(1) Psychological symptoms of depression in patients with diabetes are more specific to depression than their somatic counterparts
(2) Specificity of the somatic symptoms of depression is increased when the somatic symptoms are severe, start concomitantly with depressed mood or anhedonia, are unrelated to diabetes, or appear out of proportion to what is expected
(3) Consider the use of scales such as the BDI and PHQ-9 to help diagnose and guide treatment of depression over time
(4) Initiate cognitive screening early as both diabetes and depression have been linked to earlier onset of dementia
(5) Even mild depressive disorder is associated with adverse outcomes in diabetics, so consider treatment of major depression at all severity levels
(6) CBT
with an emphasis on diabetes self care maybe one of the best treatments
(7) When choosing an antidepressant, remember to assess the patient for complications or long-term effects of diabetes and consider bupropion, venlafaxine, or duloxetine before an SSRI when appropriate
(8) Dual acting agents
(Venlafaxin, Duloxetine, Desvenlafaxin) are generally a better choice than TCAs or older medications
(9) Engage primary care physicians
in the care of patients with comorbid depression and diabetes as both diseases exert adverse effects on the other; optimum care involves treatment of both disorders