Several
studies suggest that diabetes doubles the risk of depression compared to
those without the disorder.2 The chances of becoming depressed increase
as diabetes complications worsen. Research shows that depression leads to
poorer physical and mental functioning, so a person is less likely to follow
a required diet or medication plan. Treating depression with psychotherapy,
medication, or a combination of these treatments can improve a patient's
well-being and ability to manage diabetes.
Causes underlying
the association between depression and diabetes are unclear. Depression
may develop because of stress but also may result from the metabolic effects
of diabetes on the brain. Studies suggest that people with diabetes who
have a history of depression are more likely to develop diabetic complications
than those without depression. People who suffer from both diabetes and
depression tend to have higher health care costs in primary care.
Despite
the enormous advances in brain research in the past 20 years, depression
often goes undiagnosed and untreated. People with diabetes, their families
and friends, and even their physicians may not distinguish the symptoms
of depression. However, skilled health professionals will recognize these
symptoms and inquire about their duration and severity, diagnose the disorder,
and suggest appropriate treatment.
Depression
Facts
Depression
is a serious medical condition that affects thoughts, feelings, and the
ability to function in everyday life. Depression can occur at any age. NIMH-sponsored
studies estimate that 6 percent of 9- to 17-year-olds in the U.S. and almost
10 percent of American adults, or about 19 million people age 18 and older,
experience some form of depression every year.4,5 Although available therapies
alleviate symptoms in over 80 percent of those treated, less than half of
people with depression get the help they need.
Depression results from abnormal functioning of the brain. The causes
of depression are currently a matter of intense research. An interaction
between genetic predisposition and life history appear to determine a
person's level of risk. Episodes of depression may then be triggered by
stress, difficult life events, side effects of medications, or other environmental
factors. Whatever its origins, depression can limit the energy needed
to keep focused on treatment for other disorders, such as diabetes.
Diabetes
Facts
Diabetes
is a disorder that impairs the way the body uses digested food for growth
and energy. Most of the food we eat is broken down into glucose, a form
of sugar that provides the main source of fuel for the body. After digestion,
glucose passes into the bloodstream. Insulin, a hormone produced by the
pancreas, helps glucose get into cells and converts glucose to energy. Without
insulin, glucose builds up in the blood, and the body loses its main source
of fuel. In type
1 diabetes, the immune system destroys the
insulin-producing beta cells of the pancreas. This form of diabetes usually
strikes children and young adults, who require daily or more frequent insulin
injections or using an insulin pump for the rest of their lives. Insulin
treatment, however, is not a cure, nor can it reliably prevent the long-term
complications of the disease. Although scientists do not know what causes
the immune system to attack the cells, they believe that both genetic factors
and environmental factors are involved.
Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes
in the United States, occurs equally in males and females, and is more common
in Caucasians. Symptoms include increased thirst and urination, constant
hunger, weight loss, blurred vision, and extreme fatigue. If not treated
with insulin, a person can lapse into a life-threatening coma.
Type
2 diabetes, which accounts for about 90 percent
of diabetes cases in the United States, is most common in adults over age
40. Affecting about 6 percent of the U.S. population, this form of diabetes
is strongly linked with obesity (more than 80 percent of people with type
2 diabetes are overweight), inactivity, and a family history of diabetes.
It is more common in African Americans, Hispanic Americans, American Indians,
and Asian and Pacific Islander Americans. With the aging of Americans and
the alarming increase in obesity in all ages and ethnic groups, the incidence
of type 2 diabetes has also been rising nationwide.
Type 2 diabetes is often part of a metabolic syndrome that includes obesity,
high blood pressure, and high levels of blood lipids. People with type 2
diabetes first develop insulin resistance, a disorder in which muscle, fat,
and liver cells do not use insulin properly. At first, the pancreas produces
more insulin, but gradually its capacity to secrete insulin falters, and
the timing of insulin secretion becomes abnormal. After diabetes develops,
insulin production continues to decline.
Symptoms include fatigue, nausea, frequent urination or infections, unusual
thirst, weight loss, blurred vision, and slow healing of wounds or sores.
Some people have no symptoms at all. Researchers estimate that about one-third
of people with type 2 diabetes don't know they have it.
Many people with type 2 diabetes can control their blood glucose by following
a careful diet and exercise program, losing excess weight, and taking oral
medication. However, the longer a person has type 2 diabetes, the more likely
he or she will need insulin injections, either alone or together with oral
medications.
Gestational
diabetes develops during pregnancy. Like
type 2 diabetes, it occurs more often in African Americans, American Indians,
Hispanic Americans, and people with a family history of diabetes. Though
it usually disappears after delivery, the mother is at increased risk of
getting type 2 diabetes later in life.
Managing
Diabetes
Research has shown that
tight glucose control is the best way to prevent serious complications of
diabetes, so the goal of diabetes management is to keep blood glucose levels
as close to the normal range as possible. Healthy eating, physical activity,
insulin injections, or using an insulin pump are basic therapies for type
1 diabetes. Blood glucose levels must be monitored through frequent checking.
In recent years, research has led to better ways to manage type 2 diabetes
and treat its complications with improved monitoring of blood glucose, new
drugs, and weight control management. Blood pressure drugs called ACE (angiotensin-converting
enzyme) inhibitors help to prevent or delay heart and kidney disease.
People with diabetes try to keep blood glucose (also called blood sugar)
from rising too high or falling too low. When blood glucose levels drop
too low from some medicines—a condition called hypoglycemia—a
person can become nervous, shaky, and confused. Judgment can be impaired,
and if the level is low enough, a person can faint. High levels of blood
glucose, called hyperglycemia, cause tissue damage and lead to debilitating
complications. Associated with acute long-term complications, the disease
can lead to blindness, heart and blood vessel disease, strokes, kidney failure,
amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy.
Because a large part of the population is aging and Americans are increasingly
overweight and sedentary, the prevalence of diabetes is predicted to increase.
Researchers continue to search for the causes of diabetes and ways to prevent
and cure the disorder. Scientists are looking for genes that contribute
to the different forms of diabetes, are testing new drugs, and are using
bioengineering techniques to try to create artificial beta cells that secrete
insulin.
Get
Treatment for Depression
While there
are many different treatments for depression, they must be carefully chosen
by a trained professional based on the circumstances of the person and family.
Prescription antidepressant medications are generally well-tolerated and
safe for people with diabetes. Specific types of psychotherapy, or "talk"
therapy, also can relieve depression. However, recovery from depression
takes time. Antidepressant medications can take several weeks to work and
may need to be combined with ongoing psychotherapy. Not everyone responds
to treatment in the same way. Prescriptions and dosing may need to be adjusted.
In people who have diabetes and depression, scientists report that psychotherapy
and antidepressant medications have positive effects on both mood and glycemic
control. Additional trials will help us better understand the links between
depression and diabetes and the behavioral and physiologic mechanisms by
which improvement in depression fosters better adherence to diabetes treatment
and healthier lives.
Treatment for depression in the context of diabetes should be managed by
a mental health professional—for example, a psychiatrist, psychologist,
or clinical social worker—who is in close communication with
the physician providing the diabetes care. This is especially important
when antidepressant medication is needed or prescribed, so that potentially
harmful drug interactions can be avoided. In some cases, a mental health
professional that specializes in treating individuals with depression and
co-occurring physical illnesses such as diabetes may be available. People
with diabetes who develop depression, as well as people in treatment for
depression who subsequently develop diabetes, should make sure to tell any
physician they visit about the full range of medications they are taking.
Use of herbal supplements of any kind should be discussed with a physician
before they are tried. Recently, scientists have discovered that St. John's
wort, an herbal remedy sold over-the-counter and promoted as a treatment
for mild depression, can have harmful interactions with some other medications.
Other mental disorders, such as bipolar disorder (manic-depressive illness)
and anxiety disorders, may occur in people with diabetes, and they too can
be effectively treated.
Remember, depression is a treatable disorder of the brain. Depression can
be treated in addition to whatever other illnesses a person might have,
including diabetes. If you think you may be depressed or know someone who
is, don't lose hope. Seek help for depression.
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