Saturday, February 07, 2015

Measurements of Depression and Diabetes

It's often reported that diabetics are more likely to be depressed. However, it's really hard to believe that measures of depression are accurate with regards to diabetes.
I just read a study on depression in type 2 diabetics right before starting insulin, and after 6 months on insulin, that reported that insulin (and especially the drop in A1c) lowered rates of depression.
To measure depression, they used the PHQ-9 scale, which I've taken myself at an awful lot of doctor visits. It was developed by Pfizer to help market antidepressants.
Here's how I would have scored the day before I went on insulin:
Q1: Over the last two weeks, how often have you had little interest or pleasure in doing things?
A: Well- I am still interested but it hurts to move, so not much pleasure. Let's say every day (3 points)
Q2: Over the last two weeks, how often have you felt down, depressed, or hopeless?
A: I felt desperate and determined, so I'll say not at all (0 points)
Q3: Over the last two weeks, how often have you had trouble falling asleep, staying asleep, or slept too much?
A: Well gee whiz, I can't sleep when I'm being eaten alive by thirst, and every time I do fall asleep, the need to pee wakes me up. Every single night! (3 points)
Q4: How often have you had trouble with having little to no energy?
A: Every minute of every day (3 points).
Q5: How often have you had an unusually big or little appetite?
A: I'm starving! (3 points)
Q6: Feeling bad about yourself- that you are a failure and have let yourself or others down?
A: Not all of the time, but I feel unable to meet my obligations. Let's say "several days" (1 point)
Q7: Trouble concentrating on things, such as reading the newspaper.
A: I lost the ability to keep concentrating enough to count to 20 roughly three weeks before my diagnosis. (3 points).
Q8: Moving slowly, or the opposite,  being fidgety.
A: Well, okay, I'm autistic anyways, so this is one I continue to score positively on. But at the time of diagnosis, it had gotten hard to walk, and people were noticing. 3 points.
Q9: Thoughts of hurting and/or killing yourself.
A: Actually, for the first time in many years, I STOPPED having these thoughts shortly before I was diagnosed. 0 points.

Bonus Question: How difficult have these things made it for you to do your work and get along with people?
A: Really difficult.

According to the study I just read on type 2 diabetes, a score of 15-19 qualified as moderately severe (20 was severe depression). 
And yet, I was not depressed, just in DKA. 

The article said every 1 point drop in A1c lowered score by an average of 40%. I say yeah, that's cause the high A1cs mess with memory, energy, sleep, and hunger, not because they cause depression. It's not pathological to feel exhausted and hungry if you're high.

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