Treating the Depression That Accompanies Diabetes
According to a meta-analysis of 24 different studies published in Current Diabetes Reports, depression is associated with elevated blood sugar levels. It is also associated with an increased risk for cardiovascular disease and complications caused by diabetes. Because of this, it’s very important to treat depression as well as diabetes.Several options are available to treat depression, including medication and therapy. However, Penckofer says most experts agree that cognitive-behavioral therapy in combination with antidepressant medication is the best option for people with diabetes.
Cognitive-behavioral therapy identifies our thoughts (rather than external influences) as the cause of our feelings and actions. Therapists focus on altering the way patients think, in order to help them feel better.
For instance, someone with diabetes might feel worthless after getting a blood sugar reading over 300 mg/dL. This can lead to feelings of hopelessness and resignation (“Why bother trying to control my blood sugar? I’ll never get where I’m supposed to be.”)
A professional can help the person see such thoughts as ideas, rather than facts, and help him or her develop an understanding of why an individual reading was high and how to avoid high readings in the future.
Selective serotonin reuptake inhibitors and other, newer antidepressants, such as Lexapro (escitalopram), Prozac (fluoxetine) and Zoloft (sertraline), don’t seem to cause a rise in blood sugars and may even help improve blood sugar control. However, common side effects can include stomach upset, agitation and sexual dysfunction.
Wellbutrin (bupropion) is another antidepressant that is less associated with weight gain and sexual side effects, though it has been associated with suicidal thoughts and actions in children and young adults.
Tricyclic antidepressants, such as amitriptyline and doxepin, are also commonly prescribed for people who are depressed. However, they may not be the best choice for people with diabetes because they can cause weight gain and increased blood sugar levels.
Diabetes-Related Distress
Fisher says when the “boring, tedious, demanding work involved in diabetes management goes on over time, frustration and hopelessness can build up in folks, but for the vast majority this is diabetes-related distress, not a major depression.” Distress is treatable, he says, and involves working with a health care professional to put the distress into words. After that, it can be translated into behavioral terms that can help the patient gain control of the disease -- in ways that are reasonable for each individual.“We’ve all heard that diabetes is the number one cause of blindness or renal disease in the U.S.,” he says. “But that’s not true. Poorly controlled diabetes is. And when you work with someone to understand how they can manage diabetes effectively it, it can get easier.”
Sources:
Anderson, Barbara. Telephone interview. 29 Aug 2007.
Fisher, Lawrence. Telephone interview. 28 Aug 2007.
Lustman, Patrick J., and Ryan Anderson. "Depression in Adults With Diabetes." Psychiatric Times XIX.1(2002). <http://www.psychiatrictimes.com/p020145.html.>
Lustman, Patrick J., Sue Penckofer, and Ray E. Clause. "Recent Advances in Understanding Depression in Adults With Diabetes." Current Diabetes Reports 7(2007): 114-122.
"What is Major Depression?" About Mental Illness. Sept 2006. National Alliance on Mental Illness. 3 Sep 2007 <http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7725>.
"Depression." NIMH: Depression. 13 Sept 2006. National Institute of Mental Health. 2 Sep 2007 <http://www.nimh.nih.gov/publicat/depression.cfm#ptdep3>.
Penckofer, Sue. Telephone interview. 29 Aug 2007.
