Study: Diabetes a Depressing Diagnosis

June 18, 2008— -- Michael Weiss, 60, has had the misfortune of being diagnosed with two very difficult diseases in his lifetime -- colon cancer and diabetes.

Weiss was first diagnosed with type 1 diabetes at the age of 34. Since then, he has spent much time and energy trying to control his blood sugar levels.

"My diabetes treatment required matching prescribed levels of insulin to the foods that I'm eating, to the activity level I'm encountering, and also it requires constant monitoring and being in touch with your body," Weiss explained.

But when Weiss underwent treatment for colon cancer three years ago, he found the experience to be far less emotionally devastating.

"All I had to do was find the best health care professional I could and subject myself to his judgment and abilities. I just laid there," he said. "And I was lucky that my physician was right -- my cancer was cured.

"But no matter how hard or how long I struggle with my diabetes, nothing is going to cure it, and the burden is mine and mine alone."

Weiss, a former president of the American Diabetes Association, says he has been amazed at the number of diabetes patients he's encountered who have echoed his own opinion that battling diabetes took far more of an emotional toll than battling cancer.

"A very large majority of these [diabetes patients] would confess to me that they were angry that they had the illness thrust on them, that they were frightened about the unknown and also the possibility of complications, and that they were frustrated over the additional responsibility when sometimes -- despite their best efforts -- they don't achieve results they intended," Weiss explained.

"A lot of people I met with diabetes feel this anger, fear and frustration, and feel very much alone with their illness. I experienced the same feelings," he added.

These feelings of anger, fear and frustration do not seem to be uncommon among diabetes patients. And new research finds that people who are treated for type 2 diabetes appear to be more likely to have depressive symptoms.

Diabetes a Depressing Diagnosis

A study published in the Journal of the American Medical Association on Tuesday suggests that people who are treated for diabetes have a 52 percent increase in their risk for depression compared to those without diabetes. Moreover, the researchers did not find the same link between diabetes and depression for diabetes patients who were not treating their disease -- they found that these patients who are not treated for their diabetes are not more likely to have depressive symptoms.

"One of the reasons we did the study is many studies have shown an association between diabetes and depression, and we know that people with diabetes are about twice as likely to have depression," said lead study investigator Dr. Sherita Golden, chairperson of the Glucose Control Task Force and director of the Inpatient Diabetes Management Service at the Johns Hopkins School of Medicine.

The researchers from Johns Hopkins University wrote in their article that the stress of treating diabetes may trigger depression.

According to many diabetes experts, the link between diabetes treatment and depression is an understandable one.

"Patients with diabetes experience distress and a great many negative feelings at the time of diagnosis," said Martha Funnell, a nurse at the Michigan Diabetes Research and Training Center and the Juvenile Diabetes Research Foundation Center for the Study of the Complications in Diabetes. "These feelings remain prevalent over the years with diabetes, and the majority of health professionals never address these issues."

Type 2 diabetes is, by no means, an easy diagnosis to face. Treatment of the disease requires a lifelong commitment to blood-sugar monitoring, constant attention to lifestyle and eating habits, and sometimes even daily insulin injections.

Funnell added that the act of treating the diabetes forces patients to come face-to-face with the reality of living with a chronic, life-altering disease.

"Another factor is that untreated diabetes is easier to ignore or to consider 'no big deal,' but initiating treatment triggers the understanding that it is serious, results in horrible complications, will likely shorten their life spans, and that they will now have a chronic disease for the rest of their lives," Funnell explained.

But some experts say a more important predictor of depression is whether the patient develops one of the many complications, such as eye disease, erectile dysfunction, kidney disease or failure, nerve damage, or even heart disease or stroke.

"I think this most important limitation of this study ... is the lack of controls for diabetes complications," said Richard Rubin, professor of medicine and pediatrics at the Johns Hopkins University School of Medicine. Rubin added that, in one of his own studies, which was published in Diabetes Care in 1997, it was suggested that the development of one of these complications significantly increases a patient's risk for depression.

Diabetes, Depression Go Hand-in-Hand

While depression isn't commonly listed as a complication of diabetes, this study isn't the first to find that people struggling to keep their diabetes under control are often also struggling with depression.

The connection between diabetes and depression was first documented in the late 1600s by the English physician Thomas Willis, who said that "long-term sorrow" seemed to "generate" diabetes in some people.

A study published in the journal Diabetes Care in 2004 found that about 25 percent of diabetes patients suffer from a lifetime-long bout of serious depression. This prevalence rate is three times higher in the diabetes population than the general population.

Another study, published in Diabetes Care in 2000, also suggested that treatment of depression may improve a diabetes patient's control of blood sugar levels.

But experts still don't know which comes first -- the diabetes or the depression.

In a separate analysis of this study, doctors found that people with depression were slightly more likely to develop diabetes. However, many experts say this is probably because depressed people have less healthy lifestyle habits, and not because their depression is a direct trigger for diabetes.

Psychology experts say that it is very common for people who are diagnosed with a chronic disease such as diabetes to struggle with depression. Such individuals must relearn how to live their lives based on a complex system of dietary and medical interventions, and they are usually forced to alter their lifestyle, work, or school schedules.

But, in spite of all the physical and psychological stress that controlling one's blood sugar might cause, there are few outlets in the health care community for patients struggling with diabetes and depression to turn to.

"In my clinical practice, I see many [diabetes] patients with symptoms of depression, and I think part of the problem is that we don't have mental health professionals that are specifically trained to deal with depression in a setting of diabetes," Golden said. "We need more individuals trained in that area that can work in concert with diabetes experts and other professionals in the diabetes education arena, so that we can address the mental health issues that so many of these patients face."

Weiss said he has experienced this lack of resources firsthand.

"All the while I was going through cancer treatments, everyone involved in the process would always ask me, 'how do you feel?' and would ask my family how they felt, and whether they needed help or someone to talk to," he said. "In the diabetes world, that doesn't happen very often."

Unfortunately, many diabetes patients tend to agree with Weiss' assessment. Most diabetes patients spend an average of 10 minutes with their health care provider each visit, and find that support groups or other outlets for the emotional distress associated with their disease, are few and far between.

But, according to Kenneth Freedland, professor of psychiatry at Washington University School of Medicine in St. Louis, Mo., there is some hope and good news out there for diabetes patients struggling with depression.

"Fortunately, patients who experience depression in conjunction with medical illness usually develop a mild to moderate variety of depression, and it's very often amenable to treatment," Freedland explained. "So, as bad as it can be, and as many problems as it can create, there is help out there."