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Clinical Diabetes 20:122-123, 2002
© American Diabetes Association ®, Inc., 2002

Case Study

Case Study: Nondysphoric Depression in a Man With Type 2 Diabetes

Patrick J. Lustman, PhD, Marty L. Caudle, BS, PA-C and Ray E. Clouse, MD

The first 20% of the full text of this article appears below.


   Presentation
 
R.A. is a 58-year-old married man seen by his primary physician for scheduled care of diabetes. Diagnosed 4 years ago with type 2 diabetes, he is mildly obese (5 feet, 11 inches, 218 lb, body mass index 30.4 kg/m2) and hypertensive (blood pressure 165/92 mmHg), but otherwise has no evidence of coronary heart disease or other complications of diabetes. He uses insulin and has insufficient control of hyperglycemia (recent hemoglobin A1c [A1C] concentrations range from 10 to 11.5%). He does not perform blood glucose testing.

Six months ago, the patient started having difficulty falling and staying asleep. As a result, he felt tired and fatigued most of the time. He became less physically active, stopped exercising, and gained 12 lb. Then he gradually stopped socializing and eventually lost interest in most things, including sexual activity. During this time, he earnestly denied feeling sad or depressed. He has continued to work but has trouble concentrating, frequently forgets things, and feels impatient, irritable, and frustrated. For the past month, the constellation of symptoms has been persistent and interfering.

Physical examination was remarkable only for mild obesity. Routine laboratory and CT scan of the head were normal. R.A. was treated with alprazolam (Xanax), 0.25 mg at bedtime, which relieved the insomnia but had no effect on . . . [Full Text of this Article]


   Questions
 

   Commentary
 
Can a diagnosis of depression be established?
Which treatment would be effective for R.A.?
What are the potential benefits of depression treatment?

   Clinical Pearls
 

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Copyright © 2002 by the American Diabetes Association.