Provided by the National Institute of Mental Health
Symptoms of Depression
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
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Restlessness, irritability
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.
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Introduction
Depression can strike anyone, but people with diabetes, a serious disorder that
afflicts an estimated 16 million Americans,1 may be at greater risk. In
addition, individuals with depression may be at greater risk for developing
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.2 The chances of becoming depressed increase as
diabetes complications worsen. Research shows that depression leads to poorer
physical and mental functioning, so a person is less likely to follow a required
diet or medication plan. Treating depression with psychotherapy, medication, or
a combination of these treatments can improve a patient's well-being and ability
to manage diabetes.
Causes underlying the association between depression and diabetes are unclear.
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. People who suffer from both diabetes and
depression tend to have higher health care costs in primary care.3
Despite the enormous advances in brain research in the past 20 years, depression
often goes undiagnosed and untreated. People with diabetes, their families and
friends, and even their physicians may not distinguish the symptoms of
depression. However, skilled health professionals will recognize these symptoms
and inquire about their duration and severity, diagnose the disorder, and
suggest appropriate treatment.
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and
the ability to function in everyday life. Depression can occur at any age. NIMH-sponsored
studies estimate that 6 percent of 9- to 17-year-olds in the U.S. and almost 10
percent of American adults, or about 19 million people age 18 and older,
experience some form of depression every year.4,5 Although available therapies
alleviate symptoms in over 80 percent of those treated, less than half of people
with depression get the help they need.5,6
Depression results from abnormal functioning of the brain. The causes of
depression are currently a matter of intense research. An interaction between
genetic predisposition and life history appear to determine a person's level of
risk. Episodes of depression may then be triggered by stress, difficult life
events, side effects of medications, or other environmental factors. Whatever
its origins, depression can limit the energy needed to keep focused on treatment
for other disorders, such as diabetes.
Diabetes Facts
Diabetes is a disorder that impairs the way the body uses digested food for
growth and energy. Most of the food we eat is broken down into glucose, a form
of sugar that provides the main source of fuel for the body. After digestion,
glucose passes into the bloodstream. Insulin, a hormone produced by the
pancreas, helps glucose get into cells and converts glucose to energy. Without
insulin, glucose builds up in the blood, and the body loses its main source of
fuel.
In type 1 diabetes, the immune system destroys the insulin-producing beta cells
of the pancreas. This form of diabetes usually strikes children and young
adults, who require daily or more frequent insulin injections or using an
insulin pump for the rest of their lives. Insulin treatment, however, is not a
cure, nor can it reliably prevent the long-term complications of the disease.
Although scientists do not know what causes the immune system to attack the
cells, they believe that both genetic factors and environmental factors are
involved.
Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the
United States, occurs equally in males and females, and is more common in
Caucasians. Symptoms include increased thirst and urination, constant hunger,
weight loss, blurred vision, and extreme fatigue. If not treated with insulin, a
person can lapse into a life-threatening coma.
Type 2 diabetes, which accounts for about 90 percent of diabetes cases in the
United States, is most common in adults over age 40. Affecting about 6 percent
of the U.S. population, this form of diabetes is strongly linked with obesity
(more than 80 percent of people with type 2 diabetes are overweight),
inactivity, and a family history of diabetes. It is more common in African
Americans, Hispanic Americans, American Indians, and Asian and Pacific Islander
Americans. With the aging of Americans and the alarming increase in obesity in
all ages and ethnic groups, the incidence of type 2 diabetes has also been
rising nationwide.
Type 2 diabetes is often part of a metabolic syndrome that includes obesity,
high blood pressure, and high levels of blood lipids. People with type 2
diabetes first develop insulin resistance, a disorder in which muscle, fat, and
liver cells do not use insulin properly. At first, the pancreas produces more
insulin, but gradually its capacity to secrete insulin falters, and the timing
of insulin secretion becomes abnormal. After diabetes develops, insulin
production continues to decline.
Symptoms include fatigue, nausea, frequent urination or infections, unusual
thirst, weight loss, blurred vision, and slow healing of wounds or sores. Some
people have no symptoms at all. Researchers estimate that about one-third of
people with type 2 diabetes don't know they have it.
Many people with type 2 diabetes can control their blood glucose by following a
careful diet and exercise program, losing excess weight, and taking oral
medication. However, the longer a person has type 2 diabetes, the more likely he
or she will need insulin injections, either alone or together with oral
medications.
Gestational diabetes develops during pregnancy. Like type 2 diabetes, it occurs
more often in African Americans, American Indians, Hispanic Americans, and
people with a family history of diabetes. Though it usually disappears after
delivery, the mother is at increased risk of getting type 2 diabetes later in
life.
Managing Diabetes
Research has shown that tight glucose control is the best way to prevent serious
complications of diabetes, so the goal of diabetes management is to keep blood
glucose levels as close to the normal range as possible. Healthy eating,
physical activity, insulin injections, or using an insulin pump are basic
therapies for type 1 diabetes. Blood glucose levels must be monitored through
frequent checking. In recent years, research has led to better ways to manage
type 2 diabetes and treat its complications with improved monitoring of blood
glucose, new drugs, and weight control management. Blood pressure drugs called
ACE (angiotensin-converting enzyme) inhibitors help to prevent or delay heart
and kidney disease.
People with diabetes try to keep blood glucose (also called blood sugar) from
rising too high or falling too low. When blood glucose levels drop too low from
some medicines—a condition called hypoglycemia—a person can become nervous,
shaky, and confused. Judgment can be impaired, and if the level is low enough, a
person can faint. High levels of blood glucose, called hyperglycemia, cause
tissue damage and lead to debilitating complications. Associated with acute
long-term complications, the disease can lead to blindness, heart and blood
vessel disease, strokes, kidney failure, amputations, and nerve damage.
Uncontrolled diabetes can complicate pregnancy. Because a large part of the
population is aging and Americans are increasingly overweight and sedentary, the
prevalence of diabetes is predicted to increase.
Researchers continue to search for the causes of diabetes and ways to prevent
and cure the disorder. Scientists are looking for genes that contribute to the
different forms of diabetes, are testing new drugs, and are using bioengineering
techniques to try to create artificial beta cells that secrete insulin.
Get Treatment for Depression
While there are many different treatments for depression, they must be carefully
chosen by a trained professional based on the circumstances of the person and
family. Prescription antidepressant medications are generally well-tolerated and
safe for people with diabetes. Specific types of psychotherapy, or "talk"
therapy, also can relieve depression. However, recovery from depression takes
time. Antidepressant medications can take several weeks to work and may need to
be combined with ongoing psychotherapy. Not everyone responds to treatment in
the same way. Prescriptions and dosing may need to be adjusted.
In people who have diabetes and depression, scientists report that psychotherapy
and antidepressant medications have positive effects on both mood and glycemic
control.2 Additional trials will help us better understand the links between
depression and diabetes and the behavioral and physiologic mechanisms by which
improvement in depression fosters better adherence to diabetes treatment and
healthier lives.
Treatment for depression in the context of diabetes should be managed by a
mental health professional—for example, a psychiatrist, psychologist, or
clinical social worker—who is in close communication with the physician
providing the diabetes care. This is especially important when antidepressant
medication is needed or prescribed, so that potentially harmful drug
interactions can be avoided. In some cases, a mental health professional that
specializes in treating individuals with depression and co-occurring physical
illnesses such as diabetes may be available. People with diabetes who develop
depression, as well as people in treatment for depression who subsequently
develop diabetes, should make sure to tell any physician they visit about the
full range of medications they are taking.
Use of herbal supplements of any kind should be discussed with a physician
before they are tried. Recently, scientists have discovered that St. John's wort,
an herbal remedy sold over-the-counter and promoted as a treatment for mild
depression, can have harmful interactions with some other medications.
Other mental disorders, such as bipolar disorder (manic-depressive illness) and
anxiety disorders, may occur in people with diabetes, and they too can be
effectively treated. For more information about these and other mental
illnesses, contact NIMH.
Remember, depression is a treatable disorder of the brain. Depression can be
treated in addition to whatever other illnesses a person might have, including
diabetes. If you think you may be depressed or know someone who is, don't lose
hope. Seek help for depression.
For more information about depression and research on mental disorders
Please visit the following links for more information about organizations that
focus on depression and other illnesses and research on mental disorders.
References
1Diabetes statistics. NIH Pub. No. 99-3892. Bethesda, MD: National Institute of
Diabetes and Digestive and Kidney Diseases, March 1999.
2Anderson RJ, Lustman PJ, Clouse RE, et al. Prevalence of depression in adults
with diabetes: a systematic review. Diabetes, 2000; 49(Suppl 1): A64.
3Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of
depressive symptoms on adherence, function, and costs. Archives of Internal
Medicine, 2000; 160(21): 3278-85.
4Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive
disorders service system. Epidemiologic Catchment Area prospective 1-year
prevalence rates of disorders and services. Archives of General Psychiatry,
1993; 50(2): 85-94.
5Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule
for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence
rates, and performance in the MECA Study. Methods for the Epidemiology of Child
and Adolescent Mental Disorders Study. Journal of the American Academy of Child
and Adolescent Psychiatry, 1996; 35(7): 865-77.
6National Advisory Mental Health Council. Health care reform for Americans with
severe mental illnesses. American Journal of Psychiatry, 1993; 150(10): 1447-65.
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All material in this brochure is in the public domain and may be reproduced or
copied without permission from the Institute. Citation of the National Institute
of Mental Health as the source is appreciated.
NIH Publication No. 02-5003
Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
May 2002
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