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Depression and Diabetes

© John McManamy

"One plus one equals much more than two when you add diabetes and depression."

Not only is depression is one of the worst illnesses known to humankind, it is also implicated in another of one of the worst illnesses known to humankind - diabetes. For someone with a severe case of diabetes, the disease can amount to a slow and painful execution extending over years and decades. For many years it was thought that depression was a complication of diabetes, which may well be the case. More recent research, however, points to depression as a possible cause or trigger.

A Kaiser Permanente study of some 1,680 subjects found that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About 84 percent of diabetics also reported a higher rate of earlier depressive episodes.

According to an evaluation of 20 studies over the past 10 years, the prevalence rate of diabetics with major depression is three to four times greater than in the general population. While depression affects maybe three or five percent of the population at any given time, the rate is between 15 and twenty percent in patients with diabetes, according to the American Diabetic Association. Women, in particular are at greater risk, according to other studies.

Whether a cause or an effect, the combination of diabetes and depression can be deadly. "One plus one equals much more than two when you add diabetes and depression," says Patrick Lustman, PhD, professor of medical psychology in the department of psychiatry at Washington University School of Medicine in St Louis. "Because of physiologic and behavioral interactions between diabetes and depression, each becomes more difficult to control, increasing the risks of cardiovascular disease, diabetic retinopathy causing blindness, neuropathy and other complications."

Lustman also mentions obesity as a risk factor for macrovascular disease. Unfortunately, depressed people tend to eat more and exercise less, which results in weight gain and sabotages efforts at controlling blood sugar levels. One study found that depressed adults with diabetes had significantly higher body mass indexes than nondepressed adults with diabetes.

Another study found that depression in diabetics was a greater risk factor for heart disease than high blood sugar.

But if depression can trigger diabetes or make it much worse, it stands to reason that effectively managing one's depression can help bring one's diabetes under control. Patrick Lustman and his colleagues have tested that proposition in a number of studies:

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