Mental Health

Diabetes and Mental Health: an introduction

Living with the challenges of a chronic disease such as diabetes can be emotionally challenging. It is no wonder that risk of developing depression and anxiety is greater in people with diabetes compared to those without diabetes. It may also be true that risk for development of diabetes is greater in a person with depression. Studies have shown that people with type 2 diabetes are approximately 25% more likely to be diagnosed with depression and anxiety, and 50% more likely to experience anxiety symptoms than their non-diabetic counterparts.1,2 Increased levels of stress have also been shown to significantly influence metabolism and have been linked to increased blood sugar levels and interventions to reduce stress have been shown to be effective in helping control elevated blood glucose. 3

In addition to being more prevalent in people with diabetes, mental health complications can have a significant negative effect on a person’s ability to control their blood glucose and take care of their health in general. So, if you have diabetes and also suffer from depression or anxiety, your emotional problem is actually making it more difficult for you get the diabetes care you need. The good news is that effective treatment for a psychiatric complication can make a difference. Studies have shown that effective treatment of depression in people with diabetes can help improve blood sugar control.4

Because people with diabetes face increased risk for emotional problems and these problems can negatively affect diabetes care, it is important to have tools that you can use to deal with these problems and the self awareness to know when you need help.

Emotional problems you may experience

People with diabetes tend to experience more stress, anxiety, and depression than other people and the first step in finding relief from these problems is recognizing them.

Anxiety. Anxiety typically happens in response to circumstances in life, such as living with the uncertainty and stress of having a chronic disease like diabetes. Different stressors, like financial uncertainty and worry about the future can trigger or worsen anxiety. There are a number of effective treatment options for dealing with anxiety. The first step is to bring your anxiety to the attention of your doctor. Your doctor can refer you to a healthcare professional trained to help.

Since anxiety typically occurs as a response to certain circumstances in life, treatment approaches that address those life circumstances may be particularly useful. These typically include psychotherapy, counseling, or stress reduction training. These interventions can help a person understand the source of anxiety and develop ways to handle anxious feelings.

In addition to these non-drug interventions, there are some medications that are effective in treating anxiety. These include some types of benzodiazepines, such as Valium (diazepam) and Xanax (alprazolam) and certain antidepressant medications, such as Zoloft (sertraline), Paxil (paroxetine), and Effexor (venlafaxine).

Stress. Stress affects most people, whether it has to do with work or difficult life situations. However, a person with a chronic disease like diabetes may live with more stress than others. There are many effective interventions that you can use to reduce stress in your life, including a regular exercise program, yoga, meditation and other relaxation techniques, and counseling. One effective way to acquire skills to help you reduce stress is to work directly with a professional trained in strategies for stress reduction.

Depression. Depression is common in people with diabetes. Since depression is a dangerous condition that can increase your risk for doing harm to yourself, it is important to be aware of the signs of depression so that it can be diagnosed and treated as quickly as possible. Diagnosing depression can be difficult and should be left to a professional. If you notice the symptoms of depression in yourself or a friend or family member, alert your doctor and ask for an evaluation. There is agreement among mental health experts that the best treatment for major depression is a combination of antidepressant medication and psychotherapy or counseling. While each type of treatment can provide some relief for depression, the combination works together and can be highly effective.

Major depression:

symptoms and diagnosis5

Definition
  • Typically involves mood states including grief and sadness
  • Key element that sets it apart from mood swings is that mood state persists over extended period of time
Diagnosis
  • At least 5 of the 9 symptoms below
  • Must include depressed mood or decreased interest
  • Symptoms must have persisted for most of every day for at least 2 weeks

Symptoms of Depression

  • Depressed mood (feeling blue, down-in-the-dumps, hopeless)
  • A significantly reduced level of interest or pleasure in most or all activities
  • Considerable weight loss or gain (5% or more change of weight in a month when not dieting) or change in appetite
  • Frequent thoughts of death or suicide (with or without a specific plan) or attempt of suicide
  • Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia)
  • Behavior that’s agitated or slowed down, which is readily observable by others
  • Feeling fatigued or very low energy
  • Having thoughts of worthlessness or extreme guilt
  • A diminished ability to think, concentrate, or make decisions

Your health provider can determine which antidepressant medication will be best for you. However, a variety of antidepressants have been used successfully to treat major depression. These include a group of antidepressants called tricyclics, such as Elavil (amitriptyline), Pamelor (nortriptyline), and Tofranil (imipramine), and another group of antidepressants called serotonergic antidepressants, including Zoloft (sertraline), Paxil (paroxetine), Effexor (venlafaxine), and Prozac (fluoxetine). Other types of antidepressants may also be useful, including Wellbutrin (bupropion HCl), Serzone (nefazodone), and Desyrel (trazodone). Some class of drugs sometimes used to treat Because different antidepressants cause slightly different kinds of side effects and no individual person will react the same to every medication, you will need to work with your healthcare provider to find the right antidepressant for you, based on how well it works and how well you tolerate it. It may take up to 6 weeks to find out how well a particular medication will work for you. So, work closely with your psychiatrist and be prepared to give the process time.

Antipsychotic drugs and risk of type 2 diabetes

One class of drugs called atypical antipsychotics, used to treat people with illnesses such as schizophrenia, can increase risk for developing type 2 diabetes. Atypical antipsychotics that may be associated with development of type 2 diabetes include clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Zeldox, Geodon).6

Written by: Jonathan Simmons | Last reviewed: May 2014.
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