Depression Diabetes Potentially Lethal Combination
Let’s get right to the heart of the matter. There are three things you absolutely must know and, more important, believe, about depression.
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IT IS A REAL DISEASE.
Depression is not a prolonged period of moodiness, or a downbeat reaction to the world around you, or a perpetually negative disposition. It’s a formal disease. Meaning there is a physical component (out-of-balance brain chemicals, a set of common symptoms, a way to diagnose it, and a way to cure it.
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DIABETES AND DEPRESSION ARE LINKED.
Having one significantly increases your likelihood of developing the other, according to a study in the Archives of Internal Medicine. The link goes in both directions. People diagnosed with depression have a greater risk of getting type 2 diabetes, and if you have diabetes, your chances of having clinical depression are more than double those of people of the same age and general condition who don’t have diabetes.
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IF YOU HAVE DIABETES, YOU ARE DEFINITELY AT RISK.
In one recent overseas study, fully one-third of patients attending diabetes clinics met the criteria for having depression. Yet few were diagnosed or getting care for the condition. While there hasn’t been a parallel study done in the United States, some estimates put the rate of depression among people with diabetes at over 20 percent.
Why does this matter? Because depression is far more serious than just a few days or weeks of feeling down. Not only does it make your life so much less than it can be, depression also raises your risk of other chronic conditions, including heart disease, pain, and obesity. And depression has a ripple effect, making life harder for those you love and those around you.
Most cases of depression go undiagnosed, yet it is one of the most treatable mental health conditions. The keys to it all? Patience and persistence. Just as it takes time to arrive at the right mix of medications and lifestyle adjustments to best manage your diabetes, it will take time for you and your doctor to find the right combination of treatments for your depression. Expect to feel like your old, depression-free self again, and be sure to tell your doctor if you don’t. It’s worth the effort, and the collaboration. Trying to work out depression on your own can be dangerous, and it’s not necessary. Your doctor can help.
While everyone will have occasional days when they feel so wiped out that they won’t have the energy to make a healthy salad for lunch or get out and walk, you should know when your symptoms mean something more serious. If you’ve been experiencing five or more of the following signs and symptoms for two weeks or longer, you could be clinically depressed and should see a doctor or qualified mental health professional for evaluation and help.
- You feel persistently sad or anxious.
- Your sleep patterns have changed (wanting to sleep all the time or not being able to fall or stay asleep.
- You’re experiencing a loss of appetite and weight loss or an increase in appetite and weight gain.
- You have lost your pleasure and interest in previously enjoyable activities.
- You are frequently restless or irritable.
- You have difficulty concentrating, remembering, or making decisions.
- You feel constantly fatigued or drained of energy.
- You constantly feel guilty, hopeless, or worthless.
- You are thinking about suicide or death.
While building resiliency may help you lower your risk for depression, it’s important to watch out for signs of depression, understand when it’s time to seek help, and know what you can do on your own. Self-care strategies can be helpful, but don’t substitute them for regular visits with your doctor.
Busting the Blues
Fortunately, many approaches can lift your mood. The trick is to find the ones that work for you. You’d be a rare person if you tried just one of these strategies and it worked—for most people, a sustained combination approach will be the most successful. And as with any chronic illness, don’t expect overnight miracles. It will take a few weeks, perhaps even months of diligence before you begin feeling well again. Don’t think that if one or two approaches don’t work that you’re doomed to suffer with depression. If after several weeks of diligence, whatever you’re trying isn’t working, talk to your doctor and try something else. Most likely, he or she will tap into a combination of these eight approaches.
Mindfulness classes. Mindfulness-Based Stress Reduction (MSBR) is a structured, eight-week long program that combines aspects of meditation and yoga. It began back in 1979, and was developed by Jon Kabat-Zinn, PhD at the University of Massachusetts Medical Center in Boston. In a 2007 study conducted at the Jefferson Medical College of Thomas Jefferson University in Philadelphia, researchers studied a small group of people with type 2 diabetes, and discovered that taking an MSBR course decreased their feelings of depression, anxiety, and distress. What’s more, the course actually improved their A1C levels and their blood pressure. Scores of studies have attested to the practices promise for reducing depression and its ability to improve well-being. Leading medical centers around the world now offer the program. To learn more and find a program near you, visit http://w3.umassmed.edu/MBSR/public/searchmember.aspx.
Therapy. A well-trained, experienced therapist listens incredibly well, and is full of insights, compassion, and wisdom that truly can help you change your outlook on life, and how you react to its challenges. Look for a therapist who practices cognitive behavioral therapy or interpersonal therapy, in which you learn to cope better with stress, improve your interactions with others, and deal with the effects of depression. Studies find these two forms work best. If after three months, your mental state remains unchanged, you may need to see a psychiatrist who can offer talk therapy and I prescribe appropriate antidepressants.
Workouts. The same endorphin that contribute to “runner’s high” can provide natural relief for depression, and help prevent a relapse, if you can just manage to get yourself off the couch. In one study that pitted brisk walking or jogging against sertraline (Zoloft) or a combination of the drug plus the exercise, after 16 weeks all three groups had about the same improvement, but at six months, the people who kept up the exercise had the lowest rates of recurring sadness. Just 50 minutes of exercise a week reduced the risk of relapse by 50 percent. It doesn’t seem to matter what form of exercise you do: Aerobics, strength training, and flexibility exercises like yoga all seem to provide similar benefits.
St. John’s wort. This wild yellow flowering plant (Hypericum perforatum) has been used as a mood-enhancing medicine for centuries, especially in Europe. And under the spotlight of modern science, it is holding up fairly well. St. John’s wort has been shown in studies to be as much as 71 percent more effective than placebos for treating mild to moderate depression. Trials comparing St. John’s wort to antidepressants found they both worked about the same, although patients were less likely to drop out of the trials if they took the herb, because it had fewer side effects. Note that the herb has not been proven effective for what doctors call major depression.
SAM-e. SAM-e is short for S-adenosyl methionine, a naturally occurring molecule found in the cells of plants, animals, and humans. With age, our bodies produce less of this chemical, and some experts believe that taking it as a supplement to treat certain diseases makes sense. As it turns out, research suggests that it provides some benefit in the treatment of depression—which makes sense, because SAM-e is necessary for the production of the mood-boosting brain chemicals serotonin and dopamine. What’s more, it also helps boost production of glutathione, a potent antioxidant.
A major review of studies on this supplement found that SAM-e improved symptoms of depression 27 to 38 percent better than placebos. The review also found that SAM-e was as effective as tricyclic antidepressants. And a study released in 2010 by researchers at Harvard Medical School and Massachusetts General Hospital in Boston suggested that SAM-e might help depressed patients who don’t respond to prescription antidepressants.
Qigong. One activity worth trying, particularly if you’re 60 or older, is qigong (pronounced chee-guhn), an ancient Chinese martial art that combines steady, slow movements with breathing patterns. In a Hong Kong study, people diagnosed with depression who participated in qigong surpassed the control group in every measure after eight weeks.
Omega 3 supplements. The same fish oil, or omega-3 fatty acid supplements, that can help your heart may also have the power to ease depression. In fact, in a 2011 pilot study， researchers from Harvard Medical School discovered that when women suffering from major depressive disorder and menopausal hot flashes took two grams of an omega-3 supplement, their depression scores on a standard test plummeted from 24.2 before treatment to 10.7 eight weeks later. In fact, 70 percent of the women responded to the treatment, and depression went into remission for 45 percent. As a bonus, their hot flashes also improved significantly.
And in one review of 10 studies, researchers found that high doses of fish oil improved depression significantly better than placebos, though the researchers noted that more large-scale, well-controlled trials are needed due to problems with the existing studies. You may need to take as much as four grams daily, so check with your doctor before starting.
Electroconvulsive therapy (ECT). Though it sounds like the treatment of last resort, modern ECT is far removed from what was depicted in movies like One Flew over the Cuckoo’s Nest. Today, ECT treatments use lower bursts of electricity and are given along with sedatives, and seem to cause changes in brain chemistry. Often, severe cases of depression and other mental illnesses respond immediately—especially for people who’ve been resistant to other therapies.
