Depression and Diabetes
Dealing with the dual diagnoses
of depression and diabetes
Depression can strike anyone, but people with
diabetes, a serious disorder that afflicts an estimated 17 million
Americans, may be at greater risk. In addition, individuals with depression
may be at greater risk for developing diabetes. Treatment for depression
helps people manage symptoms of both diseases, thus improving the quality of
their lives.
Several studies suggest that diabetes doubles
the risk of depression compared to those without the disorder. 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.5,6
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.
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.2 Additional trials will
help us better understand the links between depression and diabetes and the
behavioural 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. For more
information about these and other mental illnesses, contact NIMH.
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.
From National Institute of Mental Health
NIH Publication No. 02-5003. May 2002.
