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Best Antidepressant For Type 1 Diabetes

Comorbidity Between Type 2 Diabetes And Depression In The Adult Population: Directions Of The Association And Its Possible Pathophysiological Mechanisms

Comorbidity Between Type 2 Diabetes And Depression In The Adult Population: Directions Of The Association And Its Possible Pathophysiological Mechanisms

Copyright © 2015 Line Iden Berge and Trond Riise. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Type 2 diabetes and depression are regarded as comorbid conditions, and three possible directions of the association between the diseases can underlie this observation of comorbidity. First, common etiology can increase a person’s risk of both diseases; second, persons with type 2 diabetes have increased prevalence or risk of future development of depression; or third, persons with depression have increased prevalence or risk of development of type 2 diabetes. This review gives an overview over possible pathophysiological mechanisms for each of the directions of the association between type 2 diabetes and depression and further discusses epigenetics as an additional, direction independent approach. We argue that unspecific pathophysiological mechanisms involved in the stress response might, at least to some extent, explain each of the directions of the association between type 2 diabetes and depression, while changes in brain structure and function among persons with diabetes and possible increased risk of development of type 2 diabetes after use of antidepressant agents could represent more disease specific mechanisms underlying the comorbidity. 1. Background The term comorbidity was introduced in 1970 by Feinstein, a doctor of internal medicine and epidemiologist who studied cooccurrence of diseases among persons with diabetes [1]. He suggested comorbidity to be defined as “any distinct clinical entity that has existed or that may occur during the course of a patient who has the index disease u Continue reading >>

Diabetes And Depression: Coping With The Two Conditions

Diabetes And Depression: Coping With The Two Conditions

What's the connection between diabetes and depression? How can I cope if I have both? Answers from M. Regina Castro, M.D. If you have diabetes — either type 1 or type 2 — you have an increased risk of developing depression. And if you're depressed, you may have a greater chance of developing type 2 diabetes. The good news is that diabetes and depression can be treated together. And effectively managing one can have a positive effect on the other. How they're related Though the relationship between diabetes and depression isn't fully understood: The rigors of managing diabetes can be stressful and lead to symptoms of depression. Diabetes can cause complications and health problems that may worsen symptoms of depression. Depression can lead to poor lifestyle decisions, such as unhealthy eating, less exercise, smoking and weight gain — all of which are risk factors for diabetes. Depression affects your ability to perform tasks, communicate and think clearly. This can interfere with your ability to successfully manage diabetes. Managing the two conditions together Diabetes self-management programs. Diabetes programs that focus on behavior have been successful in helping people improve their metabolic control, increase fitness levels, and manage weight loss and other cardiovascular disease risk factors. They can also help improve your sense of well-being and quality of life. Psychotherapy. Similarly, participants in psychotherapy, particularly cognitive behavioral therapy, have reported improvements in depression, which has resulted in better diabetes management. Medications and lifestyle changes. Medications — for both diabetes and depression — and lifestyle changes, including different types of therapy coupled with regular exercise, can improve both conditions. C Continue reading >>

Type Ii Diabetes Mellitus In Patients Exposed To Pravastatin And Paroxetine

Type Ii Diabetes Mellitus In Patients Exposed To Pravastatin And Paroxetine

Type 2 Diabetes (T2DM) is a life-long, chronic condition affecting an individuals' ability to regulate glucose levels in the blood. Diabetes can cause many severe complications if not treated properly. Hyperglycemia is a regular effect of uncontrolled diabetes and can lead to complications such as cardiovascular disease, chronic renal failure, diabetic retinopathy and inability to maintain a healthy body weight. Cardiovascular Disease (CVD) is now the leading cause of death worldwide, affecting millions of people in both developed and non-developed countries. The buildup of cholesterol in the bloodstream may cause the excess to be deposited in the coronary arteries of the heart and the carotid arteries of the brain. The cholesterol deposits are a factor of the plaques that cause blockage of the arteries which can in turn lead to heart disease and stroke. By lowering the blood levels of cholesterol, risks of heart disease, strokes and heart attacks are reduced. Medications such as HMG-CoA reductase inhibitors and fibrates are useful in the prevention of CVD. Pravastatin is a member of the drug class of statins, also known as HMG-CoA reductase inhibitors, and is shown as an adjunctive therapy to diet. It is known to reduce the amount of cholesterol and other fatty substances in the blood. In addition, pravastatin is indicated to reduce the risk of myocardial infarction, revascularization and cardiovascular mortality in hypercholesterolemic patients who do not have clinically apparent coronary heart disease. The recommended starting dose for adults is 40 mg once daily. For patients who do not reach the LDL-C goal with 40 mg, it is recommended to use an 80 mg dose. For persons with significant renal impairment the recommended dose is 10 mg. Children aged 8-13 years have a r Continue reading >>

Diabetes And Depression

Diabetes And Depression

The interrelationship between depression and diabetes is only now being studied and understood. It can almost seem like a chicken-and-egg question. Which comes first? Do symptoms of depression predate those of diabetes, or are the very early stages of diabetes causing depression? The situation becomes even more complicated when you consider the adverse effects that some antidepressant medications have on body weight and blood glucose levels. Treating depression with medications can put some patients into pre-diabetes or move them from pre-diabetes into full-blown diabetes. Tracing the connection In the past several months, several papers have been published that examined the interplay between diabetes and depression. Depression is seen twice as often in people with type 2 diabetes as it is in the general population, but no similar increased incidence is seen in type 1, said Paula M. Trief, PhD, senior associate dean for faculty affairs and faculty development, and professor in the Departments of Psychiatry and Medicine at the State University of New York Upstate Medical University in Syracuse. “People who have diabetes and depression have poorer diabetes-related outcomes,” she said. “They have poorer glycemic control, more complications, higher mortality, and higher costs.” Trief was the lead author on a study that screened more than 6,000 patients with type 1 diabetes and found that between 4.6% and 10.3% had signs of major depression. Those who were found to be depressed tended to have worse clinical outcomes; they were more likely to exercise less often, to miss insulin doses, and to experience more complications.1 A major public health problem This August, the National Institute of Diabetes and Digestive and Kidney Diseases, in collaboration with the Nationa Continue reading >>

Hypoglycemia May Occur With Prozac

Hypoglycemia May Occur With Prozac

I recently spoke with a friend with diabetes who had just started Prozac. He was amazed to find he was having repeated hypoglycemia within days after starting the drug, and had to cut back on his insulin doses. He obviously wondered if it were somehow due to Prozac. Prozac has been a wonder drug for the treatment of depression, but it has a possible effect on diabetes that has not been widely recognized. Prozac, a brand name for the drug fluoxetine, was introduced in the 1980’s, and was the first in a class of antidepressant medications called SSRIs (selective serotonin reuptake inhibitors). It turns out that Prozac (and other SSRIs) have a possible effect of concern for people with diabetes: they can lower blood glucose enough to require downward adjustment of medications taken for control of diabetes. I went to the drug’s label, as posted at the FDA website. The possibility of hypoglycemia when on Prozac has been in the Prozac label for years. It currently reads: “Glycemic Control - In patients with diabetes, PROZAC may alter glycemic control. Hypoglycemia has occurred during therapy with PROZAC, and hyperglycemia has developed following discontinuation of the drug. As is true with many other types of medication when taken concurrently by patients with diabetes, insulin and/or oral hypoglycemic, dosage may need to be adjusted when therapy with PROZAC is instituted or discontinued.” That’s exactly the same wording as the earliest label I can find on-line, from 1999. And if you go to Prozac’s website, it’s right there on the first page: “People who have diabetes and take PROZAC may have problems with low blood sugar while taking PROZAC. High blood sugar can happen when PROZAC is stopped. Your healthcare provider may need to change the dose of your diabet Continue reading >>

Treatment For Diabetes Nerve Pain

Treatment For Diabetes Nerve Pain

Diabetic peripheral neuropathy is the term for nerve pain caused by diabetes. The symptoms can range from tingling to numbness and pain. Treatment for diabetes nerve pain may including tackling the symptoms themselves, as well as making sure diabetes is as well managed as possible. Good blood glucose control is the single most important factor in preventing neuropathy, slowing its progress once you have it, and relieving many symptoms. Over-the-counter pain relievers for diabetes nerve pain Some people find relief for mild diabetes nerve pain on their pharamcist's shelves. Common pain relievers and some topical creams may help, depending on the severity of pain. Anyone with diabetes should talk to their doctor before taking any medication. Even over-the-counter medications can interact with other medications or cause severe side effects in people with diabetes. Here are some over-the-counter pain relief options to consider: NSAIDs (nonsteroidal anti-inflammatory drugs). These drugs reduce inflammation and relieve pain. NSAIDs available without a prescription include aspirin and ibuprofen. But NSAIDs can cause harmful side effects such as stomach irritation and bleeding in some people if taken for weeks or months. When taken long-term they can also lead to kidney and liver damage, which may be more likely in people with diabetes. Paracetamol and other over-the-counter medicines containing paracetamol relieve diabetes nerve pain without reducing inflammation. These medications do not cause the stomach irritation that NSAIDs do. However, taking more paracetamol than recommended can lead to liver damage. It is important to read labels and check with your pharmacist if you have concerns. Other topical creams. Salicylate is a chemical similar to aspirin, and is found in some Continue reading >>

Diabetes - Type 2

Diabetes - Type 2

Description An in-depth report on the causes, diagnosis, treatment, and prevention of type 2 diabetes. Alternative Names Type 2 diabetes; Maturity onset diabetes; Noninsulin-dependent diabetes Highlights Diabetes Statistics According to the U.S. Centers for Disease Control and Prevention’s (CDC) National Diabetes Fact Sheet, nearly 26 million American adults and children have diabetes. About 79 million Americans aged 20 years and older have pre-diabetes, a condition that increases the risk for developing diabetes. Diabetes and Cancer Type 2 diabetes increases the risk for certain types of cancer, according to a consensus report from the American Diabetes Association and the American Cancer Society. Diabetes doubles the risk for developing liver, pancreatic, or endometrial cancer. Certain medications used for treating type 2 diabetes may possibly increase the risk for some types of cancers. Screening for Gestational Diabetes Mellitus The American Diabetes Association recommends that pregnant women without known risk factors for diabetes get screened for gestational diabetes at 24 - 28 weeks of pregnancy. Pregnant women with risk factors for diabetes should be screened for type 2 diabetes at the first prenatal visit. Aspirin for Heart Disease Prevention The American Diabetes Association now recommends daily low-dose (75 - 162 mg) aspirin for men older than age 50 and women older than age 60 who have diabetes and at least one additional heart disease risk factor (such as smoking, high blood pressure, high cholesterol, family history, or albuminuria). Guidelines for Treatment of Diabetic Neuropathy The anticonvulsant drug pregabalin (Lyrica) is a first-line treatment for painful diabetic neuropathy, according to recent guidelines released by the American Academy of Neurol Continue reading >>

Type 1 Diabetes And Depression

Type 1 Diabetes And Depression

"When I was diagnosed [with diabetes], the first thing I thought was, "Now I am completely different from anybody else,'" says Dana Lewis, a 20-year-old junior at the University of Alabama who has had type 1 diabetes since she was 14. Lewis, who is now a diabetes advocate and has testified before Congress about the need for more diabetes research, says that having type 1 diabetes can leave you feeling completely alone — and that there is no one who can help you or understand what you are going through. "Depression is common in anyone with a chronic disease, but it is particularly common in patients with type 1 diabetes," says Jennifer Goldman-Levine, PharmD, a diabetes educator and associate professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences in Boston. Depression and Type 1 Diabetes: Understanding the Link Studies have shown that if you have diabetes, you are at increased risk of becoming depressed — in fact, you might have double the risk, according to one study. The exact reasons aren’t fully understood, but the stresses associated with having type 1 diabetes are thought to play a part. Diabetes-associated stresses may include: Feelings of isolation, since only 5 to 10 percent of the diabetes community has type 1 diabetes (the majority have type 2) Feeling overwhelmed by the many things you have to do to manage your diabetes Worrying about diabetes-related complications such as nerve damage Loss of your sense of control when your blood sugar levels are out of control Tension between you and your doctor Depression and Type 1 Diabetes: Signs To Be Aware of "Depression is not a character flaw, nor is it your fault," says Goldman-Levine. She says that your health care provider should be screening you for symptoms of depression on Continue reading >>

Pramlintide Injection

Pramlintide Injection

You will use pramlintide with mealtime insulin to control your blood sugar levels. When you use insulin, there is a chance that you will experience hypoglycemia (low blood sugar). This risk may be greater during the first 3 hours after you inject pramlintide, especially if you have type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). You may harm yourself or others if your blood sugar drops while you are involved in an activity that requires you to be alert or to think clearly. Do not drive a car or use heavy machinery until you know how pramlintide affects your blood sugar. Talk to your doctor about what other activities you should avoid while you are using pramlintide. Tell your doctor if you have had diabetes for a long time, if you have diabetic nerve disease, if you cannot tell when your blood sugar is low, if you needed medical treatment for hypoglycemia several times in the past 6 months,, or if you have gastroparesis (slowed movement of food from the stomach to the small intestine. Your doctor will probably tell you not to use pramlintide. Also tell your doctor if you are taking any of the following medications: angiotensin converting enzyme (ACE) inhibitors used to treat high blood pressure, heart disease, or diabetic kidney disease; beta blockers such as atenolol (in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol XL, in Dutoprol, in Lopressor HCT), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal, Innopran, in Inderide); clonidine (Catapres, Duraclon, Kapvay, in Clorpres); disopyramide (Norpace); fenofibrate (Antara, Lipofen, Tricor, others); fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax); gemfibrozil (Lopid); guanethidine (Ismelin; no longer Continue reading >>

Diabetes And Sex – Everything You Need To Know

Diabetes And Sex – Everything You Need To Know

Not tonight, honey! You love your partner, you’re feeling romantic, and the dim lights push you along to get intimate. Except that you can’t. You feel desire, but you aren’t aroused. The libido has gone for a long walk, and you don’t know if it’s ever coming back. Your partner will wonder what’s wrong with you and whether you still have feelings for them. You want to scream that yes, of course you do, but something’s come in the way of you expressing it. That something could be your diabetes. Shocking fact: Research shows that for men, there’s a more than 50 per cent probability that low libido is a result of high blood sugar. A poor sex life is a very good reason to meet your doctor, even if you aren’t comfortable with talking about sex. Let’s look at why diabetes and sex have such a serious impact on your marital life and how we can do the right things, to make a real difference. Diabetic Neuropathy Too much sugar in the blood damages nerves all over the body, a complication of diabetes called diabetic neuropathy. As if the damage from the sugar wasn’t enough, diabetes drugs join the party and deplete vital nutrients from your body. In the case of nerves, the affected vitamin is Vitamin B12. This vitamin is a critical component of nerve sheath in the human body. Think of it as the “insulation” in electrical wires. Poor insulating sheath means damaged nerves. It can cause tingling or numbness in hands and feet and even damage delicate nerves. The pleasure zones of the body are no exception to this affliction. Poor sensation in the sexual organs can be a real downer for arousal. If you can’t feel it, you don’t want it. Vascular Damage Another long term effect of diabetes is the damage to blood vessels. Damaged blood vessels mean, among othe Continue reading >>

Diabetes Type 2

Diabetes Type 2

Many people with type 2 diabetes are prescribed tablets to help control their blood glucose levels. Metformin is the first-line medication for diabetes in the UK but there are many more types of medication for type 2 diabetes discussed below. Most people had tried initially to control their blood glucose with a regimen of diet and exercise before being given oral medication. Many people took metformin alone to control blood glucose, and some were taking metformin and gliclazide. Both medications help to reduce blood glucose but work differently. Metformin reduces the amount of glucose produced in the liver, and also makes muscle tissue absorb more glucose; gliclazide increases the amount of insulin produced by the pancreas. While people found that the medication they took had helped reduce and control their blood glucose, many had experienced side effects. Metformin can cause diarrhoea and other digestive problems and many people went back to their GPs for advice. Some people felt concerned about the risks they might face from certain drugs after reading negative reports in the media (see 'Misunderstandings about diabetes'). Rosiglitazone has been linked to an increased risk of heart attack and stroke. Since these interviews were conducted in 2008, there has been growing concern about the potential harmful effects of rosiglitazone (Avandia, but also contained in Avandamet and Avaglim) and from September 2010 in the UK and Europe, new prescribing of this drug has stopped, and most people who were taking the drug have been changed to alternative medication. Most people we interviewed had been prescribed higher dosages of medication to control their blood glucose as their diabetes got worse over time. Some people had transferred to insulin while continuing on metformin (se Continue reading >>

Antidepressant

Antidepressant

Antidepressants are drugs used for the treatment of major depressive disorder and other conditions, including dysthymia, anxiety disorders, obsessive–compulsive disorder, eating disorders, chronic pain, neuropathic pain and, in some cases, dysmenorrhoea, snoring, migraine, attention-deficit hyperactivity disorder (ADHD), addiction, dependence, and sleep disorders. They may be prescribed alone or in combination with other medications. The most important classes of antidepressants are the selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), reversible inhibitors of monoamine oxidase A (RIMAs), tetracyclic antidepressants (TeCAs), and noradrenergic and specific serotonergic antidepressant (NaSSAs).[1] St John's wort is also used in the treatment of depression.[1][2] One theory regarding the cause of depression is that it is characterized by an overactive hypothalamic–pituitary–adrenal axis (HPA axis) that resembles the neuro-endocrine response to stress. These HPA axis abnormalities participate in the development of depressive symptoms, and antidepressants may serve to regulate HPA axis function.[3] Medical uses[edit] For depression, the Hamilton Depression Rating Scale (HAM-D) is often used to measure the severity of depression.[4] The maximum score for the 17-item HAM-D questionnaire is 52; the higher the score, the more severe the depression. Major depressive disorder[edit] Clinical guidelines[edit] The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, because the risk-benefit ratio is poor. The guidelines recomme Continue reading >>

Alternative Therapies: Part I. Depression, Diabetes, Obesity

Alternative Therapies: Part I. Depression, Diabetes, Obesity

Natural supplements are widely used in the United States and, while claims of their therapeutic effects abound, medical research does not always support their effectiveness. St. John's wort acts as a weak selective serotonin reuptake inhibitor with fewer side effects. S-Adenosylmethionine (SAMe) has enough of an antidepressant effect to warrant further research. More human studies are needed before garlic, bitter melon, soy and fenugreek supplements can be recommended for the management of diabetes, although chromium may be a promising treatment in some cases. Alpha lipoic acid is used in the treatment of diabetic neuropathy. The effects of ma huang/guarana combinations in obesity have not been well studied. These combinations may have potentially serious side effects but may also offer some benefit. The combination of hydroxycitric acid and garcinia has proved no more effective than placebo. Because the number of family physicians recommending nutritional supplements to treat a variety of diseases is increasing, an awareness of the medical and legislative issues surrounding these products is critical. In 1994, a grassroots campaign led to congressional passage of the Dietary Supplement Health and Education Act. This legislation restricted the authority of the U.S. Food and Drug Administration (FDA) over any herb or supplement as long as the manufacturer makes no claim that the product is able to affect a “disease state.” Under this legislation, a supplement is presumed safe until the FDA receives “numerous reports” of adverse effects. (From 1993 to 1998, the FDA received 2,621 reports of adverse effects linked to supplements. These complaints included reports of 101 deaths.) Family physicians must be aware of this lack of scientific oversight and must be on the Continue reading >>

Fda Approves Antidepressant Cymbalta For Treatment Of Pain Caused By Diabetic Peripheral Neuropathy, Which Affects Up To 5 Million Americans

Fda Approves Antidepressant Cymbalta For Treatment Of Pain Caused By Diabetic Peripheral Neuropathy, Which Affects Up To 5 Million Americans

« Previous Release | Next Release » Agency grants priority approval to first medicine to treat common, painful complication of diabetes The U.S. Food and Drug Administration (FDA) has approved the antidepressant Cymbalta® (duloxetine HCl; pronounced SIM-BALL-TA), judging it safe and effective for the management of diabetic peripheral neuropathic pain, a symptom of nerve damage that affects up to 5 million Americans, Eli Lilly and Company (NYSE: LLY) announced today. Cymbalta, a balanced and potent serotonin and norepinephrine reuptake inhibitor, is the first and only FDA-approved treatment for pain caused by diabetic peripheral neuropathy. This approval came after a six-month priority review. More than 18 million Americans have diabetes and are at risk for developing persistent pain - often described as burning, stabbing or shooting pain - as a result of nerve damage believed to be caused by high blood sugar. "It has been a phenomenal month for Lilly, with four drug approvals since early August," said Sidney Taurel, Lilly's chairman, president and chief executive officer.1 "Our long-term investment in drug research continues to pay dividends, both to the company and, more importantly, to patients around the world suffering from a variety of illnesses." This is the second time in a month that the FDA has judged Cymbalta a safe and effective therapy for a major medical disorder. On Aug. 3, the agency approved Cymbalta as a treatment for major depression in adults. It's available immediately by prescription in pharmacies across the United States for the treatment of major depression or pain associated with diabetic peripheral neuropathy. Lilly proved Cymbalta's safety and efficacy in the treatment of pain caused by diabetic peripheral neuropathy at doses of 60 and 120 m Continue reading >>

Antidepressants

Antidepressants

Introduction Antidepressents are a type of medication used to treat Clinical depression or prevent it recurring. They can also be used to treat a number of other conditions including: Antidepressants are also sometimes used to treat people with long-term (chronic) pain. Read more about what antidepressants are used for. How antidepressants work It is thought that antidepressants work by changing the levels of a group of chemicals in the brain called neurotransmitters. Certain neurotransmitters, such as serotonin and noradrenaline, can improve mood and emotion, although this process is not fully understood. Increasing levels of neurotransmitters can also disrupt pain signals sent by nerves, which may explain why some antidepressants can also help relieve symptoms of long-term (chronic) pain. While antidepressants can help treat the symptoms of depression, they do not always address its causes. This is why they are usually used in combination with therapy to treat more severe depression or other mental health conditions caused by emotional distress. How effective are antidepressants? Most people benefit from taking antidepressants to some degree, but research suggests that antidepressants may not be as effective as previously thought in cases of mild depression. However, they are the most effective treatment in relieving symptoms quickly, particularly in cases of severe depression. The Royal College of Psychiatrists estimates that 50-65% of people treated with an antidepressant for depression will see an improvement, compared to 25-30% of those taking inactive “dummy” pills (placebo). This means that most people do benefit from antidepressants, even if it is sometimes a result of the placebo effect.. Doses and duration of treatment Antidepressants are usually taken in Continue reading >>

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