In general, depression can impact anyone at anytime and does not need to be a life long illness. Depression comes in a wide range of intensities from a low lying depression called dysthymia to more debilitating, which may be diagnosed as a Major Depressive Disorder. A Major Depressive Disorder can be an acute or a recurrent problem impacting all areas of life.
Depression is a complex issue that is difficult to define as it comes with many symptoms and no one person presents the same. Most people are not the stereotypical individual that society has presented in movies, who lives on their couch all day, unable to function at any level. Most people living with depression work a job and function well enough to maintain relationships.
Depression is a mood disorder that typically includes feelings of: detachment, loneliness, isolation, depression, hopelessness and sadness. It may cause a decreased enjoyment of activities that were previously enjoyed and a lack of interest in the world around them.
According to the American Association of Diabetes Educators as well as the American Diabetes Association, depression is 2-3 times more prevalent in people with both Type I and Type II diabetes.
There are several different ideas as to the cause of depression that have been identified. These include genetics, social and environmental factors, and neurobiological factors. One or all of these may play a role. Regardless of exact cause, depression is a chemical imbalance predominantly seen in those with childhood trauma.
Other causes may relate to traumatic events in life that have a devastating impact on an individual. Like people who experience a traumatic loss may develop symptoms similar to depression. When the loss is the death of a love one the symptoms although the same as depression it would be diagnosed as mourning, unless it last longer then 2 months at which time it would be considered depression.
Reasons it is more prevalent in individuals with Type 1 diabetes:
The symptoms of depression are vast but the issue is not the complexity of the symptoms but that many of the symptoms of high blood glucose levels are similar to depression. This is important when diagnosing depression in an individual living with diabetes, as high blood sugar needs to be ruled out.
Major Depressive Disorder and High Blood Glucose Levels Symptoms:
Other Major Depressive Disorder Symptoms:
Other High Blood Glucose Symptoms:
Diagnosis of any mental illness needs to be done with a Mental Health
Professional (MHP) trained in diagnosis, which maybe a Licensed Clinical Social
Worker, Licensed Psychologist or a Psychiatrist.
In diagnosing depression in an individual with diabetes it is important that the
client/patient advocate for him or herself by tell the MHP evaluating them that
they have diabetes. Don’t wait to be asked, be honest with them and upfront, tell
them if your blood sugars are out of control and what symptoms that may cause.
If your psychotherapist or psychiatrist is unfamiliar with the symptoms of high
blood sugar, inform them what happens to you when your blood sugar is high. If
your mental heath professional is still unsure about the impact of blood sugars
refer them to speak with your certified diabetes educator or endocrinologist.
Make sure to sign a release allowing them to talk to your endocrinologist to
All this will help the MHP rule out that your blood sugar control isn’t the cause of the depression.
The initial assessment is performed by a MHP, creating a Bio-Psycho-Social
Assessment that evaluates all aspects of an individual’s life, which assists in the
diagnostic process. As part of the process the MHP will conduct a Differential
The Differential Diagnosis takes into account that the depression might be a
result of some specific extrinsic factor such as drug abuse, various medications,
or general medical conditions like hypothyroidism. Depending on various factors
the MHP may have you get screened for a specific extrinsic factor to rule it out as
the cause of the depression.
The Diagnostic Static Manual (DSM-IV-TR) is the primary source in diagnosing
mental health disorders. It is used to rule out symptoms and other criteria like
length of symptoms need to be meet before a diagnosis can be made.
Criteria for Major Depressive Episode and Major Depressive Disorder:
There is a wide range of treatments for depression from psychotherapy to medications. For individuals with diabetes, Self Management Education has therapeutic value, because better control reduces some symptoms of depression and builds self-esteem.
Since, there are various reasons a person may be depressed, not all forms of treatment will resolve any one persons depression. Every individual is different and that means treatments need to be tailored to your specific needs. Just because someone you know was put on Zoloft does not mean that it will work for you.
First step is to seek the help of a Mental Health Professional where you can get an initial assessment. Keep in mind that high or out of control blood sugars during your assessment or over the past few weeks to years will impact the diagnostic process.
The cause of your depression, once known, usually defines treatment. For more information on the various causes see the “Depression Etiology” section.
Treatment is based off the initial assessment discussed in the “Depression Diagnosis” section. I would recommend meeting with a certified diabetes educator while seeking emotion help from a psychotherapist. It is important to rule out the diabetes with the help of a CDE and/or your psychotherapist.
Certified Diabetes Education helps people get their diabetes management under better control, which may alleviate some symptoms of depression depending on cause. Best when used in conjunction with Cognitive Behavioral Therapy or Psychodynamic Therapy.
Psychotherapy helps reduce various life stressors and symptoms of depression, while increasing self-esteem. It helps people resolve personal issues and manage painful feelings like anger, sadness, hopelessness and frustration, to name just a few.
Once you have been assessed and extrinsic factor like your diabetes has been ruled out, your psychotherapist may refer you to a psychiatrist for further evaluation. For some people medication will be needed to resolve some of the symptoms of depression that talk therapy wont resolve.
Medication Therapy helps reduce or resolve some of the symptoms of depression that may be interfering with your diabetes management. Some symptoms of depression make it difficult or even impossible to manage diabetes.
Before starting any medication, over the counter medication or herbal alternative to medication, please inform both your endocrinologist and psychiatrist of the medications you are already on. As some psychiatric medications may negatively impact both diabetes and non-diabetes medications you already take and vise versa. For example, some psychiatric medication may lower or raise blood sugar levels.
Electroconvulsive therapy (ECT) is a last resort, when all else fails. It is much safer then it used to be with minimal side effects. It is a process where electrical currents are used to induce a small Seizure. It causes rapid changes in brain chemistry, reversing the symptoms of depression.
If believe you might be depressed, Contact my practice, as soon as possible. http://diabetictalks.com/potential-clients.html We can help!
If you are concerned that you are going to hurt your self or someone else please call 911 right away.
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