July 1, 2014

Depression or Distress?

“Depressed” people with diabetes may not be clinically depressed – they may just be reacting to having an illness.

Depression is often an unwelcome sidekick to diabetes. There is no physiological connection between type 2 diabetes and depression, but the rate of depression among people with diabetes is higher than in the general population.

Researchers now think that in many cases, the depression may be a result of the stress of being diagnosed with a chronic illness. It's called “diabetes distress,” which conveys it well, and they say it’s probably much more common than the medical community has realized.

“Because depression is measured with scales that are symptom-based and not tied to cause,” study author Lawrence Fisher said in a statement, “in many cases these symptoms may actually reflect the distress that people are having about their diabetes, and not a clinical diagnosis of depression.”

Many of the depressive symptoms reported by people with type 2 diabetes are really related to their diabetes, and don't have to be considered psychopathology.

Fisher and his team had patients with diabetes fill out questionnaires to determine whether and to what degree they were distressed about having diabetes, and whether they had depressive symptoms in general. For those who did have both, the team randomly assigned them to one of three treatments that were all designed to reduce feelings of distress about the disease and to boost their confidence and knowledge about it. Therapy involved various combinations of online, in-person, snail mail, and phone contact.

At the end of the treatments, all three groups reported less distress about their diabetes and fewer symptoms of depression. There were no differences in how effective the three treatments were.

“What's important about this,” said Fisher, “is that many of the depressive symptoms reported by people with type 2 diabetes are really related to their diabetes, and don't have to be considered psychopathology. So they can be addressed as part of the spectrum of the experience of diabetes and dealt with by their diabetes care team.”

The results are especially encouraging since another long-term study found that the greater the depressive symptoms seen in people with type 1 diabetes, the higher the risk of mortality. This, the authors suggest, may be due to the link between depression and heart disease risk, although more research needs to be done to understand the connection more fully.

If you’ve been diagnosed with diabetes and are also experiencing symptoms of depression, don’t think it’s just the way it has to be. See your doctor or mental health professional about ways to manage it more effectively — and not just how to cope with the disease, but how to manage your feelings about the disease. Figuring that out will ultimately be much more therapeutic than simply treating the symptoms of depression alone.

The study was carried out by a team at the University of California, San Francisco and presented at the American Diabetes Association's 74th Scientific Sessions.
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