobbies or activities, including sex
  
• Fatigue and decreased energy
  
• Difficulty concentrating, remembering details, and making decisions
  
• Insomnia, waking up during the night, or excessive sleeping
  
• Overeating or appetite loss
  
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease, even with treatment
  
• Thoughts of suicide or suicide attempts
  

“People caring for a loved one with a terminal illness should add "feelings of anticipatory grief" related to a sense of impending loss to the list, says Ruth Steinman, a psychiatrist at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia. "This is a symptom where a palliative care service can be especially helpful," Steinman says.”


It is important to recognize that the stress you are experiencing can sometimes lead to depression. This is the first step to preventing it and burnout from happening. Then take the second step and find a palliative care team's social worker or mental health professional. Talk about your feelings, frustrations, and fears. This talking will help you understand what is happening to you and the person in your care. When caregivers understand that they are not in total control of the situation, this alone can bring on a great sense of relief. This will also allow the caregiver to have goals that are more realistic.


I will quote this as it contains important information.
“In addition, to keep depression at bay:

• Maintain a life outside of caregiving. Stay connected to friends. Don't give up your daily routines.
  
• Maintain your health. Get regular check-ups, eat a balanced diet, and exercise. "It wasn't until I was hospitalized that I started thinking about my own health. That was a real wake-up call," says Nancy Knitter, who is caring for her husband with Parkinson's disease in their Rochester Hills, Mich., home.
  
• Exercise. It un-kinks tense muscles, revs up the cardiovascular system, and floods the brain with feel-good chemicals, such as endorphins.
  
• Use simple de-stressing techniques: deep breathing, muscle relaxation, meditation, and self-massage. And laugh. "People don't think of humor as a way to cope with stress, but they should," says Irv Ginsburg, of Ooltewah, Tenn., who cared for his wife, Nada, while she had brain cancer.
  
• Join a support group. In support groups, you validate your role as caregiver, voice your fears, vent your frustrations, and learn coping strategies and techniques. Hospitals and most disease-specific organizations sponsor groups. If you can't get out to a group, many organizations sponsor online support groups, and the Veterans Administration has a free caregiver support line (855-260-3274).
  
• Ask for help from the palliative care team, family, and friends. Delegating lessens stress and provides ways for others to show they care. "People want to help, they just don't know what needs doing," says Helene Morgan, MSW, clinical social worker in the pediatric palliative care program at Children's Hospital Los Angeles.
  
• Use respite care. Organizations -- home health agencies, adult day care programs, nursing homes, faith groups, Area Agencies on Aging, the Veterans Administration -- and friends can provide short breaks that lessen stress and allow batteries to recharge. "Using respite care didn't just help me with the caregiving, it helped my wife and me have a social life."
  

Some of the above points are covered in three prior blogs - here, here, and here.

Diabetes and Depression – CDE Style

At last, a certified diabetes educator that is willing to talk about depression. Although I am not sure I completely agree with everything she says, at least she has opened a dialog. Where it will go from here remains to be seen. Will the American Association of Diabetes Educators (AADE) make it a topic of interest? This could be interesting if they would.

I am admittedly tired of explaining to other people with diabetes why CDEs seem to close out sessions with diabetes patients when the word depression is mentioned or when CDEs are asked for help. The instance, what I talked about in a previous blog seems to hold true time after time. It is like most CDEs are afraid to talk about depression and don't want to be around people with any level of depression.

Talking about depression and obtaining help for people with depression is becoming more difficult as many programs are being cut by lack of funding and qualified people to handle depression. In my state, mental health facilities are less than one quarter of what they were 15 years ago and finding doctors willing to refer you to professionals capable of assisting people with depression is almost non-existent. Those that do have a practice are so busy they do not have time for new patients.

Most medical providers today just attempt to help by prescribing antidepressants for a period of time. Even with all the discussion about mental health care because of school shootings and obtaining guns has not been looked on with favor because there just is not provisions to handle this potential influx of patients. Most of the governors in the surrounding states have stated that this would be ideal, but with the lack of facilities and professionals to handle this, it is unrealistic to support mental health care for persons needing this.

That is the main reason for my surprise that a CDE would even blog about depression since her colleagues seem to walk – no, run away from people even mentioning the word depression. Clearly they lack the training to deal with depression. What stops them from talking to the patient's doctor about this still has me puzzled as this seems the least they should to do to assist the patient.

This behavior by CDEs says they don't know how to assess diabetes patients for depression and are not interested in helping people with depression. I can only hope that the dialog opened by one CDE does not die for fear of having to deal with diabetes patients and depression.

CDE's Ignore Patients with Depression

I had wondered when I would receive the next email from someone dealing with depression and being ignored by a CDE. This time it was two emails about four hours apart. Both had been referred to a CDE and did need assistance for diabetes. One is a type 1 and the other a type 2. Both had been diagnosed since the beginning of the new year and both were not receiving family or for one even spousal support.

The person with type 1 (19 years of age) was rejected by his family and they did not want him around because there was no history of diabetes and therefore he could not have diabetes. In essence, his family had turned their back on him. He was not welcome in their home and they did not want contact from him until he grew up and admitted he did not have diabetes. Is it any wonder he had depression?

He said in his email that they were almost done with his CDE appointment, but he wanted some information and help with his depression. He stated next that it seemed to him that the CDE could not gather up her materials fast enough and say on her way out the door, that she was late for another appointment. He wanted to know what it was about diabetes that drove people away from him. He knew he had depression because of the parent's rejection and how he was feeling around people. I was fortunate this time as one phone call was necessary and he had an appointment with someone that knew what to do for him. Three weeks later, he sent another email saying that he was happy with the appointment and felt that I had found him the right person. He said he would have several more appointments, but wanted to thank me.

The second person is in his late 40's and is wondering what to do. He had an appointment with a CDE and when she walked in, she asked how he was. He said he answered, depressed, and he said she turned around and left the room. He said he waited for 10 minutes and then walked to the reception area. He was told that this CDE would not see patients with depression. Now he has lost his family and has not been able to find help.

I asked him in a return email what had happened. He said that his wife had been present when he received the diagnosis and over the next month, the situation went from bad to worse. His teenagers rejected him and were asking him when he would have his legs cut off and they refused to change their eating habits. His wife would not change her cooking habits and the highly processed foods and would not prepare separate meals. He said he started cooking again and this helped for a while until the teenagers kept bringing home more horror stories about what happened to people with diabetes. Then his wife said she would not take care of him when things like this happened. He said he came home from work in March and they had moved out and two weeks later, he received divorce papers at work.

He stated that he had tried three different places to get counseling, but could not get an appointment at any of them. I asked if he had talked to his doctor or even to anyone in his church. He admitted that he had not and would talk to his doctor the next day. The next day I received an email saying his doctor had gotten him an appointment with someone and he would let me know if he was being helped. I am still waiting, but the appointment won't happen until near the end of April.

What surprises me is the lack of support the two received and the total rejection by both families. There may have been unknown facts with the second individual, but I have known other divorces where diabetes was the cause and one or the other spouse was not going to help with future health issues. Sad things can happen.

Is Diabetes Causing You Burnout?

This blog in Diabetes Health is interesting. Yes, diabetes burnout is common and happens more often than we might like. Many people have burnout and wonder why they feel like they do. Some people do not recognize this and have a difficult time dealing with this for a period of time. Others become depressed and know they have something that needs correcting, but it can take time. Some that have depression and don't know they have it. As a result, their management of diabetes takes a vacation. Some of the solutions are unrealistic for many people and others will not be able to consider the solutions offered.

The second article is from About dot com and is a little more realistic. I enjoy this analysis of diabetes burnout. Unlike the first article, the author recognizes that recovery happens, but not all at once. She says rightly so that it often takes baby steps to overcome diabetes burnout. I know this is right because even though I have been blogging consistently, I am fighting burnout myself. I am not enjoying this at all and wish I could say that I have not had depression. The depression is behind me now and I am working on correcting the areas of diabetes management that have suffered for the last two months.

No, this is not easy to write, but it needs to be written about by people that have been through the wringer. What started it, I am not totally sure. I know an argument with a doctor did not help. I can think of a lot of little things that add up and make you want to find something to take it out on. I have a couple of people that are what I term “the food police” and I see them more often than I like. I try to ignore them, but when they are constantly in my face, they are hard to ignore.

There have been other health concerns as of late and until mid June, I won't have an answer. I also know that I had about a week that blood glucose readings got higher than I like and by more than I like, and with a lot of analysis, I could not figure out what or why it happened. This may have been much of the trigger and the food police that just aggravated the situation. Now it is climbing out of the pit I have gotten myself into.

Since I am researching diabetes burnout, I have to say this makes the most sense to me so I will use the points that Elizabeth Woolley lays out and make comments about each.

Accept that you can't be perfect. Being the near perfectionist that I am, makes this almost as bad as the lesson I had to learn when I was diagnosed. What has happened can't be changed so accept it and move on. It is almost behind me and I have got to keep it there.

Remember it's all about you. Yes, I am the only one that can take responsibility and make the changes necessary. I cannot blame anyone else for my errors or shortcomings. I have to get my good habits back in control for better management. I think that a positive attitude helped me from sinking too low, but now I have to recapture this as well.

Become proactive in solving management challenges. I am hoping the fact that in dealing with the medical community I am a proactive person will aid me in being proactive in improving my diabetes management.

Connect regularly to the diabetes world. This will not be difficult, as I will have my appointment next week with the endocrinologist. The A1c will have to be what it is. Approximately two months of poor management can't be corrected in a week. In reviewing my first month’s records, I was doing so well – shame it has to be this way.

Now I wish I had the list that comes next in the article. A couple of them may have made it harder, but I am still using this list so that next time, I may be able to short-circuit some of the problems. Here is the list and my comments.

Take small steps in the right direction. Sometimes this is the best and then if you succeed you are able to celebrate a success. If you fail, you won't have lost a lot of ground. Continue with the small successes and eventually you will have your diabetes management back.

Take a doctor-guided break if needed. I will definitely give this some consideration, as this may be a way to lessen the effect of burnout. Hopefully, this will be possible, communication has been good, and this looks like something I could handle.

Find inspiration. I will have to work on this. Yes, I was reading, but reading for research and blogging. I had to work harder to write blogs and often reread some articles. I missed several of our group meetings and spent much of my time just writing and rewriting when it was not making sense.

Reestablish a connection with the diabetes community. I am hoping that just by continuing to blog will aid me in getting rid of this down feeling or energize me to be myself. According to the author, I am to reconnect with the diabetes social community.

See a diabetes educator. This is not possible. Insurance will not cover at this time and I am in no mood to have mantras shoved at me. This is me and I feel that this would put me back in depression. I know, I know, for some people this will be an advantage and serve them well. What will work for some, will not work for me this time.

Count your blessings. This can be important for many. This will also aid in getting you back to a positive attitude and feeling good about yourself. Give this an honest try.

Make peace with the diabetes police. If you are able, this may go a long way in restoring peace in a family or among your friends. Include the diabetes food police, as they can be worse than the diabetes police. I am in luck with two of these individuals, but with the third person, I am not sure this is going to be possible. I feel this may be one that has to remain at arms length.

Make sure you are not experiencing depression. Sorry, I've already been through a minor depression and have my life back. For anyone reading this, sometimes a person is able to work their way through and out of even a minor depression and at other times, it may be necessary to talk with your doctor or other qualified professional to help you. They can also determine if other means may be needed for the short and long-term.

Depression is not sometime to take lightly and sometimes professional help is the best solution. I admit that I have not needed it, but I am prepared if it becomes necessary and have talked to my doctor about just that. The doctor will give me a referral if needed.

I have several blogs about depression, but I find it a difficult topic to define and the professionals just like their technical jargon and apparently find it difficult to write about it in laymen terms. My attempt may be read here.

How you handle diabetes burnout depends on you and your attitudes. I have found that having a positive attitude about diabetes has generally served me well and made it easier to handle diabetes burnout. Not everyone will react the same. Another article on how diabetes can take a toll on our emotional health may be read here.

There is one important topic missing.  Take your medications, if you are on any.  I feel fortunate that through the burnout and depression something kept reminding me to take my medications.  Yes, often it was after I had gone to bed, but something in the back of my mind would not let me sleep and was saying insulin, insulin, until I got up and took my medications.  I guess after almost ten years, habits are good at times like this.

Will CDEs Really Help PWDs With Depression?

With the exception of a few CDEs working for physicians that are concerned about their patients and make sure that their CDEs are knowledgeable about depression, apparently the American Association of Diabetes Educators is still mired in the past and could care less about the patients. All they seem concerned about is their certification standing and their paycheck. Sad, but true. Read this blog for more confirmation.

Many of us were hoping that with a new leader that is trying (according to her) to improve the profession, we might see some changes. But, apparently those in the trenches are not buying into the changes and we as patients are getting more of the same BS they have been dishing out for years.

After reading the above-mentioned blog, I called my relative that is a CDE in a large practice and asked her about the webinar. She said that one of their CDEs was to have monitored the webinar and she would have a talk with her and get back to me by Monday evening.

I have now had a return call from her. The only statement I am allowed to use is this - “thank goodness the practice we work for gives and sends us to good continuing education classes.” I ask if this applied to the webinar. No, was the answer. We talked about some other topics of interest like self-monitoring of blood glucose and she would only state that she liked some of my blogs on SMBG.

As long as I do not quote her or mention specifics, she will talk openly about many topics as long as they remain just between us. So do not ask for quotes has been good for me. When it comes to her honesty about most topics, she has very good for advice to me and does not spout the mantras of ADA or other professional groups. I have to respect her for this and staying as a relative I can consult.

Based on my own observations, I would conclude that Wil Dubois is probably very much on target with his analysis of the CDE webinar.

Some Blogger Suggestions for Handling Depression

Bloggers do tackle the topic of depression and help educate all of us. Sometimes we write from our personal experiences about depression, but we also read a lot as well.  The first blog I want to bring to your attention is one by Will Ryan at the Joyful Diabetic. Will covers some of the facts about depression and gives several good suggestions to aid in combating and managing depression.

As people with diabetes, we need all the help we can obtain and I always appreciate blogs like Will Ryan's. While I agree with his suggestions, not everyone may. To this I say, find what works for you and discard the rest. I seldom discard things, but bookmark it for later reference in case something changes for me. I also have the habit of having different topic word processor pages, which I copy the URL to and often make notes to the URL to refresh my mind later.

I will point out that Will Ryan and David Mendosa work hard for us and do it in a positive fashion, which makes the information more valuable. With this, here are two previous blogs by David Mendosa that can help you with minor depression and chronic sorrow. This first blog from November 2, 2008 discusses diabetes, depression, and the use of exercise as a possible step in managing both.

In his second blog of January 4, 2010, he lists some of the potential aids he uses to help him manage depression. These can help break out of depression for me and I blogged about using them here and how they have or have not helped me. I do need to make one change about Omega 3. It has given me some help and then I did add vitamin B12 to my supplements about six months later and the two of them seemed to really help in leveling my mood swings and I avoided having depression for the rest of 2010 and well into 2011. I did have a mild bout of sadness or mild depression last September, but it only lasted for a couple of days.

One thing that keeps me going is working for the positive attitude and I really think the power of positive thinking keeps depression out of most of my life, even when I have periods of wondering what I have done wrong in my diabetes management. My blood glucose levels in the first six hours after I wake are right on target. Then in the late PM, they seem to rise more than they should. I have used the same vials of insulin and even rotate the injection locations, but they still rise.

Sometimes they level out in the upper 100's, but I am having some readings over 200 in the late PM. I know the insulin is good and still the readings are climbing. I have been reducing my carbohydrates and still they climb in the late PM. I think I have stopped this for now. Maybe not the best of solutions, but high fat and the rest protein with zero carbs other than what is in fresh lettuce and spinach. Blood glucose has remained under 130 mg/dl for three evenings now.

Dr. R. Centor has something to say that we all need to know. He has two questions for his patients that he uses to see how patients are actually doing. He uses them to detect depression and for some of the underlying issues such as sleep apnea, systolic dysfunction, and other diseases. There are some comments, but nothing as definitive as his two questions. More doctors should use these questions, but many just enter the exam room, check the lab reports and discuss any changes to be made and leave.  They have no interest in checking for anything else and are thinking about the time they will save.

The Depression and Diabetes – A Cycle?

This discussion is not to include the major depressions, but realize they can happen. Mild and short-term depression is the most common for people with diabetes – about double the risk, with approximately two-thirds of people with diabetes at risk for depression. For people with depression, the risk for diabetes is about 20 percent.

Several items came to light in my continuing research on the depression affecting people with diabetes. One person says people may have chronic sorrow rather than clinical depression. Chronic sorrow according this person says it means that people new to diabetes are now coping with new long-term lifestyle changes that they may find stressful.

This condition as it is termed comes from simple things like not being able to join a group for a piece of birthday cake, which can leave the person feeling apart from the group and resentful. For a person to feel sad is a normal reaction about a chronic disease that has taken so much away from you. This make the illness a burden to bear alone and we need to have empathy and support from those around us.

Another piece of advice given is always worth checking out is the thyroid, as it is in the same gland family as the pancreas. Hypothyroidism is a major cause of depression and weight gain. In all cases of diabetes, this should be checked on a regular basis. Another thought is checking for a vitamin deficiency because low levels of vitamins B1 and B12 can cause depression.

Depression – diabetes and the reverse can be a vicious circle for some. As depression gets worse, the complications of diabetes may become worse because the depression causes people to stop or slow their diabetes management. This may cause the people to develop long-term complications like retinopathy, neuropathy, and nephropathy.

It is unfortunate that a large share of the people suffering from depression and diabetes never receive help for the depression. Sometimes it is not recognized by healthcare professionals, and sometimes people with diabetes who are depressed do not communicate to their doctors about their feelings or do not even realize they are depressed.

If you are a person with diabetes, learn the symptoms of depression or chronic sorrow to be able to communicate with your doctor about these. Learn also that people with diabetes can become burned out managing their diabetes. They can often become upset, gloomy, and have the helpless feeling because they cannot control their blood glucose levels.

There are reasons that cause people with diabetes to develop depression or chronic sorrow, and this can vary from one individual to another. Learn as much as you can about what affects you and learn the best way to deal with sorrow or depression.

The following articles are sources for this blog: article 1, article 2, article 3, and article 4.

The Types of Depression

I am writing this blog to give you some information for my two following blogs. I am presenting information about the different types of depression. Many people speak of depression and write about depression, but seldom do they specify what type of depression they are talking discussion. I am guilty of this, and I have read many studies and articles guilty of this. I firmly believe this is because as a layperson, the classification of the different types of depression is not an easy topic to understand.

Feeling sad or what many of us refer to as being depressed can be a form of depression if it lasts for more than a few hours. Being sad for a few hours and then becoming your normal self is generally not considered depression. Can we be in a state of depression for a few days without being clinically depressed? This is a difficult determination and there seems to be few people willing to classify this as a mild form of depression. Most professionals find a way to hide it in technical terms that are hard to understand.

In my own unprofessional understanding, about 67 percent of people with diabetes do suffer from some type of depression; however, most of the time you will see this listed as just depression with no definitive definition. Then about 19 percent of people with diabetes suffer from serious depression and again no accurate definition accompanies this statement.

I must preface the following as being about all types of depression and not just about depression associated with diabetes although it can include depression. When talking about depressions types, understand that some sources will use different terms for the same type. There are several forms or types of depression or depressive disorders. This source says major depressive disorder and dysthymic disorder are the most common. Although this is not clearly stated, I would assume this to be for the more serious forms of depression. However, one source uses dysthymic disorder for mild to moderate depression.

Major depressive disorder is also known as major depression. With this disorder, a patient suffers from a combination of symptoms that undermine his ability to sleep, study, work, eat, and enjoy activities he used to find pleasurable. Experts say that major depressive disorder can be very disabling, preventing the patient from functioning normally. Some people experience only one episode, while others have recurrences.

Dysthymic disorder is also known as dysthymia, or mild chronic depression. The patient will suffer symptoms for a long time, perhaps as long as a couple of years, and often longer. However, the symptoms are not as severe as in major depression, and the patient is not disabled by it. However, he may find it hard to function normally and feel well. Some people experience only one episode during their lifetime, while others may have recurrences.

A person with dysthymia might also experience major depression, once, twice, or more often during his lifetime. Dysthymia can sometimes come with other symptoms. When they do, it is possible that other forms of depression are diagnosed. When severe depressive illness includes hallucinations, delusions, and/or withdrawing from reality, the patient may be diagnosed with psychotic depression.

I will mention postpartum depression in passing because it affects women after giving birth and is not part of the discussion about diabetes although women with diabetes may have this as well.

SAD (seasonal affective disorder) is much more common the further from the equator you live. A person who develops a depressive illness during the winter months might have SAD. The symptoms go away during spring and/or summer. In some countries, where winter can be very dark for many months, patients commonly undergo light therapy - they sit in front of a special light. Light therapy works for about half of all SAD patients. In addition to light therapy, some people may need antidepressants, psychotherapy, or both. Light therapy is becoming more popular in other northern countries, such as Canada and the United Kingdom.

Bipolar disorder (manic-depressive illness) is a mood disorder characterized by chronic mildly depressed or irritable mood often accompanied by other symptoms (as eating and sleeping disturbances, fatigue, and poor self-esteem). It is not as common as major depression or dysthymia. A patient with bipolar disorder experiences moments of extreme highs and extreme lows. These extremes are known as manias.

Some illnesses accompany, precede, or cause depression such as anxiety disorders, and include PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder), social phobia; generalized anxiety disorder and panic disorder often accompany depression. If you are dependent on alcohol or narcotics, you may have a significantly higher risk of having depression.

Depression is more common for people who suffer from HIV/AIDS, heart disease, stroke cancer, diabetes, Parkinson's disease, and many other illnesses. According to studies, if a person has depression as well as another serious illness he or she is more likely to have severe symptoms, and will find it harder to adapt to his medical condition. Studies have also shown that if these people have their depression treated the symptoms of their co-occurring illness improve.

Other types or sub-types of depressions I include here are:

• atypical depression (sub-type of major depression or dysthymia
• chronic depression is a major depressive episode that lasts for at least two years
• endogenous depression is defined as feeling depressed for no apparent reason
• situational or reactive depression (also known as adjustment disorder with depressed mood) that develops in response to a specific stressful situation or event like job loss, end of a relationship, death in family, etc.
• agitated depression which is a type of major depressive disorder
• psychotic depression is a major depressive disorder with psychotic symptoms like hallucination and delusions
• melancholic and catatonic depression which are sub-types of major depressive disorder

There are obviously many more subtypes, but finding anything descriptive of the short-lived or short-term depressive nature is very difficult to find. So what other than the term of mild depression are we left with for describing what many of us feel that we have or are we just feeling sad and let down.

Two of the above types do come close to being mild and not serious – SAD and situational or reactive depression. The first generally only last for the winter months and the second for about three months and then not until about three months following the cause of the depression. While not in the category of major depression, the short time can be very depressive and symptoms can vary from mild to deep.

The articles used in this blog include article 1, article 2, article 3 and article 4.

Depression – Under-diagnosed, Antidepressant Use Up

I am seeing a host of articles about diabetes and depression the last few weeks. While I am appreciative that diabetes and depression is receiving some of the attention that it needs, I am more than a little concerned about the article that appeared last week (August 4 and August 5). What is behind the study and what is the intention of psychiatrists?

Psychiatrists are concerned about the number of antidepressant prescriptions without a psychiatric diagnosis. The number of non-psychiatrist doctor visits where antidepressants were prescribed without a documented psychiatric diagnosis increased from 59.5% to 72.7% between 1996 and 2007, according to a new study published in Health Affairs.

Experts not affiliated with the study caution that there are many possible, and plausible, explanations for an increase, and that depression remains largely under-diagnosed and under-treated in the U.S. The study does include many conditions for which antidepressants are being prescribes such as diabetes, heart disease, and nonspecific pain symptoms.

The drugs prescribed to patients without a diagnosed mental health condition were more likely provided to white women between the ages of 35-64 and patients with public insurance and chronic medical conditions, such as diabetes and heart disease.
I am not surprised by this as it is what happened to me and I'll admit I rebelled, but my heart doctor was ready and willing to explain why he had prescribed them. With the number of people that have heart problems and diabetes that are at risk for depression, it was and is still a sound medical decision.

Now if the psychiatrists are going to insist on making a diagnosis before these medications are prescribed, I doubt many people will even go to that visit. I know that I would have passed. Depression was not something talked about in my family when I was growing up and one of my uncles firmly believed that these doctors were mislead and did not understand human nature.

If the psychiatric profession wants to continue to claim that depression is under- diagnosed and psychiatrists are under-utilized, then they have to do some serious image mending and change some ways that they do business. Mental health issues are finally coming out of the closet and being recognized as having some valid health concerns.

I will conclude by saying the psychiatric profession will do a lot of damage if they become contentious about non-psychiatrists prescribing antidepressants for conditions known to cause depression. True, not everyone with heart disease or diabetes suffers from depression or even 100 percent that have both chronic conditions. Still, I have to be concerned about psychiatrists becoming overly concerned and wanting a piece of the action when they are creating other problems.

Please watch for a coming blog tomorrow, titled “Access to Urgent Psychiatric Care Severely Limited”.

Read three articles about this here, here, and here.

Restoring Happiness in People With Depression

This seems to be a new way for people to battle depression, but has very little scientific basis to support it and has not been attempted (that is known) on people with severe depression. Researchers at the University of California, Riverside and Duke University Medical Center have been working on practicing positive activities as a way to mitigate mild depression.

Positive Activity Interventions (PAIs) is the new approach for treating depression as covered by a team of UCR and Duke psychology, neuroscience, and psychopharmacology researchers. This method is something that I can believe will work for many people. I say this because I have used slightly different activities in the last several years and it does help. Other people will need to read this article and find what may work for them, but I am confident that they can find something that can help.

Depression does not affect everyone with diabetes, but about two-thirds of us do have to deal with depression. Many people refuse to recognize depression and often suffer the effects. Others refuse help and this can often cause them to be in depression for longer that they should and this in turn affects the management of diabetes and makes regaining good management often more difficult.

Quote - PAIs are intentional activities such as performing acts of kindness, practicing optimism, and counting one's blessing gleaned from decades of research into how happy and unhappy people are different. This new approach has the potential to benefit depressed individuals who don't respond to pharmacotherapy or are not able or willing to obtain treatment, is less expensive to administer, is relatively less time-consuming and promises to yield rapid improvement of mood symptoms, holds little to no stigma, and carries no side effects. Unquote

People often underestimate the long-term impact of practicing brief, positive activities. Positive activities have been around for many years and it is just recently that researchers have taken notice and are now applying measuring applications to determine their benefits and understanding why these positive activities work. The one factor that is being seen is they are simple to practice and extremely practical to do with little cost.

An association that is active in promoting the science and practice of positive psychology is the International Positive Psychology Association (IPPA). You may read about them on their website here.

I therefore plead with everyone that may suffer from depression to recognize it and learn how to deal with it for the benefit of your diabetes management.

Six Ways to Help Manage Type 2 Diabetes – P4

Error 4 - Neglecting Other Problems

In your efforts to manage diabetes, do not forget about other problems you may encounter. Depression, stress, and sleep disorders also have an effect on the management of diabetes. So in the process of learning about diabetes, learn about these as well. If you have other chronic illnesses, then you have more to learn and how each disease affect the other. All can lead to increased blood glucose levels.

Because diabetes is a 24/7/365 management demand, depression can be a large part of diabetes and one creates risks for the other. Learn to recognize the signs of depression so that you can take measures to minimize the effects and possibly avoid problems as depression can make diabetes management a very difficult task.

Treatment of depression definitely improves the mental and physical health of people with diabetes. So don't ignore the benefits and let the doctor discussion this and find a good medication fit for you. Even though the article in WebMD states that people with diabetes are twice as likely to have depression, studies show that this in more like 67 percent and then another 19 percent can have serious depression. Please don't ignore depression.

Stress is a factor that many people want to ignore, but please don't as it can produce hormones that hamper the ability of insulin to do what it does. Both patients and physicians need to take this into consideration and use activities that will reduce or eliminate stress. Exercise helps relieve stress and meditation and massage have benefits in improving blood glucose levels.

Some of the tips for easing depression also are applicable to stress. Read my blog here. For stress you need to add yoga and Tai Chi as they can assist in stress reduction.

Sleep disorders such as sleep apnea, insomnia, and others can wreck havoc to your diabetes management. You need to talk to your doctor about any of these so that you can manage them as well. Improper amounts of restful sleep makes blood glucose management that much more difficult to manage. Sometimes weight loss is in order and for others, just getting adequate amount of sleep for your needs helps is diabetes management.

As promised in part 1, read the entire article here.