Managing Depression in Diabetes Limits Problems
An antidepressant medication may reduce the risk of recurrent depression in persons with diabetes, says a report in the Archives of General Psychiatry.
"That's important not only because people with diabetes will feel better if we can control their depression," says Patrick J. Lustman, Ph.D., an expert at Washington University School of Medicine in St. Louis.
Dr. Lustman says it may increase the length of time between depressive episodes as well.
"It is also key to helping manage blood sugar," he notes. " As depression improves, glucose levels also tend to improve."
Although depression affects about 5 percent of the general population, the rate is about 25 percent for patients with diabetes.
Dr. Lustman's team has shown before that treatment with antidepressant medications and psychotherapy is an effective way to treat depression in patients with diabetes, but often depression would quickly redevelop.
"As we better understand depression, it's clear that for many patients, it is a chronic and recurring disease," Dr. Lustman says. "That appears to be especially true for patients with diabetes compared to those otherwise free of medical illness."
Although the researchers knew that short-term treatment with antidepressants was helpful with mood and with control of blood glucose, Dr. Lustman's team did not know whether the medication could prevent the recurrence of depression in patients with diabetes.
He also did not know what would happen to glucose levels in the months following successful depression therapy.
The research team studied 152 patients with diabetes. The sample included patients with type 1 diabetes and patients with type 2 diabetes.
The age of the study participants averaged just over 50 years, and all had recovered from an episode of depression following treatment with sertraline (Zoloft®).
After their depression was under control, half of the study patients continued to take sertraline while the other half took a placebo (inactive substance). Patients were followed for up to a year or until their depression recurred.
During that time, blood glucose levels were measured to keep track of hemoglobin A1C, which reflects an individual's control of blood glucose over two to three months.
At one year, more than 65 percent of those still taking sertraline remained in remission from their depression. Only about 48 percent of those taking placebo were still in remission.
On average, those who continued to take sertraline stayed free of depression four times longer than those who did not continue to take medication.
Blood glucose levels remained lower in both groups of patients, as long as depression remained under control.
"We now know that controlling depression, by whatever method - whether with exercise, activity, cognitive therapy, or medication - improves the likelihood that blood glucose will be better controlled,” remarks Dr. Lustman.
“That's the key to preventing the complications of diabetes, such as eye disease, neuropathy [a nerve disorder which may cause problems throughout the body], and kidney disease," he says.
Always consult your physician for more information.
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Diabetes is a metabolic disorder characterized by a failure to secrete enough insulin, or, in some cases, the cells do not respond appropriately to the insulin that is produced.
Because insulin is needed by the body to convert glucose into energy, these failures result in abnormally high levels of glucose accumulating in the blood.
Diabetes may be a result of other conditions such as genetic syndromes, chemicals, drugs, malnutrition, infections, viruses, or other illnesses.
The three main types of diabetes - type 1, type 2, and gestational - are all defined as metabolic disorders that affect the way the body metabolizes, or uses, digested food to make glucose, the main source of fuel for the body.
In prediabetes, blood glucose levels are higher than normal but not high enough to be defined as diabetes.
However, many people with prediabetes develop type 2 diabetes within 10 years, states the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Prediabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes.
For glucose to be able to move into the cells of the body, the hormone insulin must be present. Insulin is produced primarily in the pancreas, and, normally, is readily available to move glucose into the cells.
However, in persons with diabetes, either the pancreas produces too little or no insulin, or the cells do not respond to the insulin that is produced.
This causes a build-up of glucose in the blood, which passes into the urine where it is eventually eliminated, leaving the body without its main source of fuel.
Although the three main types of diabetes are similar in the build-up of blood glucose due to problems with insulin, there are differences in cause and treatment:
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Type 1 diabetes - an autoimmune disease in which the body's immune system destroys the cells in the pancreas that produce insulin, resulting in no or a low amount of insulin. People with type 1 diabetes must take insulin daily in order to live.
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Type 2 diabetes - results from the body's inability to make enough, or to properly use, insulin. Type 2 diabetes may be controlled with diet, exercise, and weight loss, or may require oral medications and/or insulin injections.
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Gestational diabetes - occurs in pregnant women who have not been diagnosed with diabetes in the past. It results in the inability to use the insulin that is present and usually disappears after delivery. Gestational diabetes may be controlled with diet, exercise, and attention to weight gain. Women with gestational diabetes may be at higher risk for type 2 diabetes later in life.
Always consult your physician for more information.
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