Everyone has a bad day, even a bad week, once in a while. This kind of normal depression goes away as quickly as it comes, causing no ill effects. But when symptoms of depression such as sadness, loss of interest in usual pleasures, unusual fatigue and sleep difficulties go on and on, it’s time to pay attention.
This kind of unremitting depression that interferes with normal daily functioning is categorized under the medical diagnosis of major depressive disorder or clinical depression. It affects 15 to 20 percent of people who have diabetes, approximately three times the rate of depression seen in the general population.
The reasons for this increased risk of depression for people with diabetes are not yet fully understood. Possible explanations include the daily demands of diabetes self-care, the stress of dealing with the diabetes complications and perhaps the physical effects, such as chemical and blood-flow changes in the brain, associated with the disease. Because of the known impact of depression on diabetes management, it is important not to ignore this problem.
People who have diabetes need to take serious depression even more seriously than those without the disease. That’s because in addition to the problems depression causes to anyone who suffers from it, it also has significant negative effects, both direct and indirect, on the course of diabetes.
Depression is directly related to poor blood sugar control (the major cause of diabetes complications), and it increases the risk for neuropathy and cardiovascular disease and the likelihood of the occurrence of other risky behaviors such as smoking and alcohol and substance abuse.
In addition, depression contributes to poor blood sugar control in indirect ways by promoting physical inactivity, obesity and failure to follow treatment guidelines, all of which are factors in poor blood sugar control.
Depression can also make medical symptoms, such as pain, feel worse—out of proportion to what objective testing would indicate. Further, seriously depressed people with diabetes typically don’t benefit from programs such as diet/weight management and smoking cessation classes designed to help them better control their blood sugar levels.
Recent studies of depressed patients with diabetes have found that as depression improves, blood sugar control improves as well. Fortunately, most depressed people can be treated effectively with anti-depressant medication or psychotherapy; sometimes, both approaches are used together.
It is estimated that depression in people with diabetes is diagnosed and treated only one-third of the time. This lack of recognition occurs for a variety of reasons, but the fact is that people need to be assertive about their health care needs, and not wait for the doctor to take the lead.
If you have symptoms you think may be caused by serious depression, discuss your concern with your primary care physician. Be aware that in people with diabetes, depression may also be the cause of some physical complaints, such as symptoms of hyper- or hypoglycemia when testing shows adequate blood sugar control, chronic pain or sexual problems. After discussing your symptoms with you, your doctor may treat you directly, or may refer you to a specialist for evaluation and treatment.
Keep in mind that for most people (as many as 80 percent) depression is not a one-time event. It tends to recur, and needs to be treated each time.
In addition to consulting with your doctor, free information about depression is available from many sources.
Both anti-depressant medication and psychotherapy have been shown to be equally effective at treating depression. The best choice for each individual depends on his or her symptoms and desires, as well as numerous personal, logistic and financial issues.
Several types of anti-depressants are available to help people who have both diabetes and clinical depression. The selection is based on such factors as the person’s specific symptoms, other medical problems, drug interactions and potential side effects. If, after an appropriate period of time (generally about three months), the medication isn’t doing the job, another type can be tried.
Psychotherapy can be especially helpful when depression results in interpersonal difficulties or when the person is motivated to talk about his or her feelings. Two types of psychotherapy, cognitive therapy and interpersonal therapy, have been shown to be effective for treating depression.
People may want to check with their health insurance provider to see what coverage is provided for treatment of emotional disorders.
A diagnosis of major depressive disorder is made based on the following symptoms. Symptoms must be present for most of the day nearly every day for two weeks or more, and must be the source of significant distress or impaired functioning in social settings, on the job or in other important areas of functioning in order to be considered in making the diagnosis.
* Either significantly depressed mood or markedly diminished interest or pleasure in almost all activities.
* At least four of the following symptoms:
- significant weight loss or gain (in people with diabetes, the weight loss or gain cannot be attributable to the diabetes itself)
- sleep disturbance: difficulty falling asleep or staying asleep, or excessive sleeping
- feelings of agitation or nervousness
- fatigue, loss of energy, not attributable to diabetes
- feelings of being worthless, guilty or that you are a burden to others
- inability to concentrate
- feeling that you want to die or hurt yourself
The following organizations can provide materials on depression and its treatment.
National Institute of Mental Health
1-800-421-4211
National Mental Health Association
1-800-969-6642
National Depressive and Manic-Depressive Association
1-800-826-3632
Covenant House
1-800-999-9999
or
Call 911
Diabetes and Hormone Center of the Pacific Ala Moana Pacific Center 1585 Kapiolani Boulevard, Suite 1500 Honolulu, Hawaii 96814 Tel: (808) 531-6886 Fax: (808) 523-5115
Your comments are welcomed. For medical
questions consult your physician.
| © 1998 All Rights Reserved. David Fitz-Patrick, M.D. |