Comorbid Depression And Diabetes (Case Study Sample)

Comorbid Depression And Diabetes 

Introduction to the patient

This study examines the conditions of Mr. Daniel (not his real name), a 42 years old man of Asian origin. The patient reports of experiencing panic disorder, anxiety, social phobia. As single father of two small kids; girl and boy aged four and six, respectively. He was diagnosed of diabetes type 1 five years ago and has been under medication. Mr. Daniel reports of experiencing these symptoms after his divorce with the wife two years ago. Other symptoms that he experiences include blurred vision and thirst. Mr. Daniel works in the construction industry as an engineer. Mr. Daniel approached the facility for healthcare tests and advise on how to manage his condition as he reports that these experiences has made his parenting roles more complex. One of his greatest fears is to lose the custody of his children since he has a pending court case. Mr. Daniel smokes and reports of taking alcoholic drinks during weekends. He also reports spending much time with his friends so that he doesn’t feel stressed. Daniel stopped taking the medication one year ago and has received cognitive behavioural therapies at a local healthcare facility although he stopped attending the therapies six months ago. However, he appreciates that the therapy was helpful to him as it temporarily enabled him to change some of his negative thoughts, including suicide ideation and other negative though patterns. As he intends to resume clinical and therapeutic care for his condition, Daniel is optimistic that his condition will be medically solved.
Context
The presented history is relevant to the treatment and care for the patient. This brings into context the need to offer a collaborative care for Daniel. Although the condition is not severe, his lifestyle and the characters like drinking and smoking is likely to worsen his condition. This can lead to poor lifestyle decisions, including unhealthy eating, less exercise, smoking and weight gain, which increases the health risks. This is also likely to affect Daniel’s ability to perform tasks in his capacity as a construction engineer, his ability communicate and think clearly. This care is also vital for his children since they deserve better care and parenting because they are still young. It is understandable that comorbid depression is likely to affect the patient’s ability to successfully manage diabetes, especially the recommended pharmacological treatments (Roopan and Erik Roj, 128). The objective data collected from the patient include the signs of retardation of movements, his diminishing gestures, feelings and expressions. Besides, the patient appears tired and concerned about his condition and those of his children. Mr. Daniel is also inattentive throughout the initial examination sessions and displays a lot of disinterest in eating, socializing and surrounding. However, the subjective data obtained from the patient include having no pain, itching. The patient experiences dizziness, low mood and disinterest in physical activities although he mentions loving watching football match. Finally, Mr. Daniel explains of having been under medication of antidepressants as prescribed by the physician.
Diagnosis/Conclusion
Daniel’s diagnosis is a comorbid depression and diabetes. This can be treated through a pharmacological approach using Prozac, to improve blood sugar levels. However, to effectively prevent the recurrence of depression, this study recommends the use of drugs such as Bupropion, Dopamine or Norepinephrine. Finally, a collaborative care is associated with significant improvements in patients with depressive characteristics, like Daniel. Social prescription will be crucial in Daniel’s condition because it offers an effective than the usual care and offers a useful addition to clinical pathways for such patients. This approach will improve glycaemia by increasing self-management and independence from diabetes prognosis. This approach will also be useful in improving blood pressure and blood sugar levels. The management will also include a comprehensive assessment of the previous medications, and reconciliation of the medication and educating the patient about safe and efficacious use of the medications prescribed.
Nursing perspective
Comorbid depression and diabetes are one of the major clinical challenges in nursing practice since the outcomes of both can be worsened by the other. However, the psychological burden of diabetes could cause depression, but this explanation does not exquisitely explain the relationship between the two conditions. Pharmacological treatments of diabetes and depression are driven by the underlying behavioural and biological mechanisms, including the activation of the hypothalamus-pituitary and adrenaline, sleep disturbance, inactive lifestyles and poor dietary habits (Brieler et al., 34). The patient’s key priorities include the cultural and environmental risk factors. In most instances, depression is missed in people with diabetes despite the available depression screening tools. First, the treatment goal for diabetes is maintenance of glucose homeostasis since type 1 of diabetes mainly depends on the exogenous insulin levels that prevent hyperglycaemia. Therefore, the goals for type 1 diabetes therapies is to minimize insulin secretion in response to the high glucose level in both hyper and hypoglycaemia instances. The therapeutic goal of type 2 diabetes is to maintain glucose concentrations and prevent long-term complications associated with the condition through lifestyle management effort, like weight reduction and modification of diets (Settineri et al., 299). As highlighted above, depression is common among patients with other chronic illnesses such as diabetes, and this report highlights the impacts of depressive symptoms in primary care of patients with diabetes, especially those patients under nursing care.
Pathophysiological conditions in the patient
Based on the patient analysis shows that the patient’s plasma concentration of glucose signalling the nervous system to mobilize more energy. The patient has higher risks of heart disease due to high blood pressure and the narrowing of the blood vessels. The patient also has lower blood sugar levels. However, a study by Akena et al. (6) shows that that hyperglycaemia is the main target in the pharmacological management of the condition because it is likely to cause cardiovascular disease and renal complications. The use of antidepressants has also been confirmed by Brieler et al. (36) that are more effective for such patients. In a systematic review by Cannon et al. (S8) on the use of antidepressants in patients with comorbid diabetes mellitus and depression, the study recommends the use of selective serotonin reuptake inhibitor (SSRI) for the treatment of some patients with such conditions. However, the study also recommends the use of tricyclic antidepressants. According to Petrak et al. (485) the use of SSRI is effective for treatment of patients with comorbid depression and diabetes. While using SSRI, their study recommends that the nursing professional should consistently monitor glycaemic levels. This makes this condition a complex comorbidity. Although previous investigations have found that pharmacological treatments play a significant role in improving a patient’s quality of life, the treatment should be more integrated to address the patient’s emotional and psychological needs (Kalra et al., 696). To effectively prevent the recurrence of depression in parents with diabetes, the use of drugs such as Bupropion, Dopamine and Norepinephrine are recommended other than the SSRI. For instance, the treatment of comorbid depression and diabetes using SSRIs and Bupropion offer an effective approach in managing glycaemia levels. There is no randomized study that has confirmed the effectiveness of antidepressant therapy on the comorbid diagnosis of T2DM. Carruth et al. found that the use of Dopamine (DA) plays an important role in patients with both depression and T2DM. There is adequate evidence that decreasing DA in patients with T2DM, which would also lead to decreased psychomotor activities, and motivation. DA enhances glycaemia control and increased insulin sensitivity. The use of DA agonists can reduce food intake, affecting dietary uptake.
The use of dopaminergic agents have also been found to be effective in treating depression and diabetes. These agents increase levels in DA, which enhance glycaemia control and increased insulin sensitivity, helping improve the patient’s quality of life. The use of sertraline in the treatment of such patients was also found to be effective, especially in improving Hb1Ac. This was also confirmed in a non-randomized trial by Hernández-Jiménez et al. (134) on the use of Bupropion during maintenance and acute phases. The findings showed that patients had improvements in the glycaemia levels. Although diabetes is related to a higher risk of sexual problems, the use of Bupropion in the treatment doesn't seem to deteriorate the sexual activity. Therefore, pharmacological treatment for comorbid diabetes mellitus and depression should revolve around controlling glucose levels and should mainly include the use of Sertraline, DA and SSRI. However, other studies have also shown that fluoxetine can also be used in some patients.
Pharmacodynamics, Pharmacokinetics and medication for the patient
Pharmacodynamics is an aspect of pharmacology that focuses on the side effects of the treatment processes and their mechanisms of their actions. The stages of pharmacodynamics include the absorption of the drugs, the distribution, metabolism, and excretion of the drugs. However, pharmacok...