Diabetes and Depression

Depression can strike anyone—it affects about nine percent of the U.S. population. But people with diabetes, a serious disorder that affects an estimated sixteen million Americans¹, may be at greater risk.

Studies have shown that ten to thirty percent of people with diabetes also have depression. Several studies suggest that diabetes doubles the risk of depression compared to those without the disorder.² And the chances of becoming depressed increase as diabetes complications worsen.

A Kaiser Permanente study of some 1,680 individuals found that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About eighty-four percent of diabetics also reported a higher rate of earlier depressive episodes.

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.

And research suggests that women with diabetes may be more likely to suffer from depression compared with their male counterparts, and there are strong links with poor metabolic control and diabetes complications.

Causes underlying the association between depression and diabetes are unclear. For many years it was thought that depression was a complication of diabetes, which may well be the case. More research, however, points to depression as a possible cause or trigger.

"Whether a cause or an effect, the combination of diabetes and depression can be deadly," states 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 other serious complications, like cardiovascular disease."

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.

Treatment of depression helps people manage both diseases, thus improving the quality of their lives. Treating depression with psychotherapy, medication, or a combination of these treatments can improve a patient's well-being and ability to manage diabetes.

Despite the availability of appropriate screening tools, less than half of those with depression are identified and treated. However, when individuals are referred for psychologic treatment, various therapies have been found to be successful. Prescription antidepressant medications are generally well-tolerated and safe for people with diabetes. Specific types of psychotherapy, or "talk" therapy can also relieve depression. Realize, not everyone responds to treatment in the same way.

In people who have diabetes and depression, scientists report that psychotherapy and antidepressant medications have positive effects on both mood and blood sugar control.² Additional trials will help scientists better understand the links between depression and diabetes, as well as the behavioral and physiologic mechanisms by which improvement in depression fosters better adherence to diabetes treatment and healthier lives.

The National Institute of Health suggests:

• 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 talk therapy.

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.