Type 2 diabetes is rising in epidemic proportions due to increases in lifestyle risk factors and the aging of the population. Cognitive disorders, depression, and alcohol abuse are notable psychiatric conditions that clinicians treat in patients with diabetes. Cognitive deficits and dementia prevalence are higher in persons with diabetes. While prevalence of depression is high, it is recognized and treated in fewer than 25% of persons with diabetes. Heavy alcohol intake increases the risk of developing diabetes and worsens existing diabetes. Psychotropic medications are prescribed for many conditions in diabetes. Clinicians treat painful diabetic peripheral neuropathy with antidepressants and mood stabilizers, which may deliver low efficacy or have notable risks in this population. Antidepressants and atypical antipsychotics are prescribed for depression and dementia, respectively, and may have side effects that can worsen diabetes. Thus, in older persons with type 2 diabetes, treatment with psychotropic medications requires careful consideration of risks and benefits.
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