Blood Sugar Blues: The Link Between Diabetes and Depression

By Sarah McAdams

Depression is about two times more prevalent in people with diabetes than in similar people without diabetes.

Paula Yurtzy's son Will was diagnosed with diabetes when he was 11 years old.

A few years after his diagnosis, Will began to have trouble dealing with the disease emotionally-he experienced feelings of fear, self-blame, low self-esteem, and hopelessness.

Yurtzy, now a certified diabetes nurse educator in The Diabetes Center at Mercy Medical Center in Baltimore, understands why. Will was depressed.

"Depression frequently goes with diabetes, either before or as a result of," she says. "People who have mood disorders or difficulty in coping with life situations are probably more likely to become depressed with a diagnosis of diabetes. It is just ‘one more thing' that goes wrong in their lives."

In fact, depression is about two times more prevalent in people with diabetes than in similar people without diabetes, according to Greg Nichols, PhD, a senior researcher with Portland, OR-based Kaiser Permanente Center for Health Research. Nichols presented this finding and others at the annual meeting of the American Diabetes Association. And although diabetes sometimes causes feelings of depression-as in Will Yurtzy's case-recent research shows us that it's the other way around.

In other words, depression may cause diabetes.

"We've found that about 75 percent of the time, depression was diagnosed by an average of four years prior to a diabetes diagnosis," Nichols says. "Does this mean that depression causes diabetes? You could argue that depression is immunosuppressive, so in persons predisposed to diabetes, depression could bring it on."

More likely, Nichols says, depression is a component of the "insulin resistance syndrome," which is a constellation of diseases including diabetes, obesity, and cardiovascular disease that are more common in people less sensitive to the effects of insulin.

In the human pancreas, beta cells make the hormone insulin. The insulin allows the body to use or store the glucose it gets from food. But people with diabetes either don't make insulin, don't make enough or don't respond to it. The result can be a myriad of problems like the insulin resistance syndrome diseases.

The concept is similar to the way that chronic fatigue syndrome can cause a variety of mental, physical and emotional problems, according to Dr. Patrick Lustman, a researcher at the St. Louis-based Washington University School of Medicine and considered the foremost authority on the link between diabetes and depression.

Lustman and his team have spent more than a decade proving, among other things, that depression has been linked to poor blood glucose control in patients with diabetes.

"Patients with depression show worse blood glucose control than patients without depression," says Mary de Groot, a PhD fellow who works closely with Lustman at Washington University. "We have also found a moderate association between depression and diabetes complications. Depression has been found to be associated with increased number of diabetes complications and greater severity of complications."

Lustman's team predicts that depression may occur in as many as 20 percent of people with diabetes.

Since depression may have negative effects on keeping diabetes under control, all experts agree that treating the depression as its own separate disorder is just as important as treating the diabetes.

"I think it's very important to get the word out that the majority of depression in diabetes is not caused by receiving the diabetes diagnosis, but in fact precedes the diabetes," Nichols says, adding that there is a tendency to dismiss the depression as a temporary effect of the diabetes diagnosis rather than treating it as a very real disorder.

In addition to the obvious ones, there are several benefits to treating a diabetic's depression. For instance, Lustman's research has shown that improving mood can improve glycemic control. Other studies have shown that people who are depressed are less likely to take medications, more likely to be obese and less likely to be physically active than are people who are not depressed. Obesity and inactivity are known risk factors for diabetes and heart disease.

"A person with diabetes has 99 percent of the responsibility for managing their disease and 100 percent of the consequences of their decisions," she says. "The risks of untreated depression in diabetes include the self-destructive risks of anyone with depression along with the damage uncontrolled diabetes does to the body."

That's a risk no one should take.

Sarah McAdams is a freelance writer living in Los Angeles. She covers health and beauty topics for print and online publications. Reach her at sarah_mcadams@yahoo.com

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