Diabetes + Depression = Increased Risk of Death, Review Finds

Can depression lead to death in people with diabetes? According to new research depression causes people with diabetes to follow a cycle of hopelessness, poor self care and increased risk of other health conditions. This in turn leads to increased mortality. This study urges integrative care to address the depression in individuals with diabetes.

Feb. 21, 2013 — People living with diabetes who also have untreated depression are at increased risk of death, according to a new evidence review in General Hospital Psychiatry.

 More than 42,000 patients with type 1 or type 2 diabetes and depression were analyzed in the review. The reviewers discovered that depression was associated with a 1.5 fold increase in the risk of dying. In four of the studies reviewed, co-morbid depression was linked to about a 20 percent higher risk of cardiovascular death for people with diabetes.

Diabetes affects 25.8 million people in the U.S., according to the 2011 National Diabetes Fact Sheet, and about 30 percent of these people also experience symptoms of depression.

"Depression consistently increased the risk of mortality across virtually all studies," said Mijung Park, Ph.D., lead author and assistant professor at the University of Pittsburgh School of Nursing. "We can now postulate that the harmful effect of depression is universal to individuals with diabetes."

Todd Brown, M.D., associate professor of medicine and epidemiology at Johns Hopkins University in Baltimore, said it is very common to see a patient go into a downward spiral when obesity-related co-morbidities, such as diabetes, high blood pressure, obesity and depression converge.

"Obesity can lead to worsening metabolic status that can lead to hopelessness and decreased physical activity, which in turns worsens obesity, and the cycle continues," he explained.

The encouraging news is that depression is a highly treatable condition, said Park. Because depression can make diabetes self-care more difficult and lessen quality of life, she suggested that depression treatment should be included in overall diabetes care strategies.

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The above story is based on materials provided by Health Behavior News Service, part of the Center for Advancing Health.

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How Are Diabetes And Mental Health Connected?

I am quoted in a discussion of how Diabetes impact mental health and ways to cope. By Rheyanne Weaver |

Diabetes is a growing health condition that affects 25.8 million people of all ages in the United States, according to 2010 statistics from the Centers for Disease Control and Prevention website.

These most recent statistics also state that 8.3 percent of the U.S. population has diabetes. While the number of people with diabetes increases, there are not only concerns for how diabetes impacts physical health but also mental health.

The American Diabetes Association website suggests that some people living with diabetes can experience some mental health issues due to having diabetes. These can include anger toward having a diagnosis in the first place, denial toward the diagnosis, and in more severe cases depression can result.

Living with diabetes can be stressful as well, according to the American Psychological Association website. For example, people with diabetes might stress over their eating options at restaurants, so it’s important to develop coping methods for stress and to make sure to plan ahead for some situation.

People with diabetes can also learn to recognize negative feelings they have toward diabetes, and then learn how they can treat their diabetes. Mental health professionals can help people with diabetes develop intervention and treatment plans, and they can help with coping strategies.

The American Psychological Association website also stated that according to different studies, diabetes can lead to mental health issues like depression and slow mental processing. People with depression may also in general be more prone to type 2 diabetes.

The website emphasizes that a very small percentage of people who are diagnosed with diabetes actually follow a treatment plan involving changes in diet, exercise and taking medication, suggesting that people with diabetes are having issues with lifestyle changes.

Another study found that people who did work with a mental health professional on behavior change along with making lifestyle changes decreased their chances of getting diabetes.

Some experts share even more information about the link between diabetes and mental health.

Sujatha Ramakrishna, a clinical psychiatrist, said in an email that people with mental illnesses can be more prone to diabetes and other health problems because they are more likely to make unhealthy choices related to overall health, such as poor eating and exercise habits.

People with mental illnesses who take medication can also unknowingly increase their risk of getting diabetes.

“Antipsychotic medications, also known as mood stabilizers, are associated with an increased risk of diabetes,” Ramakrishna said. “It's recommended that patients who take these medications have their weight and blood sugar levels checked regularly by their physician. Other psychotropic medications, including SSRIs such as Prozac, can also cause weight gain, which in turn increases the chance that patients might develop diabetes.”

Nerina Garcia-Arcement, a licensed clinical psychologist and a clinical assistant professor at the NYU School of Medicine, said in an email that there are many mental health issues to consider that are connected to diabetes.

“If someone has diabetes, this impacts and limits their physical abilities and diet,” Garcia-Arcement said. “This often leads to people experiencing sadness, anxiety, frustration and loss. If there are [amputations] due to complications from the diabetes, this often negatively impacts mental health.”

There are also many contributing factors related to diabetes that can lead to depression.

“The stress related to managing a chronic illness, plus fear/worry about a negative prognosis are excellent causes for depression,” Garcia-Arcement added.

Taking diabetes medication can lead to mental health issues indirectly, in addition to psychiatric medication leading to diabetes in some cases.

“Having to monitor sugar levels and take insulin is stressful, limiting of everyday activities and can lead to worry, stress, anxiety and sadness,” Garcia-Arcement said.

In general, especially if you have a mental illness, it’s beneficial to talk to a mental health professional so they can help with motivation, behavior changes and understanding the link between mood and health so you can maintain good health, she said.

“Research has shown that people with mental illness have shorter life spans, often because they neglect their health,” Garcia-Arcement said.

“For example, if you are depressed, you are less motivated to engage in pleasurable activities, get out and socialize, eat healthy ... and exercise. Many don't take their medication as prescribed, often forget doctor’s appointments, or don't have the motivation to make appointments and keep them. This in turn worsens their diabetes. As they get sicker, they often get more anxious and depressed.”

Elizabeth Mwanga, who was diagnosed in 2007 with type 1.5 diabetes (latent autoimmune diabetes), used to be morbidly obese and was close to death due to her diabetes. However, she made major changes in her eating and fitness routines, and since 2009 she hasn’t needed to take medication for diabetes and has even kept off the 100 pounds that she lost.

She definitely sees a connection between mental health and diabetes, especially because many diabetics have high and low blood sugar levels that tend to affect mood.

“Blood sugar lows and highs can cause mood swings, which can be very disruptive,” Mwanga said in an email.

She said low blood sugar levels can lead to anger and minimal energy, and sometimes hallucinations and delirium. With high blood sugar levels, depression and mood swings can be a result.

“Diabetes requires 24/7 self-care management,” Mwanga said. “Sometimes this can be frustrating, overwhelming and depressing.”

“Food and fitness is linked to better physical health and diabetes management, which in turn effects mental health,” Mwanga added.

“I find myself feeling a lot more energetic and happier when I eat a diet full of fresh fruit and vegetables. I have also begun doing research on foods that raise serotonin levels. For example, I drink green tea (for the energy boost/antioxidants) during the day, and chamomile at night (for the calming effect, also full of antioxidants and anti-inflammatory properties). I eat whole raw almonds a lot, and lean turkey.

All of these foods are low GI ([low] glycemic foods are best for diabetics) and studies have shown that all aid to the process of serotonin.”

There is never a better time to make health your priority. Proper exercise, healthy diet and sleep routines are all key to the best overall health, and at least paying special attention to these areas of life will most likely decrease your risk of developing diabetes, other physical and mental health issues.

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