Diabetes & Depression

Recent studies have linked clinical depression and common chronic conditions such as cardiovascular disease and diabetes. Depressed patients suffering from these chronic diseases usually have a worse outcome than those not depressed. This is due to the fact that the majority of depressed individuals are less likely to adhere to treatment recommendations and experience more medical complications, incurring a threefold higher health cost. Depression also can raise a person’s risk of developing type 2 diabetes by increasing insulin resistance via Hypothalamic Pituitary Adrenal Axis hyperactivity, or via sympathoadrenal hyperactivity.

Due to the strong association between depression and Type 2 diabetes, a leading cause of infertility and pregnancy complications, physicians need to identify patients who may be depressed. There are approximately 16 million Americans suffering from clinical depression, but only about half have been diagnosed and have received adequate treatment. Although depressed mood and loss of interest in activities once enjoyed are the primary symptoms of depression, they are not the only indicators. Physicians must be aware of other symptoms such as anger and frustration in men and lethargy in women. 

Physicians should conduct a diagnostic interview or use a validated screening tool if the patient exhibits any indication of depression. Counseling, especially cognitive behavioral therapy, has been proven to be highly effective. Medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) and related agents or Bupropion also can be beneficial since they have fewer side effects than other treatments for clinical depression. The patient should be warned, however, that any side effects will subside after a period of time, while the medication becomes more effective. This is why most physicians start patients at lower doses with these medications.

In the largest randomized clinical trial ever completed, ENRICHD, depressed patients experienced a significant improvement after receiving six months of weekly cognitive behavioral therapy.  Depression management has saved an average of $1,300 per patient per year in terms of higher work productivity and fewer missed work days, as compared to the usual care.

Physicians should also extend this diagnosis and treatment to patients experiencing chronic stress from infertility treatment. Although these stress levels may not cause them to suffer from clinical depression, the effects are similar. 

Date Posted: September 12, 2006