and less need for diabetes medications than conventional approaches to mission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13 …
Depression and
Symptoms of Depression
P Persistent sad, anxious, or empty mood P Feelings of hopelessness, pessimism P Feelings of guilt, worthlessness, helplessness P Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex P Decreased energy, fatigue, being slowed down P Difficulty concentrating, remembering, making decisions P Insomnia, early-morning awakening, or oversleeping P Appetite and/or weight changes P Thoughts of death or suicide or suicide attempts P Restlessness, irritability If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for depression
Diabetes
Depression can strike anyone, but people with diabetes, a serious disorder that afflicts an estimated 16 million Americans,1 may be at greater risk In addition, individuals with depression may be at greater risk for developing diabetes Treatment for depression helps people manage symptoms of both diseases, thus improving the quality of their lives
Several studies suggest that diabetes doubles the risk of depression compared to those without
the disorder2 The chances of becoming depressed increase as diabetes complications worsen Research shows that depression leads to poorer physical and mental functioning, so a person is less likely to follow a required diet or medication plan Treating depression with psychotherapy, medication, or a
For more information about depression and research on mental disorders, contact:
National Institute of Mental Health NIMH
Office of Communications and Public Liaison
Information Resources and Inquiries Branch
6001 Executive Blvd, Rm 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
Fax: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail: nimhinfo@nihgov
Web site: http://wwwnimhnihgov
NIMH Depression Publications Toll-free: 1-800-421-4211
combination of these treatments can improve a patients well-being and ability to manage diabetes Causes underlying the association between depression and diabetes are unclear Depression may develop because of stress but also may result from the metabolic effects of diabetes on the brain Studies suggest that people with diabetes who have a history of depression are more likely to develop diabetic complications
than those without depression People who suffer from both diabetes and depression tend to have higher health care costs in primary care3
Despite the enormous advances in brain research in the past 20 years, depression often goes undiagnosed and untreated People with diabetes, their families and friends, and even their physicians may not distinguish the symptoms of depression However, skilled health professionals will recognize these symptoms and inquire about their duration and severity, diagnose the disorder, and suggest appropriate treatment
bloodstream Insulin, a hormone produced by the pancreas, helps glucose get into cells and converts glucose to energy Without insulin, glucose builds up in the blood, and the body loses its main source of fuel In type 1 diabetes, the immune system destroys the insulin-producing beta cells of the pancreas This form of diabetes usually strikes children and young adults, who require daily or more frequent insulin injections or using an insulin pump for the rest of their lives Insulin treatment, however, is not a cure, nor can it reliably prevent the long-term complications of the disease Although scientists do not know what causes the immune
system to attack the cells, they believe that both genetic factors and environmental factors are involved Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States, occurs equally in males and females, and is more common in Caucasians Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue If not treated with insulin, a person can lapse into a life-threatening coma Type 2 diabetes, which accounts for about 90 percent of diabetes cases in the United States, is most common in adults over age 40 Affecting about 6 percent of the US population, this form of diabetes is strongly linked with obesity more than 80 percent of people with type 2 diabetes are overweight, inactivity, and a family history of diabetes It is more common in African Americans, Hispanic Americans, American Indians, and Asian and Pacific Islander Americans With the aging of Americans and the alarming increase in obesity in all ages and ethnic groups, the incidence of type 2 diabetes has also been rising nationwide
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and the ability to
function in everyday life Depression can occur at any age NIMH-sponsored studies estimate that 6 percent of 9to 17-year-olds in the US and almost 10 percent of American adults, or about 19 million people age 18 and older, experience some form of depression every year4,5 Although available therapies alleviate symptoms in over 80 percent of those treated, less than half of people with depression get the help they need5,6 Depression results from abnormal functioning of the brain The causes of depression are currently a matter of intense research An interaction between genetic predisposition and life history appear to determine a persons level of risk Episodes of depression may then be triggered by stress, difficult life events, side effects of medications, or other environmental factors Whatever its origins, depression can limit the energy needed to keep focused on treatment for other disorders, such as diabetes
Diabetes Facts
Diabetes is a disorder that impairs the way the body uses digested food for growth and energy Most of the food we eat is broken down into glucose, a form of sugar that provides the main source of fuel for the body After digestion, glucose passes into the
Type
2 diabetes is often part of a metabolic syndrome that includes obesity, high blood pressure, and high levels of blood lipids People with type 2 diabetes first develop insulin resistance, a disorder in which muscle, fat, and liver cells do not use insulin properly At first, the pancreas produces more insulin, but gradually its capacity to secrete insulin falters, and the timing of insulin secretion becomes abnormal After diabetes develops, insulin production continues to decline Symptoms include fatigue, nausea, frequent urination or infections, unusual thirst, weight loss, blurred vision, and slow healing of wounds or sores Some people have no symptoms at all Researchers estimate that about one-third of people with type 2 diabetes dont know they have it Many people with type 2 diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication However, the longer a person has type 2 diabetes, the more likely he or she will need insulin injections, either alone or together with oral medications Gestational diabetes develops during pregnancy Like type 2 diabetes, it occurs more often in African Americans,
American Indians, Hispanic Americans, and people with a family history of diabetes Though it usually disappears after delivery, the mother is at increased risk of getting type 2 diabetes later in life
must be monitored through frequent checking In recent years, research has led to better ways to manage type 2 diabetes and treat its complications with improved monitoring of blood glucose, new drugs, and weight control management Blood pressure drugs called ACE angiotensin-converting enzyme inhibitors help to prevent or delay heart and kidney disease People with diabetes try to keep blood 
glucose also called blood sugar from rising too high or falling too low When blood glucose levels drop too low from some medicines–a condition called hypoglycemia–a person can become nervous, shaky, and confused Judgment can be impaired, and if the level is low enough, a person can faint High levels of blood glucose, called hyperglycemia, cause tissue damage and lead to debilitating complications Associated with acute long-term complications, the disease can lead to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage Uncontrolled diabetes can
complicate pregnancy Because a large part of the population is aging and Americans are increasingly overweight and sedentary, the prevalence of diabetes is predicted to increase Researchers continue to search for the causes of diabetes and ways to prevent and cure the disorder Scientists are looking for genes that contribute to the different forms of diabetes, are testing new drugs, and are using bioengineering techniques to try to create artificial beta cells that secrete insulin
Managing Diabetes
Research has shown that tight glucose control is the best way to prevent serious complications of diabetes, so the goal of diabetes management is to keep blood glucose levels as close to the normal range as possible Healthy eating, physical activity, insulin injections, or using an insulin pump are basic therapies for type 1 diabetes Blood glucose levels
Get Treatment for Depression
While there are many different treatments for depression, they must be carefully chosen by a trained professional based on the circumstances of the person and family Prescription antidepressant medications are generally well-tolerated and safe for people with diabetes Specific types of psychotherapy, or
talk
therapy, also can relieve depression However, recovery from depression takes time Antidepressant medications can take several weeks to work and may need to be combined with ongoing psychotherapy Not everyone responds to treatment in the same way Prescriptions and dosing may need to be adjusted In people who have diabetes and depression, scientists report that psychotherapy and antidepressant medications have positive effects on both mood and blood sugar control2 Additional trials will help us better understand the links between depression and diabetes and the behavioral and physiologic mechanisms by which improvement in depression fosters better adherence to diabetes treatment and healthier lives Treatment for depression in the context of diabetes should be managed by a mental health professional–for example, a psychiatrist, psychologist, or clinical social worker–who is in close communication with the physician providing the diabetes care This is especially important when antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided In some cases, a mental health professional that specializes in treating individuals with
depression and co-occurring physical illnesses such as diabetes may be available People with diabetes who develop depression, as well as people in treatment for depression who subsequently develop diabetes, should make sure to tell any physician they visit about the full range of medications they are taking Use of herbal supplements of any kind should be discussed with a physician before they are tried Recently, scientists have discovered that St Johns wort, an herbal remedy sold over-the-counter and promoted as a treatment for mild depression, can have harmful interactions with some other
medications See the alert on the NIMH Web site: http://wwwnimhnihgov/events/stjohnwortcfm Other mental disorders, such as bipolar disorder manic-depressive illness and anxiety disorders, may occur in people with diabetes, and they too can be effectively treated For more information about these and other mental illnesses, contact NIMH Remember, depression is a treatable disorder of the brain Depression can be treated in addition to whatever other illnesses a person might have, including diabetes If you think you may be depressed or know someone who is, dont lose hope Seek help for depression
For
more information about diabetes, contact:
National Institute of Diabetes and Digestive and Kidney Diseases NIDDK Office of Communications and Public Liaison 31 Center Drive, Room 9A04, MSC 2560 Bethesda, MD 20892-2560 Phone: 301-496-3583 E-mail: NIDDK_Inquiries@nihgov Web site: http://wwwniddknihgov
References
Diabetes statistics NIH Pub No 99-3892 Bethesda,
MD: National Institute of Diabetes and Digestive and
Kidney Diseases, March 1999
Anderson RJ, Lustman PJ, Clouse RE, et al
Prevalence of depression in adults with diabetes: a
systematic review Diabetes, 2000; 49Suppl 1: A64
Ciechanowski PS, Katon WJ, Russo JE Depression
and diabetes: impact of depressive symptoms on
adherence, function, and costs Archives of Internal
Medicine, 2000; 16021: 3278-85
3 2 1
4
Regier DA, Narrow WE, Rae DS, et al The de facto
mental and addictive disorders service system Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services Archives of General Psychiatry, 1993; 502: 85-94
5
Shaffer D, Fisher P, Dulcan MK, et al The NIMH
Diagnostic Interview Schedule for Children Version 23 DISC-23: description, acceptability, prevalence rates, and performance
in the MECA Study Methods for the Epidemiology of Child and Adolescent Mental Disorders Study Journal of the American Academy of Child and Adolescent Psychiatry, 1996; 357: 865-77
6
National Advisory Mental Health Council Health
care reform for Americans with severe mental illnesses American Journal of Psychiatry, 1993; 15010: 1447-65
_______________________
All material in this fact sheet is in the public domain and
may be copied or reproduced without permission from the
NIMH Citation of NIMH as the source is appreciated
National Institutes of Health US Department of Health and Human Services
NIH Publication No 02-5003 May 2002
This is the electronic version of a National Institute of Mental Health NIMH publication, available from http://wwwnimhnihgov/publicat/indexcfm To order a print copy, call the NIMH Information Center at 301-443-4513 or 1-866-615-6464 toll-free Visit the NIMH Web site http://wwwnimhnihgov for information that supplements this publication To learn more about NIMH programs and publications, contact the following: Web address: http://wwwnimhnihgov Phone numbers: 301-443-4513 local 1-866-615-6464 toll-free 301-443-3431 TTY Street address: National
Institute of Mental Health Office of Communications Room 8184, MSC 9663 6001 Executive Boulevard Bethesda, Maryland 20892-9663 USA E-mail: nimhinfo@nihgov Fax numbers: 301-443-4279 301-443-5158 FAX 4U
__________________________________________________________________________
This information is in the public domain and can be copied or reproduced without permission from NIMH To reference this material, we suggest the following format: National Institute of Mental Health Title Bethesda MD: National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services; Year of Publication/Printing [Date of Update/Revision; Date of Citation] Extent NIH Publication No XXX XXXX Availability A specific example is: National Institute of Mental Health Childhood-Onset Schizophrenia: An Update from the National Institute of Mental Health Bethesda MD: National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services; 2003 [cited 2004 February 24] NIH Publication Number: NIH 5124 4 pages Available from: http://wwwnimhnihgov/publicat/schizkidscfm
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