What Causes Depression?
Depression is caused by an imbalance of certain chemicals in the brain. Depression isn't something to be ashamed of, nor is it a sign of a weak personality. People with depression cannot "just snap out of it" no more that it would be possible for a person with diabetes or some other medical illness to "just snap out of it."
Other things that may cause a person to be depressed - or to be more likely to become depressed include:
Life experiences such as divorce, death of a spouse, loss of a job, or serious financial problems.
Abuse of alcohol or other drugs
Certain medications and diseases
Hormonal changes in women after childbirth
A family history of depression
Sometimes the cause of a person's depression is not known. Whatever the cause, there are treatment options available.
Depression is not generally listed as a complication of diabetes. However, it can be one of the most common and dangerous complications. The rate of depression in diabetics is much higher than in the general population. Diabetics with major depression have a very high rate of recurrent depressive episodes within the following five years. A depressed person may not have the energy or motivation to maintain good diabetic management. Depression is frequently associated with unhealthy appetite changes. The suicidal diabetic adolescent has constant access to potentially lethal doses of insulin.
Being diagnosed with diabetes is a major life stress. It requires a large number of physical and mental accommodations. The individual must learn about a complex system of dietary and medical interventions. Lifestyle, work, and school schedules may have to be altered. This can consume a lot of energy for both the individual and his or her family. Just as important, are the psychological adjustments. One must adjust to a new view of oneself. For those who liked to see themselves as invincible, this may be particularly difficult.
Many newly diagnosed diabetics go through the typical stages of mourning. These are denial, anger, depression and acceptance.
Denial:
This can be one of the more dangerous stages of the grief process. It may not occur only once. Many individuals cycle back to this phase several times. The honeymoon phase, associated with early Type I diabetes, may reinforce denial. Denial is a common stance for adolescent diabetics.
Anger:
It really does seem unfair. The type II diabetic, trying to lose weight, may envy heavier people who seem to enjoy good health. One might erupt at someone who innocently offers a desert. Unfortunately, anger can drastically affect glucose levels.
Depression:
Mild depressive feelings are a normal part of grieving and adaptation. As long as they are not pervasive or prolonged, they may not be harmful. However, when the depression lasts a long time, becomes severe or interferes with diabetic management, one should seek prompt treatment.
Acceptance:
Individuals achieve different degrees of acceptance and inner peace. Some will need to experience the denial, anger and depression several times as they move through different phases of life and different stages of diabetes. Some people move through a chronic disease to a state of much greater self-knowledge. They may actually say that the diabetes was, in part, a blessing. Through their close attention to diet and exercise, and their close monitoring of stress levels, they have arrived at a deeper understanding of themselves and their relations to others. They realize that for all human beings, life is vulnerable and precious.
Often, individuals with depression do not realize that they are depressed. It is easy to attribute the symptoms of depression to the diabetes. This is particularly difficult since depressed diabetics may have poorer glucose control. Sometimes a spouse or close friend can give good feedback. However, medical professionals or mental health clinicians may be the best ones to determine what is the diabetes and what is due to depression. A psychiatrist has had medical training before specializing in mental health. He or she can sort out the diagnosis, communicate with your regular doctor and help coordinate the treatment of the depression with treatment of the diabetes.
Symptoms of Depression:
Depressed mood for most of the day
Decreased pleasure in normal activities
Difficulty sleeping or significantly increased need to sleep
Weight loss or weight gain.
Feelings of guilt or worthlessness
Low energy level
Difficulty making decisions of concentrating
Suicidal thoughts
Treatment of Depression:
The most important starting point is an accurate diagnosis. There have been major advances in the treatment of depression. There are specific medications and specific psychotherapy techniques that have been shown to help depression. Often individuals do well with a combination of antidepressant treatment and psychotherapy. Be sure that your clinician is willing to take the time to communicate with your diabetes team. Ideally, the mental health clinician should be familiar with your type of diabetes.
Antidepressants:
Today, we have a much wider variety of antidepressant medications than were available fifteen years ago. Because we have more medication choices, we can often minimize annoying side effects. The older tricyclic antidepressants can increase glucose levels in non-depressed diabetics. However, when depressed diabetics take them, diabetic control improves. Selective Serotonin Reuptake Inhibitors (SSRIs such as Prozac and Zoloft) are easier to administer and have fewer side effects, so they are more often used as the first line antidepressants.
JUST REMEMBER....You are not alone
Talk to a family member, friend, health care provider....anyone.
There is help available!
Informational Links On Depression
