Depression is a complex mental illness that has genetic, environmental, and emotional causes. Depressive illness is a brain disorder. Brain imaging technologies such as magnetic resonance imaging (MRI) have shown that the brains of people with depression look different than people without depression. The parts of the brain involved in shaping mood, thinking, sleep, appetite, and behavior are different. But these data do not reveal the causes of depression. They also cannot be used to diagnose depression.
If you have type 1 or type 2 diabetes, then you have an increased risk of developing depression. And if you are depressed, you may be more likely to get type 2 diabetes.
A three-year study was conducted at the University of Washington (UW), which involved 4154 patients with type 2 diabetes. The results showed that subjects who had minor or severe depression along with type 2 diabetes had higher mortality rates than patients with type 2 diabetes only.
“Depression is a common disease among people with type 2 diabetes. This high prevalence can have dire consequences. And minor and severe depression in people with diabetes is closely associated with increased mortality. ”
The good news is that both diabetes and depression can be treated successfully, including if they coexist together. And effective control of one disease has a positive effect on another.
Symptoms and Signs of Depression
“It's so hard for me to get out of bed in the morning. I just dream of hiding under a blanket and not talking to anyone. I have lost a lot of weight lately. Nothing pleases me anymore. I do not want to communicate with people, I want to be alone with myself. I get tired all the time, I can’t fall asleep for a long time and don’t get enough sleep at night. But now I need to get to work, because I need to feed my family. I feel that nothing can be changed for the better, ”are typical thoughts of a person suffering from depression.
- Loss of interest in previously liked activities
- Cessation of communication with people, restriction of socialization
- Inability to concentrate
- Insomnia (difficulty falling asleep)
- Excessive guilt or worthlessness
- Loss of energy or fatigue
- Appetite changes
- Clear mental or physical slowness
- Thoughts of death or suicide
How are diabetes and depression related?
Depression usually occurs in diabetics in the same way as in ordinary people. Until now, there are no accurate studies on the effect of diabetes on the occurrence of depressive states, but it can be assumed that:
- Difficulties in managing diabetes can cause stress and lead to symptoms of depression. Diabetes management takes a lot of time, constant medication or insulin injections, frequent measurement of sugar through puncture of the fingertips, dietary restrictions - all this can provoke the development of a depressive state.
- Diabetes can cause complications and health problems that can trigger depression.
- Depression can lead to an improper attitude to your lifestyle, for example, to improper diet, restriction of physical activity, smoking and weight gain - all these omissions are risk factors for diabetes.
- Depression affects your ability to complete tasks, communicate, and think clearly. This may interfere with your ability to successfully control your diabetes.
How to cope with depression in the presence of diabetes?
- Development of a comprehensive program of self-control. Stop being afraid of your diabetes, better make an alliance with it and start controlling your disease. Make a diet, eat healthy food, start losing weight if you have problems with it. Monitor your blood sugar, if there are complications, take the prescribed treatment courses. Engage in physical activity, more are in the fresh air. Try to help other people, including those with diabetes. Knowing that you are in control of diabetes will greatly reduce your symptoms of depression.
- Psychotherapy and counseling of a psychologist. If necessary, take psychotherapy courses to combat depression. If possible, conduct personal conversations with a good psychologist. Cognitive-behavioral therapy courses are particularly useful, which, according to studies, have reduced subjects' depression and improved diabetes care.
- Admission of antidepressants (strictly prescribed by a doctor). Antidepressants can significantly improve your condition for depression, but you need to understand that they also have side effects. Diabetes patients are strictly forbidden to choose their own type of antidepressant and take it. These medicines should be prescribed by your doctor.
Types of antidepressants prescribed for depression in patients with diabetes
Other types of antidepressants are Selective Serotonin Reuptake Inhibitors (SSRIs) - they have much fewer side effects than a group of tricyclic antidepressants. Examples of this type of antidepressant: Lexapro (Cipralex), Prozac, Paxil and Zoloft (Sertraline). They work by blocking the reabsorption of serotonin in the brain.
Another type of antidepressant commonly used in the treatment of depression in patients with diabetes is Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSRIs). These drugs are also called dual-action antidepressants, they block the reabsorption of serotonin and norepinephrine. These antidepressants include: Effexor (Venlafaxine), Pristik (Desvenlafaxine), Duloxetine (Symbalta), Milnacipran (Ixel).
Studies have shown that tricyclic antidepressants and SSRIs increase the risk of developing diabetes. This effect is most pronounced when tricyclic antidepressants and SSRIs are taken together. The exact reasons why these medications increase the risk of developing diabetes are not yet clear. Weight gain is usually observed when taking tricyclic antidepressants, which can also be a factor in the development of diabetes.
Side Effects of Antidepressants
Common side effects of tricyclic antidepressants include:
- Blurred vision
- Dry mouth
- Weight gain
- Insomnia (difficulty falling asleep and maintaining sleep)
- Changes in sexual desires and sexual intercourse
- Muscle twitching (tremor)
- Increased heart rate
Common side effects of SSRI antidepressants are:
- Changes in sexual desires and sexual intercourse
Common side effects of SSRIs antidepressants:
- Nausea (in particular when taking Simbalta)
- Dry mouth
- Increased blood pressure (in cases of taking Effexor / Venlafaxine)
- Excessive sweating
- Changes in sexual desire.
Side effects of antidepressants conceived pass or become tolerant over time. To minimize side effects, your doctor may prescribe a small dose of the medicine and gradually increase it to the optimum.
Side effects also vary depending on the particular antidepressant used, not every drug causes all these side effects. Thus, they can help you choose the most suitable antidepressant for your body.
If you have diabetes, closely monitor the signs and symptoms of depression, such as a loss of interest in normal activities, a feeling of sadness or hopelessness, and also for unexplained physical problems, such as back pain or headaches.
If you think that depression has not passed you, be sure to consult a doctor, do not treat it yourself.
To eliminate these sensations, you should know 6 things:
1. Now is the 21st century, many people with diabetes, both types 1 and 2, live happily ever after. Complications of diabetes mellitus are not symptoms of the disease, so it’s not necessary that you develop them or, if any, progress sharply. If you are attentive to yourself and your diabetes, follow the recommendations of doctors, then you have very good chances that everything will be fine with you.
2. Diabetes is an important part of your life, but that does not mean that diabetes should manage your life.
3. You are not a bad person because you got diabetes. This is not your fault. And you will not become “bad” because you did not train enough today or ate more than you planned for dinner.
4. It is important to realistically evaluate your progress in diabetes control. You can never do everything perfectly to control your diabetes, but this is not necessary Measure your progress by results, for example, glycated hemoglobin, blood pressure and cholesterol, but not by daily events. Remember, the indicators of the meter should not determine your attitude and respect for yourself. Your meter may be important, but it doesn’t mean “bad” or “good.” These are only numbers, only information.
5. Make sure you have a specific feasible action plan. If you only have a vague feeling that you need to “exercise more” or “measure your blood glucose more often,” then you can never achieve a good result. To get started, choose one action that can have a positive effect on diabetes control. Be specific. For example, How much are you going to train this week? Namely, what are you going to do? When? How often? Divide it into periods, and set for each time intervals how much you can achieve each result. But evaluate your strength realistically. Only having a clear action plan in front of you can you achieve better results.
6. Try to get the support of family or friends in controlling your diabetes. Do not worry about everything yourself. Teach them, for example, the rules for stopping hypoglycemia, glucagon injection technique. Also try to attend diabetes schools and attend various educational programs for people with diabetes. You can come to them with people close to you.
In the first scientific work devoted to this issue, the author noted a clear connection between depression and diabetes. In his opinion, “grief and prolonged sadness” ultimately disrupted the patient’s carbohydrate metabolism and caused diabetes. The article was released several centuries ago, and all this time it was believed that a diabetes patient is depressed because of his problems and anxiety.
In 1988, it was hypothesized that depression may be accompanied by lower tissue susceptibility to pancreatic hormone insulin, which is important in the development of diabetes. Another author published the data of his study, during which he gave antidepressants to diabetic patients with diabetic neuropathy. It turned out that such treatment reduced both depression and pain caused by neuropathy.
Almost 10 years later, another work came out. This time, the author observed 1715 patients with diabetes for 13 years and concluded that with type 2 diabetes, the risk of depression is higher than in healthy people. His data began to be double-checked, a lot of interesting work was done that made it possible to establish: yes, indeed diabetes is often accompanied by depression.
Insulin sensitivity and cortisol
It only remained to find out the sheer smallness - why. Eight years ago, the results of a large meta-analysis were described in the literature (when they take a few scientific papers and look for general things in them). It turned out that patients with depression are at risk for carbohydrate metabolism disorders. And this violation was associated with a number of important points:
- A person who is depressed is characterized by a sedentary lifestyle, such patients smoke a lot, and some directly "jam" their troubles with sweets.
- It is shown that adrenal hormone cortisol and pro-inflammatory cytokines (substances that contribute to inflammation) are released during depression. These events may decrease the sensitivity of cells and tissues to insulin.
- Increasing cortisol levels contributes to obesity with the accumulation of major fatty deposits on the abdomen, and such obesity is already a risk factor for type 2 diabetes.
A diabetic patient, on the other hand, has many reasons to develop depression. Having been diagnosed with diabetes, patients have to start monitoring their blood glucose levels on their own, change their diet, drink drugs or insulin on time, increase physical activity, reduce weight, and at the same time regularly visit a doctor to monitor the progress of the disease. Some patients are seriously afraid of complications, including hypoglycemia. And all this taken together can easily end in depression. One of the authors working on this problem showed that depression is less common in patients with undiagnosed type 2 diabetes than in patients with a diagnosis.
Do diabetes complications make depression worse?
Even worse is the development of diabetes complications. Scientists have proven that damage to the eyes, kidneys, nervous system and large vessels in diabetes affects the formation of a depressive state. How exactly is this influence realized? Researchers suggest that slow inflammation and poor nutrition of the nerve tissue caused by cytokines reduce the flexibility and adaptability of the nervous system and can become a source of depression in the future. In addition, complications of diabetes are also associated with an increase in the level of the hormone cortisol, which, as we recall, can be released during depression.
Diabetes, Depression, and Stress in Diabetes Patients
Another theory has been developed that can combine depression with type 2 diabetes. The fact is that both of these conditions can be caused by stress. Various experts pointed out that the impaired carbohydrate metabolism is associated with mental injuries received when the patient was still a child (for example, with insufficient warmth in relations with parents). Stress can contribute to unhealthy behavior - smoking, alcohol abuse, unhealthy diets, and decreased activity in everyday life. In addition, under stress, the same cortisol is released, which causes obesity in the abdomen and tissue resistance to insulin. However, this theory does not explain why depression is equally common in patients with type 1 and type 2 diabetes.
Symptoms of Depression
- Depressed mood for most of the day.
- Lack of pleasure / interest in any type of activity for most of the day.
- Increase or decrease in appetite or weight.
- Sleep disturbance - excessive sleep or insomnia (lack of sleep).
- Psychomotor agitation - a feeling of anxiety or tension (for example, frequent wringing of hands, fidgeting, trembling of legs, nervous pacing, etc.) or psychomotor inhibition - slow movements, slow speech, and so on.
- Lack of energy, feeling tired.
- Feeling of worthlessness or guilt.
- Inability to concentrate.
- Repeated thoughts of death or suicide.
If most of these symptoms are present continuously for at least 2 weeks, the patient is diagnosed with depression.
The effect of depression on diabetes
With depression, a patient with diabetes is more difficult to achieve improvement and complications more often occur. The patient's quality of life and, in general, desire to be treated are reduced. Interestingly, a combination of both diseases leads to an increase in healthcare costs for treatment.
Thus, depression is often associated with diabetes. However, today a lowered mood in a diabetic patient is considered a normal response to the diagnosis of a chronic serious illness, and signs of depression are not given any significance. Methods for detecting depression in patients with diabetes mellitus and new, additional studies are needed, because, despite the abundance of publications on the relationship between depression and diabetes, many aspects of the process are still unclear.
Meanwhile, it is estimated that in children born today, the risk of diabetes during life exceeds 35%. Therefore, it is so important to find out how this disease is associated with depression, and to develop methods for treating patients with both pathologies.
Common Causes for Diabetes and Depression
Depression is the result of a deviation in the functioning of the brain. The relationship of negative emotional factors, such as sadness or grief, with the development of diabetes has long been identified. Diabetes can develop after a strong or moderate negative experience, although this is not always obvious because type 2 diabetes can often not be diagnosed for many years. Depression can also occur as a result of certain metabolic processes in the brain.
Psychosocial factors: The difficulties faced by people with low socioeconomic status, such as low levels of education, stressful life events, and a lack of social support, are risk factors for both depression and diabetes.
Poor fetal nutrition during maternal pregnancy: malnutrition of the mother during pregnancy can lead to impaired fetal development. This can lead to impaired glucose control or diabetes later in life. Similarly, low birth weight babies are at risk of developing depression during the onset of adulthood or in old age.
Genetics: research data suggests that among people whose close relatives have mental disorders, such as depression or psychosis, there is an increased incidence of diabetes.
Counter-regulatory hormones: high levels of stress lead to increased production of counter-regulatory hormones such as adrenaline, glucagon, glucocorticoids and growth hormones. These hormones do not allow insulin to maintain a normal glucose level, which leads to its increase in the blood.
The effects of depression and diabetes on each other
In patients with depression, it may be difficult to identify symptoms of diabetes. Due to their psycho-emotional state, they neglect their health. They may lack motivation or energy to take care of themselves. Depressed patients may have difficulty thinking and communicating. They become indecisive, suffer from sudden mood swings. It becomes difficult for them to perform simple tasks. Often they can ignore the appointment of doctors. They can overeat, gain weight, avoid physical exertion, can even start smoking, drinking alcohol or taking drugs. All this leads to poor control of diabetes symptoms.
As a result, patients are susceptible to microvascular complications, such as kidney problems, vision problems, and neuropathy.
It has also been found that people with depression and diabetes have an increased risk of developing cardiovascular complications, such as heart attacks, strokes, or poor blood circulation in their legs. These complications can make depression worse. For example, chronic pain is not only a risk factor for depression, but depression, on the other hand, can exacerbate chronic pain. Similarly, if a depressed patient has a heart attack or stroke with diabetes, rehabilitation is slower, which in turn can only aggravate depression.
Due to the exclusion of high-calorie processed foods with a high fat content from the diet, the formation of free radicals in the body is reduced. It has been proven that free radicals contribute to the development of depression. Thanks to a nutritious, balanced diet rich in antioxidants, depression can be minimized. A well-balanced diet also plays an important role in controlling blood glucose.
A full sleep allows the patient to feel rested and energetic. A positive emotional background reduces the desire to eat and helps stabilize blood sugar. Full sleep also helps minimize stress, which reduces the effects of counter-regulatory hormones, thereby lowering blood glucose levels.
Normalization of weight:
For overweight patients, regular exercise and a balanced diet help to reduce weight and increase insulin sensitivity, which allows better control of blood glucose levels. Studies have shown that targeted weight normalization also has a positive effect on patients with depression.