Depression is a highly disabling disorder, in fact so much so that the World Health Organization has predicted that by the year 2020, it will be the disease that causes the most worldwide disability. Depression consists of a persistent sad or 'empty' mood, feelings of guilt, helplessness and worthlessness, restlessness and irritability, fatigue, and sleep and weight disturbances. As well as being a commonly diagnosed disorder itself, there is a high incidence of it occurring in conjunction with other illnesses and mental disorders.
It is a known fact that people with chronic, life-threatening diseases are more at risk of developing depression, so it is not surprising that studies which were presented at a recent meeting of the American Diabetes Association suggested that people with diabetes suffer from depression more often than non-diabetics. What was surprising is that some of the studies suggest that depression may in fact cause the disease.
The studies found that approximately 21 to 24% of diabetics had a history of at least one episode of depression prior to their diagnosis of diabetes compared to a rate of about 10% in the general population. These results support the theory that depression causes diabetes and researchers suggest that hormonal changes during depression may play a role. However these changes, along with other factors known to raise the risk of diabetes, need further study.
What is known, though, is that patients who are depressed experience greater distress, more impaired functioning, and less ability to comply with medical regimens, which in the case of diabetics would imply less ability to control their blood sugar levels. It is also a commonly accepted fact that the more severe the medical condition, the more likely the person is to develop clinical depression. This has led to many people assuming that feelings of depression are common or even normal for people struggling with serious health conditions, but this is not true.
It is important that both patients and health professionals recognize the possibility of depression co-occurring with the other illness, as then a treatment plan can be formulated, in which both the conditions are treated. This can improve the psychological condition of the patient, enhance their quality of life, improve compliance with medications, and reduce suffering.
Part of the treatment plan will include being educated about depression and how you can work to improve it. It may also include medication and/or psychotherapy. Often taking part in a self-help group is encouraged, where it is possible to talk to people who share the same types of problems. The Depression and Anxiety Support Group offers more information about depression, telephone counselling by trained counsellors, and referrals to appropriate mental health professionals and to various support groups throughout South Africa. They can be contacted, Monday to Friday, between 8am and 7pm, and on Saturdays, between 8am and 5pm, on (011) 783-1474/6. According to the American National Mental Health Association, treatment by medication, psychotherapy, or a combination of both is successful in more than 80% of people with depression.
Studies done with other illnesses have shown that patients who get help for their co-occurring depression experience improvement in their overall medical condition, although more research is needed to determine if successful treatment of the depression will improve blood sugar control and, in turn, the long-term course of diabetes.
The good news, though, is that there is evidence that getting blood glucose levels under control leads to improvements in both physical and mental well-being, general health, vitality and overall quality of life.
Whether depression is a cause or an effect of diabetes, it is essential that it is recognized and treated along with the diabetes. It could mean the difference between a return to full functioning and permanent disability.