Treating Depression in Diabetes

Diabetes Mellitus, most commonly known as simply diabetes, is a chronic disease which course can be affected by different psychological and psychopathological conditions. Among the affective disorders which are detected on patients with diabetes, the most frequent is depression. As indicated by recent studies, “people with diabetes have a higher risk of developing depression, and that adults with depression are 37 percent more likely to develop type 2 diabetes.” (“Diabetes and Depression,” 2008). In that regard, this paper addresses diabetes, i.e. Diabetes Mellitus, and its association with depression.

Diabetes Mellitus

In general diabetes refers to the disease in which the body does not produce insulin, a hormone that participates in the conversion of sugar into energy. Assessing the reasons for the occurrence of this disease, it is unfortunately unknown, where only hypothesis can partly explain the origins of such disease. It is estimated that approximately 7.8%of the United States population have diabetes, or 23.6 millions, in which nearly one quarter are unaware of their disease (“All About Diabetes,” 2009).

The symptoms of diabetes can be distinguished based on the major recognized forms of diabetes, which can be outlined as following:

• Type I Diabetes is characterized by the deficiency of insulin production caused by the destruction of insulin producing beta cells in the pancreas. This condition results in high levels of blood glucose. The characteristic symptoms of the type I diabetes are polyuria (excessive discharge of urine), polydipsia (constant thirst), polyphagy (constant hunger), and the loss of weight. Some of the complications of type I diabetes includes: “heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy).” (“All About Diabetes,” 2009). This type is mostly developed in the younger group of the population, although might also occur in adults.
• Type II Diabetes is characterized by either the total lack of insulin or the inability of the body to use it, which results in a high blood glucose levels. The characteristic symptoms of type II diabetes are clinical signs that slowly develop with time, such as skin itch, dry mouth, overall muscle weakness, headache, visual impairment, and others. Many of this symptoms are also characteristic of type I diabetes. Type II diabetes increases the risk of more serious complications, such as “heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy).” (“All About Diabetes,” 2009). This type of diabetes is mostly developed in middle-aged and older adults and frequently associated with obesity, although can appear in younger population.

The treatment of diabetes include keeping the blood glucose level low, and insulin shots and pumps for type I, and assigning a diet losing weight for type II. Treating type II diabetes on later stages of development might include the usage of different medicaments.

Depression

Although depression was not listed as a complication of diabetes, this might be only due to the disagreements in whether depression is complication of diabetes or a cause. In a study at Kaiser Permanente’s Center for Health Research in Portland, it was found that patients with diabetes were “more likely to have been treated for depression within six months before their diabetes diagnosis” (“Scientist Examine Link Between Diabetes, Depression,” 2000), which points to possible conclusions of the depression being involved I the development of diabetes. Despite the fact that the study did not establish a causal link, the correlation between the two variables, i.e. depression and the diagnosis of diabetes, the link between implied the need for a further study.

In that regard, another study suggested, that treating the patients that are diagnosed with diabetes and depression with anti-depression medicine can improve both conditions (“Scientist Examine Link Between Diabetes, Depression,” 2000). An additional study in 2004, the examination of 11,615 non diabetic adults with depressive symptoms found that depressive symptoms predicted the development of type II diabetes (Golden, et al., 2004). Regardless of the diabetes being a cause or an effect, in such combination of “diabetes and depression, each becomes more difficult to control, increasing the risks of cardiovascular disease, diabetic retinopathy causing blindness, neuropathy and other complications.” (“Depression and Diabetes,” 2009).

Additionally, a difficulty might arise in treating depression for patients having diabetes. This factor is related to the fact that a lower medical aid appealability of patients with depression. This might be due unawareness of having such a disorder, or concentrating the attention on only somatic symptoms of depression. “Many people do not like the idea that they may have emotional difficulties. Some find it easier to attribute everything to physical problems or life circumstances.” (Watkins, 2007). The recognition of depressive disorders might also be complicated due to the existence of some mutual somatic symptoms in both cases.

Addressing the factors behind the association between the depression and diabetes, there are many possible explanations. One of the explanations addresses the stress that results from daily diabetes management and the potential consequences, such as having trouble controlling blood sugar level or nerve damage. Additional explanation was based on study in 2005 that found out that “The group of people with both diabetes and depression was more likely to be older, included more women and ethnic minorities, included more people who didn’t exercise, included more people who were overweight or obese, and included more people who had a history of high blood pressure, heart disease, and stroke.” (“Depression and Heart Disease in Diabetes,” 2009).

As stated earlier, it was found that treating diabetes patients who have depression with depression medications proved beneficial for both illnesses. In that sense, providing an accurate diagnosis, depression can be treated with a variety of methods such as using antidepressants and psychotherapy.

Conclusion

As it can be seen through the paper, diabetes is a dangerous illness which if combined with depressions a cause or effect can lead to many complications. In that sense, effective treatment of both illnesses is a vital issue that should not be ignored, where “The proportion of depressive disorders in patients with poorly regulated diabetes, is very high.” (Berge, Lund, Aanderud, & Hundal, 2008). In that regard, neither of the disorders should be ignored, specifically paying attention to depression, as an illness that is frequently disregarded.

References

1. All About Diabetes (2009).
2. Berge, L. I., Lund, A., Aanderud, S. J., & Hundal, O. (2008). Major depression is very frequent in poorly regulated diabetes. European Psychiatry, 23(Supplement 2), S244-S244.
3. Depression and Diabetes (2009).
4. Depression and Heart Disease in Diabetes (2009).
5. Diabetes and Depression (2008).
6. Golden, S. H., Williams, J. E., Ford, D. E., Yeh, H.-C., Sanford, C. P., Nieto, F. J., et al. (2004). Depressive Symptoms and the Risk of Type 2 Diabetes. Diabetes Care(27), 429-435.
7. Scientist Examine Link Between Diabetes, Depression (2000).
8. Watkins, C. E. (2007). Diabetes, Depression and Stress.