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Controlling Depression Can Help to Control Diabetes

Healthier lifestyle found to be result of symptom treatment.

Depression is prevalent in the diabetic population and has been linked to increased hyperglycemia, increased morbidity, and increased mortality. Each year there are over 8 million physician offices, hospital outpatient, and emergency departments with major depressive disorder as a primary diagnosis. It is a major issue in the United States. The treatments for the symptoms as well as for depression can lead to improvement in quality of life.

Depression is feeling blue or sad, which can interfere with daily life and be a burden on the patient and those around them. There are many symptoms of depression. To list a few:

  • feeling of depressed or sad mood
  • diminished interest in activities, which used to be pleasurable
  • weight gain or loss
  • psychomotor agitation or retardation
  • feeling of guilt
  • difficulty concentrating
  • recurrent suicidal thoughts

There are many causes of depression such as genetics, environmental factor, or psychological factors.

Those with depression tend to have parts of the brain that are involved in mood, thinking, sleep, appetite, and behavior that are different compared to those without depression. Though these are noticeable changes, an MRI image cannot be used to diagnose depression nor can it be used to reveal the cause of depression. Some depression tends to run in families and scientists are investigating certain genes that make an individual more prone to depression. However, while genetics do play a big part in depression, many would agree that it is the combination with environmental or other factors that would bring on depression. The loss of a loved one, trauma, difficult relationship, or any stressful situation may trigger a depressive episode in a patient. These are debilitating symptoms for a patient and can prevent them from taking proper care of themselves.

Unfortunately, depression is prevalent in the diabetic community. People with diabetes are more likely to be depressed and stressed than other individuals. These mental health problems are linked to increased risk of hyperglycemia and other complications. A recent study sought to determine if the use of antidepressant medication in patients with depression and type 2 diabetes is associated with improved glycemic control. The retrospective cohort study looked at 1,399 patients diagnosed with both depression and type 2 diabetes, and compared their glycemic control using their A1c levels. The study found that 50.9% of depressed patients who are on antidepressants have good glycemic control as compared to only 34.6% of depressed patients without antidepressants. After adjusting for covariates, the study found that those on antidepressants are twice as likely to attain their glycemic goals as compared to those not receiving antidepressants.

The authors of the study theorize that as depression improves, the patients are more likely to live a healthier lifestyle as well as become more adherent to their diabetes medications. Another plausible reason to the lower glycemic control could be the shift in stress hormones linked the use of antidepressant may affect blood glucose. However, the study was not able to conclude if treating depression leads to better glucose control or if glucose control leads to improving depression. Both scenarios are possible and both show that it is important to keep both depression and diabetes in check. By overcoming their depression, patients are more likely to adopt healthier lifestyle, which in turn helps them better control their diabetes. Healthcare providers should be wary if a diabetes patient is depressed so that their issue can be addressed and the patient can have both greater quality of life as well as great control in their diabetes.

Practice Pearls:

  • Depression is a major issue in the United States with over 8 million patients seeking healthcare with depression as primary diagnosis.
  • A new retrospective cohort study suggests that depressed type 2 patients are more likely to have normal glycemic control based on A1c levels compared to those not on antidepressants.
  • Healthcare providers should assess a patient for depression. By treating their depression, a patient can most likely also see better control in their glycemic control.

Brieler, Jay A., et al. “Antidepressant medication use and glycaemic control in co-morbid type 2 diabetes and depression.” Family practice (2016): cmv100..  Centers for Disease Control and Prevention. “Depression”. www.cdc.gov.  National Institute of Mental Health. “Depression”. www.nimh.nih.gov.

Researched and prepared by Jimmy Tran, Doctor of Pharmacy Candidate LECOM College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE