Features: Health & Fitness

The tangled web of diabetes and depression

by Robin Tierney

Does depression increase risk for developing diabetes? Does diabetes lead to, or aggravate, clinical depression? How can the vicious circle be broken?

New findings about links between diabetes and depression were addressed at both the American Diabetes Association (ADA) and National Mental Health Association (NMHA) conferences in DC in mid-June.

Chances are high that someone close to you has or will develop diabetes, a disease stemming from the body's inability to produce or properly use insulin, a hormone essential to regulating blood sugar. Consider these numbers from the ADA: Nearly 20.8 million Americans suffer from diabetes, and another 41 million have pre-diabetes, meaning above-normal blood glucose levels and likelihood of developing full-blown diabetes within 10 years.

Each day, 4,110 people are diagnosed with diabetes. One in three Americans born in 2000 will develop diabetes in their lifetime. And make that one in two for minority children.

Then there's the staggering financial impact. One out of every 10 health care dollars is spent on diabetes and its complications, averaging $132 billion annually (based on 2002 figures). Furthermore, diabetes can lead to blindness, stroke, and kidney and heart disease. No wonder it's the nation's fifth leading cause of death by disease.

A technical but important distinction: with Type 1 diabetes, autoimmune destruction of key pancreas cells impairs insulin production. In contrast, Type 2 diabetes--the most common form--involves the body's inability to use its own insulin. While more likely to affect people over 45 and overweight, Type 2 has increasingly been seen in children and teens in recent years.

Type 1 requires daily injections to regulate glucose. Those with Type 2 diabetes must control blood glucose levels through diet, exercise, weight control and sometimes medications.

During the ADA's 66th Scientific Sessions, researchers revealed new findings in three areas:

• depression as both a cause and a consequence of diabetes
• the effect of prescription anti-depressants on diabetes risk
• the profound impact of depression on diabetics' management of their disease

Using antidepressant drugs was linked to a much greater risk of developing Type 2 diabetes, according to Richard Rubin, PhD, associate professor of Medicine and Pediatrics at Johns Hopkins University School of Medicine in Baltimore. Risk of diabetes did not increase in study participants not taking antidepressants, suggesting that antidepressants predisposed people to diabetes.

While previous studies have linked antipsychotic drugs to diabetes, this is the first indication that antidepressant drugs could increase the risk of diabetes.

New research also suggests that people having both diabetes and depression must carefully manage their depression, or else they get neglectful about self-care, failing to eat right, exercise and control their weight.

So which comes first, depression or diabetes? This chicken vs. egg issue has long been debated.

Major 1990s studies showed that depressed people develop Type 2 diabetes at twice the rate of non-depressed people. Newly released research results indicate that concern over diabetes' health problems can lead to clinical depression.

It goes both ways, noted the diabetes researchers. Chronic stress and depression have been shown to cause hormonal changes, thus boosting risk for other diseases. A depression-linked condition called hypercortisolism may be the pathway. Johns Hopkins assistant professor of Medicine and Epidemiology Dr. Sherita Hill Golden, who spoke on "Cause or Consequence," described how recent findings supported a "bidirectional" theory: "It goes in both directions--diabetes can cause depression, and depression can cause diabetes."

What to do? Doctors should counsel diabetes patients about the importance of self-care and watch for the onset of depression symptoms.

With an estimated 10 percent of the population taking antidepressants--and use rising--these new research findings are important for physicians, mental health professionals, people with or at risk of diabetes or depression, and their family members, whose support is vital.

Over at the National Mental Health Association annual meeting on Capitol Hill, Dr. Tom Insel, director of the National Institute of Mental Health, emphasized the importance of involving the family - and that family psycho-social interaction must be part of any treatment plan.

Like diabetes, mental illness is one of the world's biggest public health epidemics, as shown by statistics for debilitating depression and suicide. NMHA estimates that 54 million people have mental disorders in the U.S. The association's current effort, "Campaign for America's Mental Health," aims to raise awareness about mental health and fight the stigma of mental illness.

Studies have shown that the most effective approved medications for psychological conditions are associated with the most weight gain, which translated to greater risk of developing Type 2 diabetes.

This doesn't mean to forgo pharmaceuticals, but rather, that medication be carefully decided by patient and doctor together. And by realizing the links between depression and diabetes, and the potential effects of various medications on mood, weight and other factors, we can help those close to us avoid getting tangled in a web of health complications.

For more information:
American Diabetes Association 1-800-DIABETES www.diabetes.org
National Mental Health Association 800-969-NMHA (6642) www.nmha.org