How to effectively manage diabetes along with depression?

Question

Hello doctor,

I have been suffering from anxiety and depression for the past few years. I have tried various antidepressants and am currently taking Vilazodone (one tablet in the morning) and Clonazepam (0.25 mg) for the last ten days. However, I am experiencing breathlessness and palpitations with even minimal physical activity, along with irritability. My hands often feel numb, and I experience itching on my hands and legs. I suspect this may be related to my diabetes. I also feel heaviness in my chest, and I have significant pain in my legs and back.

My fasting blood sugar level is 130 mg/dL, and my postprandial level is 235 mg/dL. I am taking Glimepiride, but my sugar levels fluctuate significantly, and my HbA1c was above 7 a few months ago. I believe my sugar intake may be contributing to these fluctuations, although it is usually controlled. Additionally, I feel very low energy due to my depression medications, and I am frequently drowsy, with persistent irritability and negative thoughts. I also have a habit of chewing tobacco.

Could you please advise on possible treatments or steps I should take?

Answer 1

Hello,

Welcome to icliniq.com.

I am sorry to hear that, despite your best efforts, you are not responding to your current antidepressants and are still experiencing active symptoms. Given your diagnosis of diabetes with depression, I suggest the following treatment:

Take Duloxetine 30 mg in the morning and another 30 mg in the evening. This medication is effective for managing pain symptoms associated with diabetic neuropathy as well as depression.
Take Aripiprazole 5 mg in the morning. Although it belongs to the antipsychotic group, it is intended here to enhance the effects of the antidepressants and address any anger associated with depression.
You may continue taking Clonazepam at its current dosage if you are achieving adequate sleep. However, if sleep remains an issue despite the medication, I recommend increasing the Clonazepam dose to 0.5 mg at bedtime.

Vilazodone should be discontinued, as it is causing intolerable side effects and has limited effectiveness for neuropathic pain. Duloxetine will likely be a better option. Consult your specialist doctor, discuss with him or her, and take the medicines with take the medicines with their consent.

It is essential to stop tobacco use, as many of the medications mentioned above have reduced efficacy when tobacco is consumed. Please consult with your diabetes specialist, as poor diabetes control could be a significant factor in the inadequate response to treatment.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I suggest taking the Duloxetine capsule at night. While it is generally non-sedative, 10 to 20 percent of individuals may report drowsiness after using it. In such cases, it is recommended to take it at night, about 30 minutes before bedtime. Please be assured that this is not a serious side effect and is likely to resolve within a few days.

Thanks for using icliniq, and have a nice day.