In this article we will see how unmanaged or undermanaged Type 2 diabetes can be the cause of depression, and how not recognizing or managing depression symptoms can cause type 2 diabetes.
The research is clear that there is a connection between depression and Type 2 diabetes and Type 2 diabetes and depression in a “chicken and egg,” relationship.
Researchers from the University of Pennsylvania Department of Medicine confirm, “There is a link between depression and diabetes – as depression is a risk factor for diabetes, diabetes also increases the risk for the onset of depression. Not only is depression common in patients with diabetes, but it also contributes to poor adherence to medication regimens, which often results in worsening diabetes management.”(1)
This research is from 2012. Now that we are in 2020, we still find researchers and doctors trying to help patients with Type 2 diabetes cope with depressive episodes and, equally, trying to help patients with depression cope with their type 2 diabetes. At the Magaziner Center for Wellness, we see new patients all the time with unmanaged or even managed Type 2 diabetes who are tired and have various health issues that need to be dealt with. We see patients who suffer from depression and whose depression could be linked to the onset of chronic disease through the stress mechanism.
In the chicken and egg relationship, it may matter which came first in regards to customizing treatment programs based on the first visit patient history and blood work, but the program we would design would treat Type 2 diabetes and depression aggressively and simultaneously.
In July 2018, in the medical journal, Diabetes, metabolic syndrome and obesity : targets and therapy, (2) researchers wrote of the treatment of comorbid depression and Type 2 diabetes is more effective when embedded in an integrated approach, in which both conditions are addressed together.
The challenges in treating both however with standard pharmaceutical treatments are acknowledged:
Pharmacological treatment with antidepressants such as selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective and to prevent the recurrence of depression in patients with diabetes.
Bupropion, a norepinephrine and dopamine (DA) reuptake inhibitor, would seem to be at least equally effective as SSRIs in Type 2 diabetes
No antidepressant therapy has been specifically indicated based on a comorbid diagnosis of Type 2 diabetes nor have been any particular antidiabetic regimens that might have varying effects on mood indicated for comorbid depression in the setting of Type 2 diabetes.
What the researchers are saying is that medicine is still stuck in a treat each of the patient’s challenges as independent of each other.
Inflammation is a problem that needs to be addressed in both Type 2 diabetes and depression.
Here the study makes a point that anti-inflammatory treatment programs should help Type 2 diabetes and depression.
Anti-inflammatory agents are under investigation for depression in the setting of inflammatory comorbidity and treatment-resistant depression.
A bidirectional relationship between inflammation and Type 2 diabetes has been observed, and depression is associated with inflammation in Type 2 diabetes suggesting that anti-cytokine or other anti-inflammatory approaches may be useful as additional or adjunctive therapies.
Treating inflammation is a centerpiece of our holistic care programs.
This research suggests a program to its readership that focuses on improvement in depressive symptoms; improvement in blood glucose, blood pressure, and cholesterol; and improvement in self-care behaviors would benefit both diabetes and depression outcomes, emphasizing the benefit of a holistic approach in treating both challenges as one.
Research suggests natural and alternative therapies can help patients cope with their depression better
A December 2018 study from the University of Alabama (3) at Birmingham finds that depression and diabetes have a mutual player that is negatively impacting the patient’s health. Perceived stress.
How did the stress problem manifest itself?
“The presence of elevated depressive symptoms and/or perceived stress was generally associated with:
increased waist circumference,
higher CRP (inflammation), and
lower HDL cholesterol levels.
However, the study’s findings suggest that healthy lifestyle factors may attenuate the association between psychological distress and metabolic health impairment.
Managing depression so you can manage diabetes
In an April 2020 study,(4) researchers wrote: “In multimorbid populations, depression is more likely to be associated with self-care maintenance than the other self-care dimensions. Therefore, self-care maintenance behaviors (e.g. physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity.”
Our interventions at the Magaziner Center for Wellness include an assessment of each patient’s physical state and treat any triggers of depression, including type 2 diabetes, without the use of medication. To begin, we look at food sensitivities and allergies – as reactions to wheat, for example, and other elements have been linked to depression and problems of diabetes If such sensitivities are detected, we work with the patient to modify diet and environment to eliminate the element’s negative impact. We also look at exposure to mold and other environmental irritants, such as building materials and household chemicals, which often harm the nervous system and impact mood.
Depression has been linked to problems or imbalances in the brain with regard to the neurotransmitters serotonin, epinephrine, norepinephrine, GABA and dopamine. We analyze the urine to test the levels of these neurotransmitters, and use blood tests to look at levels of key amino acids. We also review the levels of fatty acids, namely Omega-3 fatty acids, and test for deficiencies in trace minerals such as intracellular magnesium and zinc, and vitamins including B-12, as low levels of any of these have been linked to depression. This comprehensive analysis enables us to treat the disorder using nutritional supplementation.
We rule out that the patient is not suffering from excessive tissue levels of heavy metals or chemicals such as pesticides or solvents. These substances can have an adverse impact on the nervous system and contribute to depression.
Lastly, we encourage our patients to seek out – and stick with – stress reduction techniques to help manage, and in most cases, drastically reduce, their depression and related symptoms. Consistent exercise should be included to help stimulate mood-elevating endorphins.
If you would like to explore more information, please contact our office so we can start a conversation with you.
1 Siddiqui MA, Khan MF, Carline TE. Gender differences in living with diabetes mellitus. Mater Sociomed. 2013;25(2):140-2. doi: 10.5455/msm.2013.25.140-142.
2 Darwish L, Beroncal E, Sison MV, Swardfager W. Depression in people with type 2 diabetes: current perspectives. Diabetes Metab Syndr Obes. 2018;11:333-343. Published 2018 Jul 10. doi:10.2147/DMSO.S106797
3 Gowey MA, Khodneva Y, Tison SE, Carson AP, Cherrington AL, Howard VJ, Safford MM, Dutton GR. Depressive symptoms, perceived stress, and metabolic health: The REGARDS study. International Journal of Obesity. 2018 Dec 5:1.
4 Iovino P, De Maria M, Matarese M, Vellone E, Ausili D, Riegel B. Depression and self-care in older adults with multiple chronic conditions: A multivariate analysis [published online ahead of print, 2020 Apr 13]. J Adv Nurs. 2020;10.1111/jan.14385. doi:10.1111/jan.14385