DEPRESSION AND DIABETES

by Peter J. Nebergall, PhD

There is a growing body of evidence linking episodes of emotional depression with long-term diabetes.� The relationship is complex, and needs to be carefully explored.

First, there are several kinds of depression.� An emotional low that stems from a depressing situation, "circumstances got you down," is said to be "situational depression."� Depression that stems from hormonal imbalance, brain injury or chemical instability is said to be "organic depression."�

Now we all know that diabetes is depressing.� There is a lot about it that can "get you down," and little to lift you up again.� If that were all, it would be pretty simple.� But it's not all.

Statistical studies show solid "association" between significant diabetic complications and serious depression.� Does this prove that "depression causes diabetes?"� No.� Does it prove that "diabetes is depressing?"� No.� It is an association, which means only that far more of the factors were found together than could be explained by random happenstance.� It doesn't mean you're nuts.

Why does this matter?� We already know that diabetes is serious--that its rules must be followed, and its complications taken seriously, if health is to be preserved.� We know almost as much about depression.

Major depression, regardless of cause, can lead to eating disorders, physical inactivity, abandonment of consistent routine, and other behavioral changes that can harm your diabetes control.� The feelings of hopelessness and worthlessness that are a common symptom of depression can lead one to "noncompliance," to abandonment of necessary self-care, or worse.

Successful treatment for depression, whether with counseling, medication, or both, improves one's capacity to independently carry out the necessary tasks of diabetes self-management.� The person who becomes less depressed is able to do a better job with his/her diabetes.� But there's more.�

Certain medications used to treat depression have also proven effective against diabetic complications.� Tricyclic antidepressants appear effective against certain forms of diabetic neuropathy.� Other medications may be effective as well, although such medications may impact one's blood sugar control.

To Review:� It is a real spiderweb of interlocking causes.� We see a lot of folks who have both long-term diabetes and serious depression--and depression appears up to five times more likely among diabetics than among the rest of the population.� But depression doesn't cause diabetes, and diabetes doesn't "cause" depression, either.� The nature of the link is still unclear.� What is clear is that significant improvement to either condition can improve the other.� We may not know the exact nature of the linkage we are observing, not yet, but we know the old word "holistic," all parts considered together, is the right word to use here.