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Diabetes and Depression

Link between Hyperglycemia & Depression

 

Each year 13 to 14 million people in the United States will report experiencing a period of depression, although the number is likely much higher.  In addition, an estimated 16 million people have some form of diabetes, with these numbers increasing at the rate of a million per year.  With the extreme prevalence of depression and diabetes, questions are raised whether the two are linked.

 

Physical diseases and mental illness often occur together, making it difficult to determine whether or not one causes the other.  The high level of co-occurrence can also make symptoms difficult to treat.  Therefore, it is important to understand the clinical distinction between depression and diabetes.

           

Depression is a mental disorder: an illness of the brain caused by neurological imbalances that are mainly attributed to genetics and environment.  Diabetes is a physical disease.  More specifically, Type I diabetes (where the immune system destroys the insulin-producing cells of the pancreas) is not preventable and is generally passed by family genes and is affected by the environment in which the person lives.  Type II diabetes (where the body develops a resistance to insulin) is a part of a metabolic syndrome that typically includes high blood pressure, obesity, and high levels of blood lipids.  Both depression and diabetes create intense complications for a person’s life.

           

If you have already been diagnosed with diabetes, you may have experienced some of the symptoms such as easy fatigue or weakness, frequent urination, rapid weight changes, tingling or numbness in the hands and feet, personality changes, or skin infections/wounds that are slow in healing.  The symptoms of depression can range in intensity and duration, and can sometimes be attributed to diabetes.  If you experience 5 or more of these symptoms, you should consult with your physician immediately.

 

SYMPTOMS OF DEPRESSION 

  • Persistent sad, anxious, or "empty" mood

  • Feelings of hopelessness, pessimism

  • Feelings of guilt, worthlessness, helplessness

  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

  • Decreased energy, fatigue, being "slowed down"

  • Difficulty concentrating, remembering, making decisions

  • Insomnia, early-morning awakening, or oversleeping

  • Appetite and/or weight changes

  • Thoughts of death or suicide, or suicide attempts

  • Restlessness, irritability

If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for depression

           

Regarding the causation relationship between diabetes and depression, experts are convinced that it is a complex combination of genetic makeup and psychosocial factors (such as environment and overall health).  However, scientists do not believe that diabetes alone can trigger depression.  In a study by the American Diabetes Association, researchers found no connection between high blood glucose and depression in people with any type of diabetes (Engum et al., 2005).  This study also found that factors connected with depression in people with Type I and Type II diabetes were also connected to depression in the general population.  Therefore, an aspect of the genetic code of a diabetic or the environment in which they live must enhance the risk for depression.

                

A report in the Psychiatric Times by Lustman and Anderson (2002) indicates that depression is associated with poor glycemic control.  Glycemic control is defined as the typical levels of blood sugar in a person, and it is crucial for diabetics to maintain “good” glycemic control in order to prevent disease-related complications.  Poor glycemic control refers to blood sugar levels that are consistently elevated.  For individuals with diabetes who already struggle to control their blood sugar levels, depression can further complicate the disease by promoting poor glycemic control. 

 

FACTORS THAT INFLUENCE GLYCEMIC CONTROL 

  • Diabetes Severity  The longer a person has diabetes, the more difficult it is to control glycemic levels.  This is particularly true for individuals with Type II diabetes, as the body deteriorates from resisting insulin to not producing it at all.

  • Health Status  Factors such as blood pressure, BMI, and cholesterol levels are critical factors in glycemic control.  Obesity and high cholesterol levels are strongly associated with poor glycemic control.  Cigarette smoking also negatively affects glycemic control.

  • Access/Quality of Care  Individuals without proper health care or health insurance tend to suffer from poor glycemic control.  This is most likely due to lack of medicinal care and information.

  • Behavioral Factors These mainly refer to dietary control, physical activity, and education level.  Poor diet, a sedentary lifestyle, and lack of knowledge regarding health issues such as diabetes, depression, or health in general are associated with poor glycemic control.

The most current research suggests that depression is a co-occurring mental illness that is highly associated with diabetes.  While depression does not occur as a direct result of the disease, the influence of glycemic control may strongly increase the likelihood of a diabetic developing depression. 

 

Despite the fact that diabetes can permanently alter an individual’s lifestyle, depression does not have to be one of the negative effects.  Research has shown that the treatment of depression has a positive impact on the effects of diabetes.  Newer antidepressants do not seem to increase hyperglycemia in diabetics and have actually been shown to improve glycemic control.  When combined with psychotherapy, medicinal treatments have even more positive effects.  The most effective treatment for depression includes an integration of medicine, therapy, and lifestyle changes.

 

If you feel that you or someone you know might be suffering from depression and/or diabetes, it is critically important to receive a combination of treatments in order to improve the quality of health and life.   

 

RESOURCES

 

Benoit, Fleming, Philis-Tsimikas, Ji (2005).  Predictors of Glycemic Control Among Patient with Type II Diabetes: a Longitudinal Study.  BMC Public Health.  Retrieved 2006 Jan 30. http://www.biomedcentral.com/1471-2458/5/36.

 

Lustman, P.J and Anderson, R.  (2002).  Depression in Adults with Diabetes.  Psychiatric Times, 14(1).  Retrieved 2006 Jan 30. http://www.psychiatrictimes.com/p020145.html

 

Depression and Diabetes.  Depression and Bipolar Support Alliance.  Retrieved 2006 Jan 30.http://www.dbsalliance.org/Diabetes.html