Saturday, March 31, 2012

Depression, Exercise and Medications

People with diabetes and other chronic diseases have more depression.
And people with depression don’t take care of themselves as well and that means poor blood glucose control.
As discussed in a recent post, exercise helps blood sugar control for people with diabetes.
And now an analysis of 90 studies showed that exercise appears to improve depression.

In this analysis, exercise was shown to help depression in those with a variety of chronic illnesses like diabetes.
Although the beneficial effect of exercise is modest, exercise might be considered in those with mild depression especially for those who decline psychotherapy or taking a medication.

For those people willing to take a medication for depression,
medications that do not cause weight gain are almost always preferred.

Bupropion is one of those that does not cause weight gain
Bupropion has the added benefit of not causing sweating or sexual dysfunction.
Keep in mind that none of the medications for depression is addictive.

There are many other anti-depressant medications each with its pros and cons.
Paroxetine (Paxil) is one of the worst of these, for many reasons.

And who should be checked for depression?

We should think of depression in those people with several of the following symptoms:
·      Low energy
·      Problems getting to sleep or staying asleep
·      Frequently feeling sad or hopeless
·      Loss of interest, motivation or pleasure in things
·      Overeating or poor appetite
·      Problems with mental concentration or memory
·      Feeling that you are no good for yourself or others
·      Frequent thoughts about death

Too often doctors may not take the time or have the knowledge to find out if someone has depression.
Some doctors might just say: “Do you think you’re depressed”?

Doctors don’t ask the patient to diagnose their diabetes or thyroid problem.
Doctors make those diagnoses by appropriate exams and blood tests.

There are no blood tests for depression.

For depression, the diagnosis is made by talking with the patient and asking key questions in a sensitive manner.
Sometimes questionnaires are used to help diagnose depression.

There are many online resources for people who want to learn more.
Here’s one from  the National Alliance on Mental Illness 

Hearing the patient’s story is always important.
The electronic medical record is not optimal for listening or what is called narrative medicine.
Grief, loss and traumas are often but not always contributing factors in depression.

And once the diagnosis of depression is made treatment should be discussed.

Now it looks like exercise can be part of the treatment plan.
The challenge often is getting people motivated to start exercise.
Perhaps the hardest part is getting started.

Taking a walk might work for starters. 
Then talking to your doctor at the next visit.
I hope he or she is good listener.

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