‘Depression and diabetes all hang out together,’ expert says
Treating some diabetic patients for depression could help prolong their lives, says a leading U.S. diabetes expert.
Photograph by: STAFF
OTTAWA — Treating some diabetic patients for depression could help prolong their lives, says a leading U.S. diabetes expert.
“It may be the most powerful thing we do, helping people with depression,” psychologist William Polonsky told an Ottawa conference of health-care providers Saturday.
One in five people struggling with diabetes also suffers from depression, and the toxic combination can destroy lives, mounting research shows.
Among eastern Ontario’s 90,000 diabetics, one in three has sought mental-health services, according to Toronto’s Institute for Clinical Evaluative Sciences.
“Depression and diabetes all hang out together,” said Polonsky, who advises doctors and patients on the behavioural aspects of diabetes.
“And of course, if you’re significantly depressed, you may start taking poor care of yourself, which leads to a nasty, negative spiral effect.”
Speaking at the conference sponsored by the Champlain Diabetes Regional Coordination Centre, Polonsky said the daily routine of monitoring blood-sugar levels, watching what they eat and being physically active discourages many diabetics.
Family, friends and even health-care providers often feed a diabetic’s guilt by blaming them for their weight or uncontrolled glucose levels.
Polonsky, a psychiatry professor at the University of California in San Diego, pointed to a growing body of research that shows the struggle to cope with diabetes can lead to deep sadness.
In turn, depression can cloud judgment and thinking, which get in the way of dieting, exercising, and even taking the medicines that can control diabetes.
The resulting downward spiral can increase the risk of complications — blindness, amputations, kidney failure — and more than double the risk of death. Studies show heart attacks and stroke, in particular, kill eight out of 10 diabetics, making them the leading causes of death among people with the diabetes.
And because doctors often overlook symptoms of depression in diabetics, they become frustrated when their patients don’t cooperate with medical advice.
“How many times have we sat across from somebody and said, ‘What’s wrong with these people? Why can’t I get through to them?’ It’s probably because they’re depressed,” said Polonsky.
A University of Pennsylvania study, published in January’s Annals of Family Medicine, is the latest to show that treating depression, through a combination of anti-depressants and behavioural therapy, can help diabetics control their blood-sugar levels.
While the link between diabetes and depression is well documented, scientists aren’t sure which comes first, or whether the sequence is different in people with Type 1 or Type 2 diabetes.
Type 1, which makes up about 10 per cent of all diabetes cases, is a genetically based autoimmune disease that develops early in life and destroys the cells that make insulin. Type 2 is more common and typically occurs in older adults who are overweight and whose bodies don’t respond properly to insulin hormone. Both forms lead to a dangerous buildup of sugar in the blood, which damages nerves and organs.
Since both diabetes and depression often go undiagnosed for years, answering the chicken-and-egg question is complicated, said Polonsky.
The number of Ontarians with diabetes has doubled to more than 1.1 million since 2000, and is on track to double again over the next decade, according to the Canadian Diabetes Association.
To fight the epidemic, which is straining medical services, the Ontario government has invested $741-million over four years to improve diabetes care. The disease currently costs the province $4 billion a year in health care and lost productivity and could rise to $7 billion by 2020.
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