With people with diabetes being at a greater risk of developing depression than those without diabetes, it is imperative to recognize the signs of depression. Failing to recognize and/or treat this disorder can impact how you or your loved one chooses to manage diabetes. Treatment for depression helps people manage symptoms of both diseases, thus improving the quality of their lives.
Several studies suggest that diabetes doubles the risk of depression compared to those without the disorder. As diabetes complications get worse, it is common for depression to increase as well, which can lead to people not taking care of themselves as well as they should.
What causes depression?
Depression is a complicated disease that could have a number of different causes, including genetic, biological, environmental, and psychological. However, the cause for the link between diabetes and depression remains uncertain. It may be due to stress or the metabolic effects of diabetes on the brain. It is not known if the presence of diabetes causes the depression, vice versa, or both. But whatever the cause, the addition of diabetes appears to increase the risk of depression occurring due to the difficulty and stress of managing the disease, and sometimes the appearance of and management of complications.
At the same time, some symptoms of depression may reduce overall physical and mental health, not only increasing your risk for diabetes but making diabetes symptoms worse. For example, overeating may cause weight gain, a major risk factor for diabetes. Fatigue or feelings of worthlessness may cause individuals to ignore a special diet or medication plan needed to control their diabetes, worsening their diabetes symptoms. Studies have shown that people with diabetes and depression have more severe diabetes symptoms than people who have diabetes alone.
What are the symptoms of depression?
People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness.
Symptoms of depression most commonly include:
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Changes in appetite
- Thoughts of death or suicide, or suicide attempts
- Restlessness, irritability
- Physical discomforts, such as headaches, aches and pains, or digestive discomfort that doesn't respond to treatment.
If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for depression.
How is depression diagnosed and treated?
The first step to getting appropriate treatment is to visit a doctor or mental health specialist. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation.
Currently, the most common treatments for depression include:
- Cognitive behavioral therapy (CBT), a type of psychotherapy, or talk therapy, that helps people change negative thinking styles and behaviors that may contribute to their depression
- Selective serotonin reuptake inhibitor (SSRI), a type of antidepressant medication that includes citalopram (Celexa), sertraline (Zoloft), and fluoxetine (Prozac)
- Serotonin and norepinephrine reuptake inhibitor (SNRI), a type of antidepressant medication similar to SSRI that includes venlafaxine (Effexor) and duloxetine (Cymbalta).
The doctor may refer you to a mental health professional, who should discuss with you any family history of depression or other mental disorder, and get a complete history of your symptoms. You should discuss when your symptoms started, how long they have lasted, how severe they are, and whether they have occurred before and if so, how they were treated. The mental health professional may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide.
Depression, even the most severe cases, can be effectively treated. The earlier that treatment begins, the more effective it is.
Reviewed by Janis Roszler, MSFT, RD, CDE, LD/N 3/13
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...