(see below for article sources)
Take Depression Self-Assessment Test
Mental Health Studies & Research
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):
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
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.
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Health care reform for Americans with severe mental illnesses. American
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Regier DA, Narrow WE, Rae DS,
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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
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Stabler B, Surwit, RS, Lane JD, et al. Type A Behavior pattern and blood
glucose control in diabetic children Psychosomatic Medicine 1987; 49:
main Mental Health page
Mental Health main Diabetes Lifestyles page
Diabetes and Depression
Symptoms, Risks, Causes, Treatment & Prevention
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
Diabetes and Depression Facts
Treatment for Depression (Medication, Therapy)
Some Interesting Study Findings
Symptoms of Depression
to see if you have any of the following symptoms of depression:
hopelessness, helplessness, guilt, worthlessness,
becomes overwhelming or limiting,
Loss of interest in
pleasurable activities and hobbies
Loss of interest in
decisions making, concentration, remembering things,
particularly early-morning waking, or oversleeping,
irritability, mood swings,
Changes in appetite,
Weight gain or loss,
Thoughts of death,
suicide, or have attempted suicide?
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.
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?
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.
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
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
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 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:
6% of 9- 17-year olds suffer from depression,
10% of all adult Americans (18 years of age and older) suffer some
degree of depression, yet
Over 80% of those treated for depression will respond favorably,
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
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
Side effects from medications,
Other environmental factors.
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
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
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.
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
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
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.
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.
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
Note: Cymbalta, released in 2004, is FDA approved
for both depression and diabetic
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,
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.
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.
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.
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.