Diabetes and Depression

Anytime the terms diabetes (Mellitus or Insipidus) are said aloud at the same time, a strange, shivering feeling that is both feverish and surprising comes over you. The disease’s notoriety is the only reason for it. Over the years, diabetes—and particularly mellitus—has managed to hold a convenient place in the category of extremely fatal anomalies.

One of the biggest worldwide emergencies, according to data from 2015, affected one in eleven adults. Since then, the number of cases has grown, particularly in urban areas. It has also resulted in increased medical and financial difficulties.

One of the worst things about diabetes is that, when it manifests, it often coexists with a deadly chain reaction of other illnesses. They are

• aberrant alterations in blood artery structure that may cause a heart attack, stroke, etc.

• Peripheral neuropathy, a disorder affecting the peripheral nerve system, and autonomic nervous system dysfunction can result in compromised bladder function and cardiovascular responses, among other issues.

• depression (the article’s main topic).

Another reason depression is well-known is that it can have a variety of detrimental repercussions on one’s health. Furthermore, it is not just well-known like diabetes.

With a lifetime prevalence that ranges from 11% in low-income nations to 15% in high-income countries, it also holds a distinguished place on the list of diseases that are a plague on the human population in terms of health, raising severe concerns for the international health community.

Let’s take a brief look at these two health issues’ unique features before seeing how they are related.

What are diabetes and depression?

The first topic for analysis is depression.

We may characterize it as a psychological condition that encourages the overall state of mind’s effective actions to be reduced. And millions of people around the world are impacted by it. The following symptoms can be used to categorize different types of depression:

• low spirits
  
• alterations in weight, appetite, and sleep
  
• Greater agitation or less activity
  
• difficulty focusing
  
• Low vigor
  
• feeling guilty, helpless, etc.

How doctors diagnose patients using the Diagnostic and Statistical Manual (DSM-5) influences whether or not the symptoms of the alleged depressed individual meet the criteria for being classified as depression.

There are now several different types of depression, such as seasonal affective disorder (SAD), bipolar disorder, major depressive disorder (MDD), atypical depression, reactive depression, perinatal disorder, premenstrual dysphoric disorder (PMDD), and major depression with psychotic features.

Treatments:

• pharmaceuticals (SSRIs such as Lexapro, Prozac, Paxil, Zoloft, etc.),

• Phototherapy

• Treatments using brain stimulation

• Psychoanalysis

• Behavioral and cognitive therapies

• interpersonal counseling, etc.

Let’s take a quick look at diabetes to properly summarize the overview (Mellitus).

Diabetes mellitus is a syndrome characterized by poor metabolism of proteins, fats, and carbohydrates that is brought on by a loss in tissue sensitivity to insulin or a lack of insulin secretion. Diabetes mellitus can be divided into two general classifications or types:

Type 1 Diabetes

Insulin secretion is deficient in type 1 diabetes, commonly known as insulin-dependent diabetes mellitus. Type 1 diabetes (DM 1) can be brought on by illnesses that affect the islets of Langerhans, the pancreatic beta cells, or by injuries to these cells. The vulnerability of the beta cells to destruction may also be influenced by genetics, autoimmune diseases, and viral infections.

According to research, in the United States of America, diabetes mellitus typically manifests itself at the age of fourteen. It is frequently referred to as juvenile diabetes mellitus because of this. Nevertheless, due to circumstances that result in the death of the pancreatic beta cells, type 1 diabetes mellitus can strike at any age, even in maturity.

Three noteworthy events follow the development of type 1 diabetes mellitus, which can occur suddenly or gradually over a few days or weeks:

• elevated levels of blood glucose

A decrease in insulin, which is necessary for cells to absorb glucose, causes the concentration of plasma glucose to rise to 300–1200 mg/100 ml. The typical amount is 180 milligrams per 100 milliliters of blood. This level is abnormally high and causes a host of other side effects, such as osmotic diuresis, polyuria (frequent urination), tissue damage, and glucosuria (appearance of glucose in the urine).

• Enhanced production of cholesterol and increased use of fat as fuel:

Let’s say the rate at which fat is metabolized rises too high. In that instance, it causes metabolic acidosis (diabetic ketoacidosis) by releasing more ketone bodies into plasma than can be absorbed and utilized by cells.

• Protein depletion in the body:

Because the body cannot use glucose, it will use proteins more and store them less, which might result in asthenia, or rapid weight loss and low energy. Insulin therapy is the mainstay of type 1 diabetes treatment.

Read Also: How Berberine Can Help Diabetes

Mellitus, or type 2 diabetes:

Ninety to ninety-five percent of all instances of diabetes mellitus are type 2, which is significantly more common than type 1. Unlike type 1, the start usually happens after 30 years of age (usually between 50 and 60 years of age), and it develops gradually.

As a result, adult-onset diabetes is a common term used to describe this illness. However, the frequency of its incidence in people under the age of twenty has increased recently.

The fact that type 2 diabetes mellitus is characterized by hyperinsulinemia (high plasma concentration of insulin) as opposed to type 1’s hypoinsulinemia (low plasma concentration of insulin) is an intriguing and noteworthy distinction between the two types of the disease. There is a noticeable discrepancy between the two due to this variance in the associated diseases.

Another way to put it would be that type two impacts come first rather than second. These could be hypertension, lipid abnormalities, obesity, insulin resistance (which leads to insulin-resistant diabetes), hyperglycemia during fasting, etc.

Together, they are referred to as metabolic syndrome, and type 2 diabetes is the result. Treatment options may revolve around nutrition, physical activity, and even pharmaceuticals.

(Note: the alpha cells emit glucagon, a hormone that has the opposite effect of insulin, whereas the beta cells of the islets of Langerhans, the endocrine portion of the pancreas, secrete insulin).

Diabetes and Depression Co-Morbidity

Now that we have a basic understanding of these two illnesses, let’s look at how they might be related. Two evaluations published in 2015 identified three potential routes linking these two diseases:

• There could be a shared etiology (cause or origin) for both illnesses.

• Diabetes raises the likelihood of developing depression in the future.

• Most of the risk for developing diabetes in the future is increased by depression.

Reasons

The hypothesis that depression and diabetes are correlated genetically is unproven. On the other hand, several environmental factors might promote the activation of a shared pathway that ultimately results in type 2 diabetes and depression.

In addition to raising the risk of DM2, a low socioeconomic position appears to be a contributing factor in depression. Other typical factors include insufficient exercise and restful sleep.

The disruption of the stress system, which results in elevated cortisol production in the adrenal cortex as well as adrenaline and noradrenaline production in the adrenal medulla, may be the cause of the common pathway’s activation.

Prolonged sympathetic nervous system activation and chronic hypercortisolemia exacerbate insulin resistance, visceral obesity, metabolic syndrome, and type 2 diabetes mellitus.

Persistent stress produces behavioral effects related to depression. Hormones such as cortisol, noradrenaline, and others trigger the fear system, which in turn determines anxiety. Depression is a result of anorexia (lack of appetite).

According to recent research, cortisol’s effect on inflammation has a role in the pathophysiology of depression. The relationship between DM1 and depression has not been well studied, however there may be molecular connections.

Diabetes Risk in Patients with Depression

Patients with depression are more likely to acquire type 2 diabetes, according to several research. According to a survey on the relationship between antidepressant use and hypoglycemia control, antidepressant use reduced glycemic control in persons with diabetes.

With the exception of noradrenergic antidepressants, the short-term use of these medications to treat non-diabetic people is effective. When used both short-term and long-term, SSRIs may help individuals with type 2 diabetes maintain better glucose control.

The risk of type 2 diabetes is substantially increased by long-term antidepressant use. It’s critical to recognize and make an effort to reduce these medications’ side effects.

In conversation like this one, it is imperative that we continue to cite studies, or research publications. Thus, research from the past few years has once again indicated that depression is more common in those who have diabetes.

The same study revealed that only people who were aware of their diabetes experienced higher levels of anxiety. Most likely as a result of the psychological strain that comes with being aware of what causes anxiety and despair.

Nonetheless, sadness was common in people with diabetes who had not previously received a diagnosis this could be attributed to negative lifestyle choices such stress, poor eating habits, or inactivity. The hypothesis states that using antidiabetic medication may make depression worse. There was discovered to be a significant correlation between depression and oral diabetes treatment in adults in their forties.

In summary

To have a healthy society with a high life expectancy, health problems must be prevented, identified, and treated. Depression is underdiagnosed in people with diabetes, and diabetes physicians must be aware of this rather prevalent co-morbidity. A multidisciplinary approach to treating diabetes patients could help reduce mortality, increase DALYs (Disability Adjusted Life Years), and enhance disease outcomes.