py may be able to access direct help via the Improving Access to Psychological Therapy service. Patients may be able to self-refer or access treatment through their GP. Now rolled out across England; the IAPT service offers an online training course to health professionals via the Royal College of General Practitioners website (www.tinyurl.com/RCGP-IAPT).
Moderate to severe depression
With moderate to severe depressive episodes, patients may need specialist psychological intervention or medication, the availability of which may depend on where they live. Patients may benefit most when services are provided by specialist diabetes mental health professionals. However, specialist psychological services are not widely available; a report commissioned by Diabetes UK (2008) found only 15% of diabetes services had access to these.
Antidepressants are readily available and successful but patients may not notice any improvement in their symptoms for at least two weeks; it may take longer than this for patients to receive a therapeutic dose.
Practical aspects of management
When patients are depressed it may seem the best and only thing to do is find treatment for their depression. However, good overall care is still necessary and nurses may be best placed to coordinate this. Practical tips are outlined in Box 2.
Depression is common for people with diabetes. However, screening for depression can detect most of these who are affected and treatment is usually successful. Nurses involved in the care of people with diabetes are well placed to screen for depression and coordinate subsequent treatment. Good overall care for both conditions will provide patients with the most benefit.
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