Diabetes and depression - Diabetic Depression for Health Providers

Diabetes and depression

Symptoms of depression are common in people with diabetes compared with the general population, and major depression is present in approximately 15% of people with diabetes. Depression is associated with poorer self-care behaviour, poorer blood glucose management, health complications, decreased quality of life and psychological well-being, increased family problems, and higher healthcare costs.

The association between depression and diabetes is 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.

Despite the enormous advances in brain research in the past 20 years, depression often goes undiagnosed and untreated. It often takes a mental health professional to recognize these symptoms, inquire about their duration and severity, diagnose the disorder and suggest appropriate treatment.

Research shows that depression leads to poorer physical and mental functioning, so a person is less likely to follow a required meal or medication plan. Treating depression with psychotherapy (“talk” therapy), medication or a combination of these treatments can improve a patient’s well-being and ability to manage diabetes. In people who have diabetes and depression, scientists report that psychotherapy and antidepressant medications have positive effects on both mood and blood glucose management.

Prescription antidepressant medications are generally well tolerated and safe for people with diabetes. Specific types of psychotherapy can also 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.

Therefore, treatment for depression in the context of diabetes should be managed by a mental health professional, such as a psychiatrist, psychologist or clinical social worker who is in close communication with the physician providing 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 who 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 over-the-counter herbal remedy promoted as a treatment for mild depression, can have harmful interactions with some other medications.

It is important to remember that depression is a disorder of the brain that 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.

Anxiety
It’s normal to feel anxious or worried at times. Everyone does. In fact, a moderate amount of anxiety can be good. It helps you respond appropriately to real danger, and it can help motivate you to excel at work and at home.

But if you often feel anxious without reason and your worries disrupt your daily life, you may have an anxiety disorder. Anxiety disorders cause excessive or unrealistic anxiety and worry about life circumstances, usually without a readily identifiable cause.

Little is known about the relationship between diabetes and anxiety. Recent evidence suggests that the rate of anxiety disorders is elevated in people with type 1 diabetes. Anxiety disorders appear to be increased in individuals with diabetes compared with the general population (14 vs. 3 to 4%, respectively). As many as 40% of people have at least some anxiety symptoms, and fear of hypoglycemia is not uncommon in those with diabetes. Recent studies suggest that anxiety disorders in people with type 1 and 2 diabetes is associated with poor blood sugar control.

Signs and symptoms
The signs and symptoms of generalized anxiety disorder can vary in combination or severity. They may include:

Restlessness
Feeling of being keyed up or on edge
Feeling a lump in your throat
Difficulty concentrating
Fatigue
Irritability
Impatience
Being easily distracted
Muscle tension
Trouble falling or staying asleep (insomnia)
Excessive sweating
Shortness of breath
Stomachache
Diarrhea
Headache
The two main treatments for anxiety disorders are medication (anti-anxiety drugs and/or anti-depressants) and psychotherapy (“talk therapy”), either alone or in combination.

If you have difficulty controlling your worries, or if anxiety interferes with your daily life, speak with your doctor, diabetes healthcare team or mental health professional.

Eating disorders
Adolescent females and young women with type 1 diabetes have about twice the risk of developing eating disorders as their peers without diabetes. This may be because of the weight changes that can occur with insulin therapy and good metabolic control and the extra attention people with diabetes must pay to what they eat.

Researchers estimate that 10–20 percent of girls in their mid-teen years and 30–40 percent of late teenaged girls and young adult women with diabetes skip or alter insulin doses to control their weight. Studies of eating disorders and diabetes also show a higher rate of bulimia in girls with diabetes compared with healthy controls.

In people with diabetes, eating disorders can lead to poor metabolic control and repeated hospitalizations for dangerously high or low blood sugar. Chronic poor blood sugar control leads to long-term complications, such as eye, kidney, and nerve damage.

Early Warning Signs

Extremely high A1C test results
Frequent bouts of and hospitalizations for poor blood sugar control
Anxiety about or avoidance of being weighed
Frequent requests to switch meal-planning approaches
Frequent severe low blood sugar
Widely fluctuating blood sugar levels without obvious reason
Delay in puberty or sexual maturation or irregular or no menses
Binging with food or alcohol at least twice a week for 3 months
Exercise more than is necessary to stay fit
Severe family stress
If you think that you or a loved one has an eating disorder, talk to your doctor or diabetes healthcare team. They will recommend a mental health professional who will work with the diabetes team to help you and your family deal with this problem. It is important to be nonjudgmental and supportive. It is also extremely important to seek evaluation and treatment.