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(see below for article sources)


Take Depression Self-Assessment Test

Stress Management

Eating Disorders

Mental Health Studies & Research


Depression Resources

General Depression

Co-Occurrence of Depression

Suicide Facts


Article Sources

HealthyPlace.com
Intelihealth.com
Wikipedia.com

References

Anderson RJ, Lustman PJ, Clouse RE, et al. Prevalence of depression in adults with diabetes: a systematic review. Diabetes, 2000; 49(Suppl 1): A64.

Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Archives of Internal Medicine, 2000; 160(21): 3278-85.

Cohen, ST, Welch, G, Jacobson, AM, et al The Association of Lifetime Psychiatric Illness and Increased Retinopathy in Patients with Type I Diabetes Mellitus Psychosomatics 1997; 38: 98-108.

Diabetes Statistics. NIH Pub. No. 99-3892. Bethesda,  MD: National Institute of  Diabetes and Digestive and Kidney Diseases, March 1999.

Goldston, DB, Kelley, AE, Reboussin, DM Suicidal Ideation and Behavior and Noncompliance with the Medical Regimen among Diabetic Adolescents American Journal of Child and Adolescent Psychiatry 1997. 

Koenigsberg, HW, Klausner, E, Pelino, D et al. Expressed Emotion and Glucose Control in Insulin-Dependent Diabetes Mellitus American Journal of Psychiatry 1993.

Lustman, PJ, Griffith, LS, Freedland, KE, Clouse, RE; The course of Major Depression in Diabetics  Gen Hosp Psychiatry 1997; 19(2) 138-143.

Lustman, PJ, Griffith, LS, Clouse, RE et al. Effects of Nortryptiline on depression and glycemic controlin diabetes: Results of a double-blind, placebo-controlled trial. Psychosomatic Medicine 1997;59(3) 241-250.

National Advisory Mental Health Council. Health care reform for Americans with severe mental illnesses. American Journal of Psychiatry, 1993; 150(10): 1447-65.

Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 1993; 50(2): 85-94.

Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. Journal of the  American Academy of Child and Adolescent Psychiatry, 1996; 35(7): 865-77.

Stabler B, Surwit, RS, Lane JD, et al. Type A Behavior pattern and blood glucose control in diabetic children Psychosomatic Medicine 1987; 49: 313-316.

 

 islets of hope diabetes medical library                                main Mental Health page

Mental Health                                                  main Diabetes Lifestyles page
Diabetes and Depression

Symptoms, Risks, Causes, Treatment & Prevention


diabetes burnout  William H. Polonsky
Diabetes Burnout:
 Diabetes Burnout is an interactive book that addresses the emotional issues that contribute to poor glycemic control and provides guidance to overcoming the barriers to good self-care. Worksheets help readers assess their current state of motivation and establish a successful plan of action.

Mini site Index
Symptoms of Depression
Are Persons with Diabetes at Greater Risk for Depression?
Diabetes and Depression Facts
 Treatment for Depression (Medication, Therapy)
Herbal Supplementation
Some Interesting Study Findings
References  
Resources  

Symptoms of Depression

Check to see if you have any of the following symptoms of depression:


§        
Feelings of hopelessness, helplessness, guilt, worthlessness,
§         Pessimism that becomes overwhelming or limiting,
§         Loss of interest in pleasurable activities and hobbies
§         Loss of interest in sex,
§         Decreased energy, lethargy, fatigue,
§        
Difficulty with decisions making, concentration, remembering things,
§         Sleep disorders, particularly early-morning waking, or oversleeping,
§         Restlessness, irritability, mood swings,
§        
Changes in appetite,
§        
Weight gain or loss,
§        
Thoughts of death, suicide, or have attempted suicide?

If you answered “yes” to five or more of the above, and symptoms are present daily for two weeks or longer, or interfere with daily routines, tasks, or relationships, you may be suffering from clinical depression.  Seek advice from a medical or mental health professional for evaluation.

Persons with diabetes may be at greater risk for depression.  This is especially true for those suffering from diabetes complications.  But there is treatment for depressed people that can have positive impact on their quality of life.  

   


Are Persons with Diabetes at Greater Risk for  Depression?

Studies do conflict, but at least several now seem to indicate that the risk of depression is doubled among those with diabetes in comparison to the nondiabetic population.  The rate and risk of depression among persons with diabetes increases measurably with the frequency and severity of diabetes-related complications.

Depressed patients are less likely to properly care for themselves.  They may stop being physically active or go off their eating and medication plans.  Since depression can lead to lifestyle changes that can have negative impact on diabetes management it is important to seek help at the first signs of depression.

Depression can result from stress – and let’s face it – diabetes care can be very stressful.  But depression may also result from metabolic effects that diabetes has on the brain.  Studies also indicate that those with a history of depression are more likely to develop long-term diabetes complications.

The past 20 years have shown tremendous advances in brain research in relationship to depression.  But depression still often goes undiagnosed and untreated because the symptoms may not be recognized by family, friends.  It is important to see a medical or mental health professional because you cannot diagnose, and certainly cannot treat, depression yourself.  


Diabetes and Depression Facts

Depression Facts

Depression is a serious medical disorder.  It affects feelings, thoughts, and the ability to function and enjoy everyday life.  It can occur at any age but it is also a treatable problem.  Some quick statistics include:

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6% of 9- 17-year olds suffer from depression,
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10% of all adult Americans (18 years of age and older) suffer some degree of depression, yet
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Over 80% of those treated for depression will respond favorably, and
§        
Less than half of persons with depression seek help.

Depression is a result of abnormal functions of the brain but causes are still debated and heavily researched but it seems likely that a combination of genetic predisposition and a person’s life history contribute to a person’s level of risk for depression.  Depression may be triggered by any of, or a combination of, the following:

§        
Difficult life events (top “stressors” are death, divorce, moving, and chronic illness),
§        
Bodily trauma (i.e. amputation from diabetes complications, disfigurement, diminished physical or mental capacity
      from illness or accident),

§        
Side effects from medications,
§        
Other environmental factors.

Diabetes Facts

Diabetes is a chronic, autoimmune, medical disorder that impairs the body’s ability to digest food for growth and energy.  Much of the food we eat is broken down during the normal digestive process and converted into glucose.  Glucose is a form of sugar that the body uses for fuel.  After digestion, glucose enters the bloodstream.  A healthy pancreas produces the hormone insulin which acts as a key to “unlock” cells throughout the body so that glucose can enter into the cell.  In the absence of insulin, glucose cannot enter cells, the body starves, and blood glucose levels can become dangerously high.

Having lived with diabetes, both as a diabetic and a parent of a child with diabetes, I would sum up diabetes this way:  “You live day-to-day fighting to stay in a safe glucose range so that you will stay alive, always with the knowledge that if you ever drop your guard diabetes can kill you at any time.  Then there is the long-term battle; knowing that what you do today will impact what will happen to you 10 years down the road.  Diabetes is living with constant performance pressure like nothing else I have ever experienced.”

In type 1 diabetes, the insulin-producing beta cells are destroyed and a person will need to take insulin (via shots or an insulin pump, although the FDA recently approved inhaled insulin it is not widely used at this time) every day for the rest of their lives in order to live.  In addition to taking insulin a person with diabetes needs to frequently check their blood glucose levels and often adjust their entire lifestyle and schedules in order to remain in control of their diabetes.  This close attention to eating, exercise, sleep, and other activities people normally take for granted, can be very stressful.

Persons with type 1 diabetes may also have other serious disorders associated with diabetes including Addison’s disease, celiac sprue, cystic fibrosis (CF), eating disorders, hashimoto’s thyroiditis, hemochromatosis (over overload, sometimes also called the “bronze diabetes), fibromyalgia, irritable bowel syndrome, and/or polycystic ovarian syndrome – all of which involved intensive lifestyle management and can have long-term serious health consequences and can contribute to the risk of depression.

Frustrations over the disease aspects seeming to control the person with diabetes and associated disorders involves a stressful 24 hours a day, 7 days a week vigilance – and it can takes its toll.  When complications set in, the person may feel helpless and frustrated; feelings and events that can lead to depression and the risk of developing eating disorders.

Type 2 diabetes, which accounts for approximately 90% of all persons with diabetes in the United States, also is a serious, chronic, and labor-intensive disorder to manage.  As with type 1, a person with type 2 needs to follow a healthy eating plan, exercise regularly, and may have to take oral medications, or even insulin.  Many with type 2 also suffer from obesity, or other related disorders, the same as listed for type 1, above.

With type 2 diabetes, a person is either resistant to the insulin that they produce, or, they do not produce sufficient insulin to handle glucose loads.  Although in type 2 the bet islets cells are not destroyed by the body’s immune system, over time, the pancreas can wear out and even those with type 2 may end up on daily insulin shot therapy.

It is understandable, given the stress of diabetes care management, and the worry and burdens of complications, that those with a chronic disease such as diabetes, can fall prey to depression.  

   


Treatment for Depression

No one should self-diagnose and attempt to treat his/her own depression.  Your medical doctor may be able to refer you to a mental health professional, or, you can try calling your insurance company.  Many insurance plans cover at least part of mental health care, including treatment for depression.  


Therapy

There are many types of treatment approaches for depression.  A psychiatrist is a medical doctor and will be able to treat depression from a medicinal perspective prescribing drugs to help with chemical imbalances or compulsive behavior.  A psychologist has a PhD, but is not a medical doctor and therefore, cannot write a prescription for medication.  A psychologist offers treatment predominantly through any one of many types of therapies available.  Psychologists can work with your physician when medication is required. Clinical social workers also provide support and therapy for mental health treatment including depression.  They too, should work closely with the physician who is providing your diabetes care.  

   


Medication

Antidepressants (generally well-tolerated by persons with diabetes) are often used in conjunction with psychotherapy (talk therapy) because they may take several weeks or longer to work.  This combination of treatment has been shown to have positive effect on both mood as well as glycemic control.  When a person feels better emotionally and psychologically, they are better able, and more willing to, again adhere to their diabetes care plan. 

More than one study has shown that antidepressants not only help with depression, but somehow also have positive impact on blood glucose levels.  (Lustman, PJ, Griffith, LS, Clouse, RE et al. Psychosomatic Medicine 1997;59(3) 241-250) found that when Prozac was used among depressed patients with diabetes they showed a marked improvement in over glucose control.  Lustman feels that this may be in part due to how antidepressants can “turn down” the body’s response to cortisol, a hormone produce during times of stress that can elevate blood glucose levels.

While older (tricyclic) and the newer Serotonin Reuptake Inhibitors (SSRIs) antidepressants can cause elevated glucose levels on nondiabetics, they have the opposite effect in those with diabetes:  improved glucose control.  SSRIs have fewer side effects than older drugs, but some can cause a reduction in sex drive.  Some men, especially those with type 2, may have existing diabetes-related erectile dysfunction (ED) and therefore, do not wish to take antidepressants.  It is important to remember when making medication/therapy choices with your health professional, that most ED problems related to diabetes are related to high blood glucose levels.  Antidepressants, even just pulling out of a depression, can lead to better glucose control and decrease sexual problems.

Since the consequences of poor diabetes management care be both immediately life-threatening as well as detrimental to long-term health, it is important to get help as soon as depression is suspected.

Note:  Cymbalta, released in 2004, is FDA approved for both depression and diabetic neuropathy.  

   


Herbal Supplementation

Before using herbal supplements you should discuss it with your doctor.  Supplements can interact with other medications, have side effects, are not regulated by the FDA, and some can make managing diabetes harder.  Some supplements have been recently banned because of the serious side effects caused to persons, especially with diabetes, taking them.

St. John’s Wort was reported to have positive effects on some sorts of mood disorders.  However, it is now known that this over-the-counter supplement is not benign and can interact dangerously with some other medications.  


Some Interesting Study Findings

Kaiser Permanente conducted a study on 1,680 persons with diabetes.  They discovered that within 6 months prior to a diagnosis of diabetes, these patients were more likely to have been treated for depression.  Additionally, 84% of those with diabetes reported a higher rate of depressive episodes prior to being diagnosed.

Johns Hopkins, in a team effort with other centers, conducted a study that lasted 6 years, ending in 2004.  The study tracked 11, 615 nondiabetic adults ages 48-67.  The study reported that, “depressive symptoms predicted incident type 2 diabetes."

An analysis of 20 studies over the past ten years also showed a correlation between diabetes and depression.  The study reported a frequency of 3-4 times greater incident of major depression in persons with diabetes than in the general population.  And further, that the rate of depression in the general population is between 3 and 5%, the rate of depression among those with diabetes is between 15 and 20% (according the American Diabetic Association).

However depression and diabetes are linked, they clearly are.  Improving depression can improve overall physical health and staying healthy can help reduce the risk of depression.

 We know that emotional factors and stress play a part in blood glucose management.  One study (Stabler, et al. 1987) found that children deemed to have “Type A” personalities (controlling, perfectionists) experience a greater rise blood glucose in response to stress than do children with a calmer nature.

A study (1997, Cohen et al) indicated that persons with type 1 diabetes who also had a history of mental illness were likely at an increased risk for diabetic retinopathy.  These patients were found to have higher A1c levels, an indicator of inadequate glycemic control, which can lead to many complications including diabetic retinopathy.

A telling study (Koenigsberg et al 1993) showed that when children were overly criticized by relatives their overall glucose control was poorer than children in supportive environments.  In fact, since emotional over-involvement was not correlated with poor glucose control the study seems to suggest that parents who positively approach diabetes care may have children who fare better in terms of glycemic control.

Another study (Goldston, et al, 1997) reported that adolescents with diabetes thought more about suicide than is seen in the general population.  Adolescent diabetics living in single parent homes were also associated with poorer long-term diabetes management.

   

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Page Updated 05/12/2006