Diabetes Monitor - depression and diabetes

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Diabetes Monitor - depression and diabetes

Managing Diabetes
Research has shown that tight glucose control is the best way to prevent serious complications of diabetes, so the goal of diabetes management is to keep blood glucose levels as close to the normal range as possible. Healthy eating, physical activity, insulin injections, or using an insulin pump are basic therapies for type 1 diabetes. Blood glucose levels must be monitored through frequent checking. In recent years, research has led to better ways to manage type 2 diabetes and treat its complications with improved monitoring of blood glucose, new drugs, and weight control management. Blood pressure drugs called ACE (angiotensin-converting enzyme) inhibitors help to prevent or delay heart and kidney disease.

People with diabetes try to keep blood glucose (also called blood sugar) from rising too high or falling too low. When blood glucose levels drop too low from some medicines—a condition called hypoglycemia—a person can become nervous, shaky, and confused. Judgment can be impaired, and if the level is low enough, a person can faint. High levels of blood glucose, called hyperglycemia, cause tissue damage and lead to debilitating complications. Associated with acute long-term complications, the disease can lead to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy. Because a large part of the population is aging and Americans are increasingly overweight and sedentary, the prevalence of diabetes is predicted to increase.

Researchers continue to search for the causes of diabetes and ways to prevent and cure the disorder. Scientists are looking for genes that contribute to the different forms of diabetes, are testing new drugs, and are using bioengineering techniques to try to create artificial beta cells that secrete insulin.
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 behavioral 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. (See the alert on the NIMH Web site: http://www.nimh.nih.gov/events/stjohnwort.cfm.)

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.

References

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

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

3 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.

4 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.

5 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.

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

From the National Institute of Mental Health (NIMH) of the NIH
NIH Publication No. 02-5003
June 17, 2002
http://www.nimh.nih.gov/publicat/depdiabetes.cfm

For more information about depression and research on mental disorders, contact:

National Institute of Mental Health (NIMH)
Office of Communications
Information Resources and Inquiries Branch
6001 Executive Blvd., Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
Fax: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail: nimhinfo@nih.gov
Web site: http://www.nimh.nih.gov
For more information about diabetes, contact:

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Office of Communications and Public Liaison
31 Center Drive, Room 9A04, MSC 2560
Bethesda, MD 20892-2560
Phone: 301-496-3583
E-mail: NIDDK_Inquiries@nih.gov
Web site: http://www.niddk.nih.gov