Medical Illness and Depression

Concerning the effects of depression on other major medical illnesses, Dr. Musselman reviewed some of the recent literature outlining how depression can influence the treatment of diabetes, stroke, and cancer. Current data indicate that the lifetime prevalence of depression in the general population may range from 2% to 15%, while it is much higher in patients with diabetes (9% to 27%), stroke (22% to 50%), or cancer (18% to 39%). Thus it is important to understand how depression may influence the treatment and long-term outcome of disease in these patients.

Depression

Depression is the most common psychological problem in the US. Minor Depression can be attributed to normal depressed feelings that arise because of a specific life situation, a side effect of medication, hormonal changes or physical illness, and does not usually require treatment. Major Depression (depressive illness) is a serious condition that result in extreme fatigue, sleep problems and eventually an inability to function. The exact cause is unknown, but it is thought to be a malfunction of brain neurotransmitters, which are chemicals that modulate moods. Major Depression is usually treated with a combination of psychotherapy and antidepressants which moderate or correct chemical imbalances in the brain. The group of antidepressants most frequently prescribed is the selective serotonin reuptake inhibitors (SSRIs) which regulate the neurotransmitter serotonin.

Examples:

Amitriptyline HCL
WELLBUTRIN
Wellbutrin SR
Fluoxetine
Celexa
Lexapro
Paxil
Prozac
Remeron
Zoloft
Effexor XR

Several studies have now demonstrated that there is at least a 2-fold increased risk for developing depression in diabetic patients (type 1 or type 2); and among children and adolescents with type 1 diabetes. there is at least a 2- to 3-fold increase in the prevalence of depression. Women, minorities, and patients with lower socioeconomic status or physical disability are particularly at risk. Diagnosing depression in this population can also be difficult in that some of the key symptoms of both diseases overlap, including insomnia, fatigue, and changes in appetite. Fortunately, exclusive diagnostic criteria that eliminate somatic symptoms can be successfully employed in diabetes patients to discriminate depressed vs nondepressed patients.

Comorbid depression is known to increase the incidence of diabetic complications and is associated with poor adherence to diabetic medication, exercise, and diet, as well as poor glycemic control. Depression itself is also often associated with elevated glucocorticoids, which may further complicate diabetes. One study actually showed elevated glucose levels and insulin resistance in depressed patients following an oral glucose tolerance test. Indeed, depression may increase the risk for subsequently developing diabetes by nearly 2-fold.