Diabetes & Depression Create Adverse Synergy

There’s a clear increase in risk to your health and to your life when you have a combination of diabetes and depression

DIABETES and depression are conditions that can fuel each other. Symptoms of clinical depression include anxiety, feelings of hopelessness or guilt, sleeping or eating too much or too little, and loss of interest in life, people and activities. So, there’s a clear increase in risk to your health and to your life when you have a combination of diabetes and depression.

While diabetes can be a challenge to control, depression can be difficult to treat and keep in remission. Growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia.

What this means is that depression can affect blood sugar levels and insulin metabolism through increased cortisol, contributing to unhealthy eating habits, weight gain and diabetes. On the other hand, management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression. The two are linked not only behaviorally, but biologically, says Dr. Frank B. Hu, a professor of medicine at Harvard Medical School.

However, doctors are unsure whether one condition causes the other or if a single underlying factor is responsible for both ailments. If a substantial causal connection is established between the two disorders, it would be rather novel and could potentially change how doctors understand and treat both disorders.

New research findings from the University of California at San Diego further reinforce the view that since depression and diabetes often co-occur, psychiatrists should be aware that depressed patients may be at risk of the metabolic disorder. The findings of the study were presented at the American Psychiatric Association’s 164th annual meeting in Honolulu last week.

In the San Diego study, reported the Los Angeles Times, researchers who reviewed the medical records of a group of 129 Hispanic diabetics discovered that diabetes was diagnosed first in 54 percent of men with both conditions, while depression was the initial diagnosis of 24 percent of men. Of women with both conditions, 59 percent were first discovered to have diabetes, while 29 percent were first diagnosed with depression.

While doctors are typically aware that someone with diabetes is at higher risk for depression, they may not look for mood disorders as a risk factor for developing diabetes, especially anxiety, the authors noted. Among men with diabetes and anxiety, 54% developed diabetes first and 45% developed anxiety first. Among women, 55% developed diabetes first and 39% developed anxiety first.

Latinos are known to have higher rates of type 2 diabetes than the general US population. Additionally, co-occurring mood disorders are common among these individuals. This made this group of patients an ideal population for studying the relationship between mood disorders and type 2 diabetes.

The San Diego researchers said it is unclear why there is this association between the two conditions, but said that their findings show that there is a strong need to monitor individuals with type 2 diabetes for future mental health issues as the metabolic condition appears to precede mood disorders.

Another research, conducted at Harvard University, found that study subjects who were depressed had a much higher risk of developing diabetes, and those with diabetes had a significantly higher risk of depression, compared to healthy study participants.

A study carried out by the German Diabetes Association (DDG) has also shown that depression can heighten the risk of developing type 2 diabetes as the mental illness also increases the likelihood of obesity and failing to take enough exercise.

The Chennai (India) Urban Rural Epidemiological Study involving around 23,000 participants found that depression can increase the risk of diabetes due to increased levels of counter-regulatory hormones, which can lead to obesity, insulin resistance and glucose intolerance. “The lesson in this is that not only should we treat diabetics for depression, but that by treating depression, the person may actually be able to side-step diabetes,” said co-author Dr. V Mohan.

The American Diabetes Association advises that individuals with type 2 diabetes should consider seeking mental health help if they begin to feel three or more common symptoms of depression, which may include loss of pleasure, loss of appetite, sadness, trouble concentrating and suicidal thoughts.

The bottom line: Since diabetes and depression can influence each other and thus become a vicious cycle, primary prevention of diabetes is important for prevention of depression, and vice versa.

Sources: American Psychiatric Association, American Diabetes Association

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