Depression is a preventable side effect

USA Today (Society for the Advancement of Education), Oct, 1996

Five years after finding out the had non-insulin dependent diabetes, Warren discovered a distributing pattern. "I've been trying to ignore it, but the correlation is just too strong," he told a friend. "When my blood glucose level gets too high, I get depressed." His doctor had cautioned him about the many complications of diabetes, but depression wasn't on the list. Warren, then in his mid 30s, already had experienced "fairly regular bouts of depression" for a couple of years before he was diagnosed. He wondered if surging levels of glucose also had been responsible for those pre-diagnosis emotional lows.

Talking with other diabetics, Warren found that depression was a common experience. Daily exercise seemed to keep his blues at bay and his glucose level near normal, but he was concerned about his treatment options if he became severely depressed.

"It's a good idea for diabetics to monitor their feelings as well as blood glucose," suggests Linda Rhodes, assistant professor or psychiatry at The University of Texas Health Science Center at San Antonio. "People with diabetes should become aware of signs of depression [lingering sadness, withdrawal from friends and family, excessive guilt, etc.] and discuss any emotional problems with their doctors.

"Diabetics go to the eye doctor, the heart doctor, the foot doctor. If they're depressed, they figure there's one more thing wrong with them and hope it'll go away. But emotional problems don't always go away. Like physical complications, they may get worse if not addressed promptly. When you're depressed, you have little energy and things hurt more. You just don't feel well and blood glucose control suffers, resulting in an endless destructive cycle of depression and physical complications."

"Feeling fatigued, lethargic, and even depressed are common presenting signs of diabetes," explains Ralph DeFronzo, chief of the diabetes division and deputy director of the Texas Diabetes Institute in San Antonio. "People with high blood glucose levels don't feel like dragging [themselves] out of bed in the morning. They don't feel well, but they don't know what's wrong. When we get these patients on treatment (diet, exercise, medication) and bring their blood glucose levels down, we often see a major change in disposition."

Some studies indicate depressed people with diabetes have worse blood glucose control than diabetics who aren't depressive. Researches also have found that stress affects diabetes and can cause a person's blood glucose to fluctuate, but they don't know why. the jury's still out on the relationship between mental stress and blood glucose levels, DeFronzo says. "For reasons we don't understood, mental stress affects people differently. The over-all effect isn't uniform."

"Having diabetes is a drain physically, emotionally, and financially [the cost of monitoring, medication, and medical checkups]," notes Julie Meyer, a diabetes clinical nurse specialist. "A question on our clinic survey asked patients if they were depressed about having diabetes. More than a few burst into tears and opened up about their feelings of helplessness and sadness." She found two groups of diabetics particularly prone to severe depression - young people facing life transitions and middle-aged, Mexican-American women who are accustomed to putting family first. She has seen more than a few patients depressed to the point of contemplating suicide, she indicates.

Focusing on present good health, keeping a positive outlook, staying active, and joining support groups can help diabetics dodge depression or decrease its demoralizing effects. Exercise can keep mild depression in check. It improves self-image and physical health, increases endorphins (mood-enhancing chemicals in the brain), and lowers blood glucose. counseling and medication are successful, too. Serotonin re-uptake inhibitors (such as Prozac, Zoloft, and Paxil) are good antidepressant choices for diabetics with depression, according to physicians, because these medications have few side effects and drug interactions and may minimally affect blood glucose levels. Persistent depression that does not go away should be evaluated, not accepted as an untreatable part of diabetes, Rhodes maintains.