Research Paper: Depression, Diabetes and Obesity

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[. . .] ECT is of particular benefit in patients who have significant functional impairment or have not responded to various trials of combination treatments. This mode of therapy may also be used for individuals who have major depressive disorder with associated psychotic or catatonic features or in those who require an urgent response, for example, in patients with suicidal tendencies. (Gelenburg et al., 2010) The mode of active of ECT is unknown. In this somatic therapy, seizures are electrically induced in anesthetized patients for a therapeutic effect.

Psychodynamic therapy and problem solving therapies are less common models of help in depressive disorder. Psychodynamic therapy focuses on a person's subconscious mind and its processes. These processes affect a person's behavior. The aim of this mode of therapy is to allow the patient to be fully aware of the influences of the past on present behavior. This allows the patient to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships. This mode of therapy may be useful in patients with depressive disorder who have associated alcoholism or other substances of abuse. (Wood & Wood, 2008)

Problem solving therapy is a brief psychological intervention. This mode of therapy has about seven sessions, during which the psychiatrist helps the patient to identify the problems occurring in the patient's life. After these problems are identified, each one of them is discussed individually. The clinician helps the client with a structured approach to solving each problem. (Wood & Wood, 2008)

Light therapy, also known as phototherapy, is another way of treating Seasonal Affective Disorder. This disorder is a type of depression that occurs at a certain time each year, usually near fall or winter. In this mode of therapy, the patient is asked to sit or work near a device, called a light box which uses artificial light. Light therapy acts by stimulating neurotransmitters in the brain. These transmitters cause an improvement in depressive symptoms. Light therapy may also be used in other types of depressive disorders, sleep disturbances and a few other conditions linked to abnormal transmission of impulses. (Wood & Wood)

There are also studies that regard hypnotherapy as an effective means of treating depression associated with comorbid conditions. Even though such studies have proven yielding results when hypnotherapy was combined with cognitive behavioral therapy, sufficient evidence is still unavailable to base a recommendation. (Gellenburg et al., 2010)

There are several determining factors that affect the frequency and type of psychotherapy sessions. These include: severity of depressive disorder, co-morbid conditions, cooperation on part of the patient, availability of social support systems, frequency of visits necessary to create and maintain a patient-clinician relationship to insure an effective therapeutic model of help through treatment compliance and to monitor progress, address complications and suicide risk. (Gelenburg et al., 2010)


Nurses play a significant role in the treatment of depressive disorders. There are certain guideline recommendations on how to deal with such patients. All health care providers should be empathetic in attitude and conversation. A touch or a nod may help with non-verbal cues that encourage patient comfort. When dealing with patients, a health care provider should not be judgmental and should provide the patient time to express feelings. Words can be provided when the patient hints for it. A soft, low tone voice with clear, concise and easy to understand words should be used while talking to the patient. (NANDA nursing, 2012)

Patients should be asked of their coping mechanisms to overcome such feelings. Nurses should also discuss various coping and problem solving strategies, while being careful not to interrupt the patient. The risk of suicide and self-harm should be identified during the conversation. (NANDA nursing, 2012)

Patients should be told about support groups and should be helped in identifying sources of help, which may be through family members or an existing belief system. Nurses should record drugs used by the patients, along with their dosages, and any side effects that they may be causing. (NANDA nursing, 2012)

Even though the treatment for depression follows professional guidelines, the major dilemma usually arises when deciding when to treat. According to the DSM IV criteria, Mr. H.Y. suffers from Depressive Disorder Not Otherwise Specified (NOS). The reason for this classification could be based on the diagnostic un-surety of it being a primary disorder or due to existing medical conditions.

The reason for this dilemma may be due to certain problems that have been associated with the NOS classification. Unpublished data by Mark Olfson revealed that about 37%-38% of all depressive disorders are classified as NOS. This high prevalence has not been accompanied by specific diagnostic codes or an inclusion threshold for each of the causes described under NOS 311. This low threshold has led to an increased number of individuals with psychiatric diagnosis, causing medicalization of normal distress. For this reason, under the given scenario, some clinicians may prefer non-pharmacological methods and subsequent follow-ups for close observation. (American Psychiatric Association, 2010) A major disadvantage associated with pharmacological therapy is the need for long-term treatment and a higher relapse rate, especially if drugs are discontinued early or not tapered down appropriately. The duration for effective treatment may vary from person to person and is therefore, difficult to determine. (Ellis & Smith, 2002)

This approach may also be justified through a meta-analysis conducted by Ellis and Smith (2002). In this analysis, no significant difference was found between pharmacological treatments vs. psychological therapy for mild to moderate depression. Clinicians may want to try psychological therapy in this case for moderate depression before classifying MR. H.Y. under major depressive disorder. Second and third line treatments may be initiated if adequate response to psychological therapy is not achieved.

Features included under the Depressive Disorder 311 classification may fall into three categories: features that provide significant evidence of depressive disorder, evidence for subsyndromal features, and symptomatic presentation that is either atypical or has special characteristics. Since Mr. H.Y's presentation has significant evidence to be classified as depressive disorder, both pharmacologic and non-pharmacologic therapy may yield significant results with an improved quality of life.

Most NOS classified patients exhibit a significant degree of dysfunction which if left untreated may lead to negative outcomes, such as suicide. Identifying this group of patients is important because pharmacological treatment needs to be initiated at an early stage to prevent such negative outcomes. These outcomes may also be inevitable for patients with sub-clinical symptoms classified as NOS and therefore, necessitate a detailed history, evaluation and follow-up with appropriate treatment even though they do not meet the diagnostic criteria for established disorders. (American Psychiatric Association, 2010)

Although Cognitive Behavioral Therapy, CBT, and Inter-Personal Therapy, IPT, may be equally effective for the treatment of depression, the experience and effectiveness of such therapy may vary amongst different therapist. This trial and error method may facilitate negative outcomes and therefore needs to be avoided. Pharmacological treatment should be the treatment of choice in such a circumstance. (Ellis & Smith, 2002) Moreover, evidence-based treatment does not support the sole role of CBT and IPT for Major Depressive Disorder, although not the case in this situation.

Treatment plans should always be based on a thorough assessment, duration of a depressive attack, frequency and factors that lead to such episodes. According to a meta-analysis, patients suffering from mild to moderate depression benefit less with a single course of treatment and continuation of therapy is the most important factor of benefit in such patients. In case of pharmacological intervention, treatment should continue for at least one year during the first attack and at least two years for relapse or when associated risk factors are present. (Ellis & Smith, 2002)

Based on this conclusion, the best mode of treatment for MR. H.Y. would be to initiate pharmacologic treatment and to continue it for at least 2 years along with follow ups. The treatment of choice should be an SSRI along with psychotherapy. TCAs are not used in diabetes and are avoided in obese individuals because of existing evidence of worsening glycemic control and its associated with an increased towards weight gain. Bupropion is a drug that can also be used in this patient due its effect on weight reduction. The rationale for using both modes of treatment is due to the un-established diagnosis of a primary disorder. Studies have also shown a benefit of combining pharmacological and psychotherapy in patients with interpersonal and psychosocial problems, as is the case in this scenario. (Gelenburg et al., 2010) This treatment regimen may help MR. H.Y. To adhere to his treatment plan for diabetes and obesity, deflect any negative outcome, and will also help him return to the quality of life that he would enjoy prior to diagnosis.


After establishing a diagnosis, counseling the patient, as well as… [END OF PREVIEW]

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APA Format

Depression, Diabetes and Obesity.  (2012, March 10).  Retrieved June 15, 2019, from

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"Depression, Diabetes and Obesity."  10 March 2012.  Web.  15 June 2019. <>.

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"Depression, Diabetes and Obesity."  March 10, 2012.  Accessed June 15, 2019.