As we age, more of us and our friends and family will be diagnosed with diabetes and pre diabetes.
The connections between depression and diabetes are established. The exact nature of those connections is not that obvious.  The problem is both conditions are life altering and life threatening and together, are cause for legitimate alarm.

From National Institutes of Mental Health (NIMH):
“Several studies suggest that diabetes doubles the risk of depression compared to those without the disorder. The chance of becoming depressed increases as diabetic 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.”

Research on this subject is also complicated because cause and effect are not always what they seem.  For example, a study published November, 2003 at the University of Copenhagen concluded that older patients with diabetes do not seem to have an increased risk of developing severe depression compared with patients with other chronic illness. Would the same conclusion hold for a younger population? What if the criterion was moderate depression? What’s the impact of moderate depression on originating or worsening diabetes?

NIMH has this effective guide:

  • 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.

How much of a problem is it?
According to an evaluation of 20 studies over the past 10 years, the prevalence rate of diabetics with major depression is three to four times greater than in the general population. While depression affects maybe three or five percent of the population at any given time, the rate is between 15 and twenty percent in patients with diabetes, according to the American Diabetic Association. Women, in particular are at greater risk, according to other studies.

How good are we at diagnosing Depression in a Diabetic?

From the European Depression in Diabetes Research Consortium:

“US studies estimate that only one third of people with diabetes and major depression are identified and treated, with undetected cases of depression experiencing persistently poor outcomes. This is particularly striking considering that depressed patients are known to spend more time with their doctors.

Reasons for under-diagnosis of depression in people with diabetes may include:

  • The perception that the depression is secondary to the medical condition and thus not of independent importance,
  •  Overlap between symptoms of diabetes and depression,
  •  and time-constraints in routine outpatient consultations.

Patients may not consider their depressed mood to be of relevance to their diabetes treatment, have no knowledge or low expectations of therapy effectiveness, r may be reluctant to discuss their mood disorder with their doctor.

One of the difficulties of studying depressive disorders in a diabetic population is that some of the somatic symptoms of depression (e.g., fatigue, sleep problems, weight gain/loss) may be confounded with those of diabetes. Somatic symptoms are as much part of depression as cognitive symptoms and not measuring them (exclusive approach) underestimates the rate of depression while including them may overestimate it.”

A Kaiser Permanente study of some 1,680 subjects found that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About 84 percent of diabetics also reported a higher rate of earlier depressive episodes. Evidence from prospective studies in the US and Japan indicates that depression doubles the risk of incident type 2 diabetes independent of its association with other risk factors. In people with preexisting diabetes, depression is an independent risk factor for coronary heart disease, and appears to accelerate the presentation of coronary heart disease. Because there is reason to believe that depression often precedes diabetes as well as occurring afterwards, as a spouse or friend you may have the opportunity to intervene both before and after the diagnosis of diabetes.

Depressed diabetics generally present a flat mood and even a hopeless, sometimes quietly frantic, overwhelmed presence. The negative aspect of seemingly everything is their perspective. Things, people, circumstances aren’t working well for them.  Recognizing depression must be approached with perspective and caution and with encouragement to visit a physician for an evaluation.

 

To your better health.

Ruthan

 

 

 

Ruthan Brodsky

Copywriter for health professionals

Freelance business writer

 

 

 

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Filed under: Mind and Body

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