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Depression Living with Depression

Diabetes and Depression: A Double Downer

By Christine Haran

You might expect someone with a chronic disease such as diabetes to experience some low points. After all, there are doctor's appointments to keep, medications to keep track of and dietary restrictions to follow, as well as the fear that their disease will worsen. But research shows that major depression—which affects one's ability to functionally both physically and mentally—can contribute to disability caused by diabetes.

Approximately 30 percent of the 17 million Americans living with diabetes have major depression. Besides affecting the quality of daily life, depression in people with diabetes makes it even more challenging for people to follow their diet, exercise and medication plans, and increases their chances of having other diabetes complications.

A study published in the February 2004 issue of Diabetes Care examined the impact of diabetes and major depression on people's ability to perform tasks of daily living such as carrying groceries or going out shopping. Researchers found that nearly 25 percent of people without diabetes or major depression have functional disability, compared with about 50 percent of people with major depression, 58 percent with diabetes and almost 78 percent of people with both major depression and diabetes.

Below, study author Leonard E. Egede, MD, an assistant professor of medicine at the Medical University of South Carolina in Charleston, discusses the importance of treating depression in people living with diabetes.

Why did you decide to conduct this study?
We already knew that diabetes in itself is associated with disability and that depression is also associated with major disability. So we were trying to understand how having both diabetes and depression was likely to affect functional disability.

What is functional disability?
People with a functional disability have difficulty performing common activities of daily living without the help of special equipment. From a research perspective, the different activities that would need to be impaired, for you to have functional disability, include activities such as walking up 10 steps without resting, standing or being on your feet for two hours, or participating in social activities such as visiting friends.

What factors contribute to functional disability?
Previous studies have shown that several chronic diseases are associated with functional disability. Common conditions that are highly associated with disability include chronic arthritis, chronic obstructive pulmonary disease, coronary artery disease, stroke and heart failure. And, of course, diabetes and depression are both associated with disability.

With diabetes, a lot of the impact on disability has to do with the complications that can result from diabetes. So the cardiovascular disease, stroke, blindness, end-stage renal disease and lower limb amputation can all affect functioning.

How does depression further affect functioning?
It seems like depression and diabetes affect different components of function. Diabetes seems to mostly affect physical function, so it affects activities like walking short distances, lifting things. Whereas depression seems to affect more of your cognitive functions and things like interaction with others, being able to get out of your house to go shopping.

What advice do you have for friends and family of people with diabetes?
If you have a loved one who has diabetes and if there's any likelihood that they may be depressed, you should try to make sure they bring up those concerns with their physician. If they do screen positive for depression, they should strongly consider treatment. From other studies we know that if you treat depression with psychotherapy and/or medications, you actually improve function in people with major depression. In general, it appears that you actually get probably more of an effect with medication than you get with psychotherapy alone. But there is still a stigma associated with depression, so people tend to refuse treatment or they only receive treatment for short period of time.

Do you think that people with diabetes should be screened for depression?
I think we should strongly consider screening patients with diabetes for depression, particularly those who have other chronic conditions such as heart disease. Healthcare providers who treat people with diabetes need to be aware of combined effects of having diabetes and depression on function. They should be looking out for depression in these patients and treating them when appropriate.