It’s built into our psyches from an early age: If you get hurt, Grandma gives you a cookie. If you don’t get asked to the prom or make the football team, you comfort yourself with a burger, fries and a milkshake. The job is upsetting to you, so you eat a pizza.
Given emotional trauma, no exercise, weight gain and enough comfort food, you could become a candidate for type 2 diabetes, a disease that brings with it an increased risk for depression. If you’re depressed, you are less likely to be careful with your diet and take other important self-care measures.
Dr. Paul Ciechanowski, an assistant professor of psychiatry and behavioral sciences in the University of Washington School of Medicine, said that a recent study undertaken by Group Health Cooperative found that 12 percent of the 4,200 diabetic patients surveyed suffered from major depression. In the general population, between 3 and 5 percent of people have major depression.
“According to other studies, another 20 to 30 percent of the diabetic patients had less severe but clinically significant levels of depression,” Ciechanowski adds.
Major depression, as defined by the standard manual of psychiatric diagnoses, means having five or more of the nine possible symptoms in a two-week period. The symptoms can include disruption in sleep patterns by either sleeping too little or too much, fatigue, changes in appetite and inability to concentrate. Ciechanowski points out that some of these symptoms may be hard to differentiate from diabetes symptoms, making the problem more difficult to identify and treat.
“To have a clinical diagnosis of major depression, one of these symptoms has to be what we call a cardinal symptom: Either the patient has to have a significant lack of pleasure in daily activities or a significantly depressed mood for two weeks or more,” Ciechanowski says. He adds that people who are chronically depressed tend to eat poorly, smoke and drink more, and avoid exercise.
“If you have diabetes, you know that it is a very complex disease, requiring adherence to a carefully designed plan to control blood glucose,” Ciechanowski says. “Depression can make that self-care an overwhelming burden, and it can also boost blood sugar levels.”
If you feel that you are becoming overwhelmed by depression and its attendant anxieties, Ciechanowski says the initial step should be a visit to your health-care provider. You should use this visit to discuss whether you are suffering from depression and to determine if other chronic health factors, like an underactive thyroid, may be influencing your mood. Then you can talk about ways to make diabetes self-care more manageable.
“Instead of taking on the entire self-care package at once, which can feel overwhelming, I like the approach of initially taking on perhaps two of the four components, which include glucose monitoring, medication, diet and exercise,” Ciechanowski says.
He adds, “Most clinicians, whether they are a primary-care doctor or an endocrinologist or a nurse practitioner working in a diabetes center, should be able to treat both diabetes and depression, unless the depression is complicated by other factors. A patient may have to see a specialist if the depression is recurrent, if there’s a strong family history of depression, if it’s associated with alcoholism or other substance abuse or there are other serious medical illnesses in addition to diabetes.”
He stresses that no matter the cause of the depression or how complicated it may be, there are treatments available that work.
Health Beat is a service of University of Washington Health Sciences and Medical Affairs News and Community Relations. (end)