Life is full of emotional ups and downs; we
all have our share of good days and bad.
But when the “down” times keep going or
interfere with your ability to function, you
may be suffering from a common, but
serious, illness: depression. Depression
affects your mood, mind, behavior,
relationships, and even your body.
The Elusive Symptoms of Depression
Depression's symptoms are sometimes mistaken for conditions that are associated with other illnesses. Depression symptoms include:
- Persistent sad mood
- Loss of interest in activities that were once enjoyed
- Drastic change in appetite or weight
- Difficulty sleeping or oversleeping
- Restlessness
- Loss of energy
- Feelings of worthlessness or guilt
- Difficulty thinking or concentrating
- Recurrent thoughts of death or suicide.
A Vicious Circle
Research shows that depression is closely linked with trauma such as limb loss and with serious illnesses such as diabetes. Depression can strike anyone, but the risk is doubled for people with diabetes and two to four times higher for amputees.
Even otherwise healthy people with depression are at greater risk for deteriorating health or developing an illness. Part of the reason may be that some of the factors that increase the risk of diabetes also cause or increase the risk of depression. Some of these risk factors include being overweight, doing little or no physical activity and failing to receive healthcare. Depression leads to poorer physical and mental functioning, so a person is less likely to follow a prescribed diet or medication plan. The worse a person's health becomes, the deeper the depression grows. And so it goes.
Depression affects your mood, mind, behavior, relationships, and even your body.
Research has shown that about 19 million people in the United States experience depression each year. So why is it that nearly two-thirds never get the help they need, even though counseling and medication could improve their mental health? A recent study published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report serves to explain this phenomenon and demonstrate that depression and diabetes are even more closely linked than previously thought.
A Wake-up Call for the City That Never Sleeps
More than half a million New Yorkers have been diagnosed with diabetes, and an estimated 300,000 New Yorkers experience serious psychological distress (SPD), including depression. New Yorkers with diabetes are twice as likely to experience depression, anxiety, schizophrenia and other psychological disorders than those without diabetes, according to a study conducted by the New York City Department of Health and Mental Hygiene (DOHMH). The survey of nearly 10,000 adults also found that people with comorbid (two coexisting medical conditions) diabetes and depression are more likely than those with only diabetes to experience poor physical and mental health, live in poverty, and lack access to proper healthcare and social support.
Among New Yorkers with both diabetes and depression:
- 49 percent were divorced, separated or widowed compared with 25 percent of people with diabetes only.
- 70 percent had incomes under $25,000 compared with 43 percent of people with diabetes only.
- 11 percent had private insurance compared with 41 percent with diabetes only.
- 42 percent cited cost as reason for not getting a prescription filled or not seeing a doctor compared with only 16 percent of people with diabetes only.
- 26 percent used emergency rooms as their usual source of healthcare— that's more than twice that of people with diabetes only (10 percent).
In addition, New Yorkers with both conditions were:
- Nearly twice as likely to report fair or poor health (78 percent compared with 40 percent in the diabetes-only group)
- Nearly three times more likely to report that poor health limited their activities (64 percent compared with 22 percent in the diabetes-only group)
- Seven times more likely to report limited daily activities due to poor mental health (63 percent compared with 9 percent in the diabetes-only group).
Depression: An Equal Opportunity Disorder
On the national level, depression occurs more often in females than in males. This holds true across racial/ethnic groups but appears more often among African Americans and Hispanic Americans. Other factors associated with depression include poor education; being separated, divorced, widowed or never married; and unemployment.
While both men and women can develop the standard symptoms of depression, they often have different ways of coping. Conditioned from childhood to be the“strong, silent type,” men may say they're tired, grouchy or bored rather than admit their true feelings.
Instead of asking for help, men may turn to alcohol or drugs or become frustrated, discouraged and angry. Some men throw themselves into their work to hide their depression from themselves, family and friends; others may respond to depression by engaging in reckless behavior.
Women often express depression by becoming withdrawn and gaining or losing weight. Although women are equally as reluctant as men to seek professional help, they are far more likely to rely on less formal resources, such as prayer or a support system of family or friends.
But depression isn't just for grown-ups; even infants are vulnerable. Related studies indicate that stress has been associated with the development of allergies and the triggering of Type 1 diabetes or the autoimmune process behind the disease. Infants and young children are typically in close proximity to their caregivers and are very sensitive to their environment and the mood of their parents. Psychological stress in the family (marital problems, irregular sleeping patterns, illness, low socioeconomic status, etc.) can be passed on to a child, creating stress levels severe enough to trigger or promote the autoimmune progression.
Finding Your Way Back
The first step in treatment should be a thorough examination to rule out any physical illnesses that may cause depressive symptoms. Since certain drugs cause the same symptoms as depression, you should tell your doctor about any medications you are using. If a physical cause isn't found, your doctor will refer you to a mental health professional for a psychological evaluation.
The most common treatments for depression are antidepressant medication, psychotherapy or a combination of both. Deciding which method is right for you will depend on the nature of the depression. Medication can relieve physical symptoms quickly, while psychotherapy can provide the opportunity to learn more effective ways of handling problems.
There are other things you can do to help yourself get better. Some people find participating in support groups very helpful. It may also help to spend some time with other people and to try activities that make you feel better, such as mild exercise or yoga. Just don't expect too much from yourself right away. Feeling better takes time.
Where to Get Help
If you don't know where to go for help, ask your family doctor or health clinic for assistance. You can also check the Yellow Pages under “mental health,” “health,”“social services,” “crisis intervention services,”“hotlines,” “hospitals,” or “physicians.” Or you can contact the National Hopeline Network at 800/784-2433 or on the Web at ries.contineotech.com/ries/centerSearch.do to locate a crisis center in your area.
In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for an emotional problem and tell you where and how to get more help.
Improving the Odds With Integrated Treatment
The New York study highlights the strong correlation between physical and mental health. Both diabetes and depression are chronic illnesses that can be controlled if diagnosed and properly treated.
But, more importantly, the results of the New York study also included two recommendations significant to improving healthcare for people with diabetes and depression.
- Integrating depression detection and treatment with diabetes screening and management into primary care practices could greatly improve the outcome for patients with chronic illnesses.
- Unfortunately, this study also indicates that people with both diabetes and depression face significant economic and social barriers to receiving appropriate healthcare. This is a particularly dangerous combination. These barriers must be overcome to ensure that access to healthcare is available to everyone.
Diabetes and Depression Resources
Diabetes
American Association of Diabetes Educators
Telephone: 800/33 8.3633
Web: www.diabeteseducator.org
American Diabetes Association
Includes community education and awareness
programs for minority populations
Telephone: 800/342-2383
Web: www.diabetes.org/home.jsp
American Podiatric Medical Association
Describes the importance of foot care for people with diabetes
and provides a national directory of foot care specialists
Telephone: 800/275-2762
Web: www.apma.org
Diabetes Action
Telephone: 202/333 -4520
Web: www.diabetesaction.org
Diabetes Exercise and Sports Association
Telephone: 800/898-4322
Web: www.diabetes-exercise.org/index.asp
Juvenile Diabetes Research Foundation
Telephone: 800/533 -2873
Web: www.jdrf.org
National Institute of Diabetes and Digestive
and Kidney Diseases
Includes links to National Diabetes Information Clearinghouse
(NDIC) and Weight-control Information Network (WIN)
Telephone (NDIC): 800/860-8747
Telephone (WIN): 877/946-4627
Web: www.niddk.nih.gov
Emotional Health
National Institute of Mental Health
Real Men, Real Depression Program
Telephone: 866/227-6464
Web: www.menanddepression.nimh.nih.gov
National Mental Health Association
Provides mental health information and referral services
Telephone: 703/684-7722
Web: www.nmha.org
Nutrition
American Dietetic Association
Telephone: 800/877-1600
Web: www.eatright.org/Public
Nutrition.gov
Web: www.nutrition.gov/home/index.php3
