Depressed about diabetes? Antidepressant medication can help

A recent study using the common antidepressant medication Zoloft offers good news for diabetics suffering from depression. The study, conducted by the Washington University School of Medicine in St. Louis, suggests continued use of antidepressant drugs may be one way to help control blood sugar levels while keeping people depression-free at the same time.

It’s an important development that could provide relief for Americans struggling to deal with both diseases.

What contributes to depression in diabetics?

Over 20 million Americans – or seven percent of the country’s total population – have diabetes.³ Depression, meanwhile, affects almost 15 million Americans in a given year.⁹ While the causes linking depression and diabetes are not clear,⁷ several studies suggest having diabetes doubles the risk of developing depression compared to people who don’t suffer from diabetes.⁷

Research has shown depression in diabetics may be caused by stress and the physical effects of diabetes on the brain.⁷ Managing diabetes can be a stressful experience and losing the battle to keep blood sugar levels at a target level only adds stress. As diabetes complications worsen, the chance of becoming depressed increases.⁷

What does this mean for diabetics?

Feeling good is a very important part of managing diabetes. Depressed diabetics are less likely to engage in activities that lead to effective diabetes management, like regular blood sugar testing, eating a healthy diet and exercising.⁶ It’s understandable – if you’re sad or tired, you probably won’t feel like eating much at all. If you do eat, would you feel like carefully monitoring what you’ve eaten and when? Similarly, depression can also knock you off your medication regimen.⁷ People are less likely to take their medication as prescribed, which can make the situation worse.

Depression is one of a handful of factors that can add up to become bad news for diabetics. Other things like poor blood sugar regulation, smoking and weight gain can push you away from the healthy lifestyle you’re trying to lead. Evidence has shown, like the links of a chain, each of these elements is connected and the worsening of one can negatively affect the others. While depression is a contributing factor to diabetes, it’s also been shown problems arising from diabetes – like a lack of blood sugar control – are associated with depression.¹

Depression can lead to an increased risk of other physical illnesses  often associated with diabetes, including kidney failure, blindness and chronic pain, to name just a few.¹ This is another reason why controlling depression can be extremely helpful for people who live with diabetes.

Treatment of depression

Generally speaking, people who benefit from antidepressant use after their first episode of depression are instructed to continue on the medication at the same dosage for four to nine months after they have returned to the clinically well state.⁸ The medication is then stopped under a doctor’s supervision if it is no longer required. This is done because even though antidepressants are generally seen as safe, only half of patients will have another major depressive episode.⁸ Those who relapse, however, may need long-term maintenance to prevent  a reoccurrence. In these cases, the maintenance medication is usually the same medication at the same dosage used to treat the first episode of depression.

Depression in diabetics

Given the link between diabetes and depression, its clear controlling one condition can help manage the other. A combination of treatments – including antidepressant medication, like Zoloft – can help you manage diabetes. Prescription antidepressant medications are generally seen as safe for people with diabetes, though like other treatments they should be chosen by a trained medical professional.⁷ Generally, antidepressants are prescribed the same way for a diabetic as a non-diabetic person. Scientists report, over time, antidepressant medication and psychotherapy have positive effects on both mood and blood sugar control.⁷

New study involving depression and diabetics

The new study led by Patrick Lustman, a professor of medical psychology at the Washington University, School of Medicine in St. Louis, has shown staying on antidepressant medication even after a person is no longer depressed helps to keep them well. Zoloft was selected for use in the study because the drug is one of the most frequently prescribed antidepressants.

Researchers found patients who stayed on their medication were depression-free longer than those who did not. Whether a person was medicated or not, if they were depression-free their blood sugars were significantly lower than those who yo-yoed between being well and depressed.⁵

The important conclusion, according to the study’s author, is that there is now evidence to support the belief that keeping people from getting depressed helps manage their diabetes. Blood sugar levels tend to improve as depression improves, he said.⁴

There is also evidence that suggests treatment of depression has longer-term benefits. Half of the study’s patients continued to take medication after their depression was under control and their blood sugar levels were measured for the next year or until their depression reoccurred. At the end of the year, investigators found more than 65 percent of those still taking medication remained depression-free, compared with about 48 percent of those who took a placebo.⁴ People who recovered from depression also saw improvements in their blood sugar control for at least one year, according to the study’s results.²

What it all means

Though the causes for the link are unclear, both studies and statistics suggest people who live with diabetes are at a far greater risk of developing depression than those who don’t suffer from the disease. Depression can negatively affect both your mind and body, which seems to worsen the effects of diabetes, and often one illness can make the other worse. The good news, however, is the same principle holds for improvements in diabetes and depression management – people who stay depression-free are more able to control their blood sugar levels. A recent study has shown some evidence to support this belief, and some scientists now believe antidepressant medication helps to provide some relief from complications stemming from diabetes as well as depression.

This information is intended for educational and informational purposes only. In no way should this information be used as a substitute for medical advice, and RxNorth.com strongly recommends discussing this information with a qualified personal physician. RxNorth.com will not be liable for any damage resulting from the use of the information on this site.

---

References

1. Lustman, Patrick J. and Ryan Anderson. 2002. Depression in Adults with Diabetes.
   Psychiatric Times. 19(1). http://www.psychiatrictimes.com/p020145.html
   (Accessed May 21, 2006).
2. Lustman P.J., R.E. Clouse, B.D. Nix, K.E. Freedland, E.H. Rubin, J.B. McGill, M.M.
   Williams, A.J. Gelenberg, P.S. Ciechanowski, I.B. Hirsch. 2006. Sertraline for prevention of depression recurrence in diabetes mellitus: a randomized, double-blind, placebo-controlled trial. Arch Gen Psychiatry. 63(5): 521-9.
   Pubmed.gov (Accessed May 24, 2006).
3. 2006. All About Diabetes. http://www.diabetes.org/about-diabetes.jsp (Accessed May
   24, 2006).
4. 2006. Antidepressant drug may prevent recurrence of depression in diabetics.
   NewKerala.com. http://www.newkerala.com/news2.php?action=fullnews&id=56215 (Accessed May 24, 2006).
5. 2006. Antidepressant Treatment Prolongs Time to Relapse in Diabetics. Medscape
   Today. http://www.medscape.com/viewarticle/531551 (Accessed May 24, 2006).
6. 2004. Depression. http://www.diabetes.org/type-2-diabetes/depression.jsp (Accessed
   May 24, 2006).
7. 2003. Depression and Diabetes.
   http://www.mental-health-matters.com/articles/article.php?artID=324 (Accessed May 22, 2006)
8. 1994. Depression in Primary Care Volume 2. Treatment of Major Depression.
   http://www.mentalhealth.com/bookah/p44-d2.html (Accessed May 22, 2006).
9. 2006. The Numbers Count: Mental Disorders in America.
   http://www.nimh.nih.gov/publicat/numbers.cfm (Accessed May 22, 2006).