Depression and Diabetes
Depression and Diabetes
by John McManamy
Not only is depression is one of the worst illnesses known to humankind, it is also implicated in another of one of the worst illnesses known to humankind - diabetes. For someone with a severe case of diabetes, the disease can amount to a slow and painful execution extending over years and decades. For many years it was thought that depression was a complication of diabetes, which may well be the case. More recent research, however, points to depression as a possible cause or trigger.
What We Know About Depression and Diabetes
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.
A 2004 Johns Hopkins and other centers study tracking 11,615 initially nondiabetic adults aged 48-67 over six years found that "depressive symptoms predicted incident type 2 diabetes."
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.
Whether a cause or an effect, the combination of diabetes and depression can be deadly. "One plus one equals much more than two when you add diabetes and depression," says Patrick Lustman, PhD, professor of medical psychology in the department of psychiatry at Washington University School of Medicine in St Louis. "Because of physiologic and behavioral interactions between diabetes and depression, each becomes more difficult to control, increasing the risks of cardiovascular disease, diabetic retinopathy causing blindness, neuropathy and other complications."
Dr Lustman also mentions obesity as a risk factor for macrovascular disease. Unfortunately, depressed people tend to eat more and exercise less, which results in weight gain and sabotages efforts at controlling blood sugar levels. One study found that depressed adults with diabetes had significantly higher body mass indexes than nondepressed adults with diabetes.
Another study found that depression in diabetics was a greater risk factor for heart disease than high blood sugar.
But if depression can trigger diabetes or make it much worse, it stands to reason that effectively managing one's depression can help bring one's diabetes under control. Dr Lustman and his colleagues have tested that proposition in a number of studies:
In 1997, in a placebo-contolled study, Dr Lustman found that diabetic patients responded well to the tricyclic antidepressant, nortriptyline The drug both worsened glucose levels in nondepressed patients and improved the levels in those who were depressed.
In 1998, he tried cognitive behavioral therapy and diabetes education (with no drugs) on a group of patients with type 2 diabetes and major depression, and concluded it to be an effective treatment.
Most recently, at an annual meeting of the American Diabetes Association held in June 2000, Dr Lustman made public his findings on his latest study. One group of 30 patients was given a daily dose of Prozac, the other a placebo. It was expected that the Prozac would help lift the depression in his test subjects. What he also found was the drug demonstrated a significantly greater improvement in blood sugar levels.
According to Dr Lustman, this result may be possible because an antidepressant dampens the body's response to the hormone, cortisol, which is released during times of stress.
The NIH has convened a panel to pursue more clinical trials. Someday, we will know a lot more about the role depression plays in diabetes. In the meantime:
If you suffer from depression, it pays to consider yourself at risk for diabetes and act accordingly. No smoking gun has been found, but that is the fault of science, which has been delinquent in tracking down mind-body connections. Compliance with your medications, good diet, sleep, exercise, and avoidance of stress is both good depression-management as well as possible diabetes prevention.
If you suffer from diabetes, ask your doctor for a depression screening at once. While we may not know for sure if depression can cause or trigger diabetes, we do know that depression can make diabetes a lot worse. If a screening reveals you do have depression, do not hesitate to treat your depression with both antidepressants and talking therapy.
