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[IP] DM and depression

Hi all

There has been some discussion on the list regarding diabetes and depression, 
so I thought I'd post an article that my paper ran addressing the subject. 
(It was in a special section on DM that ran Nov. 1.)


(You know you have diabetes when ...)
… your 'honey' calls you 'sweetie' and you get upset

    "Is there anything diabetes doesn't affect?" you may ask forlornly. The 
short answer is …
    … No. 
    Even one's moods, outlook on life and ability to handle day-to-day 
challenges are affected by diabetes. Slow service at a restaurant or the 
energy spent rushing about on the morning the alarm clock failed to sound can 
drop blood sugar, causing the sufferer to slip into incoherence, turn 
unexpectedly belligerent, or be immobilized with dread.
    On the other hand, an infected tooth or the stress of a job interview can 
elevate blood sugar, causing fatigue. A fatigued person can become lethargic, 
downcast or ill tempered.
    "Diabetes is a complex, demanding, pretty overwhelming situation to deal 
with," said Shelley Johns, a clinical health psychologist whose clients 
include many with diabetes. "What other disease affects every minute of the 
day? Am I getting low? Am I getting high? It's one of the most time-consuming 
diseases. Even cancer patients in chemotherapy get a break. It's not like 
that for diabetics. There's no vacation from this disease." 
    Johns, 34, practices clinical psychology in Charleston, W.Va. She has a 
master's and is on the verge of completing her doctorate. Counseling is her 
second career. For 3½ years, she was a broadcast journalist with WTWO-TV.
    Her move into psychology owes in part to first-hand experience with the 
emotional trials and pitfalls of diabetes. She was diagnosed with the disease 
at age 12. 
    "I was diagnosed the day after Christmas," she said, recalling that she 
had lost a third of her body weight by then. 
    After two weeks in the hospital and being treated with insulin 
injections, she regained her normal body weight to discover she didn't fit 
the clothes she'd been given as Christmas gifts.
    Nonetheless, she said, diabetes was not the ruin of her childhood. "I 
didn't really feel all that deprived," she said. "My mom was very, very good 
at trying to make sugar-free desserts."
    But diabetes belongs to the person who has it. "From the minute I was 
diagnosed," Johns said, "I felt I had to take care of this myself. I really 
took fast and quick ownership of this." 
    Keeping diabetes a secret from schoolmates wasn't possible, she said. 
"After you've been carted off a time or two by the paramedics (because of low 
blood sugar), you do get a reputation for being different," she said. "I did 
always grow up feeling different. I didn't feel defective but I felt I had 
responsibilities that other kids had no clue about."
    Johns echoed the feelings of many people with diabetes: "It is a lonely 
disease," she said. "Nobody ever understands it."
    In her practice, she often works with patients who are struggling with 
emotional problems alongside, or even because of, their diabetes. 
    "Two of the diagnoses that happen quite a bit with diabetes are 
depression and anxiety disorders," Johns said. "One of the main reasons that 
anxiety disorders are common is the symptoms of hypoglycemia (low blood 
sugar) are similar to a panic attack. Oftentimes, people are diagnosed with 
anxiety disorders. A lot of time, people are misdiagnosed."
    Likewise, depression is significantly more common in people with 
diabetes.     "Seven to 8 percent of the general population will experience a 
major depression sometime in their life," said Johns. "Depression is roughly 
three times more prevalent in people with diabetes. It doesn't matter if 
you're type 1 or type 2. It's a little more common in women."
    Although life with diabetes can get a person down, depression is a more 
serious disorder. 
    Diagnosable depression is a pervasive blue mood lasting two weeks or 
longer, Johns said. A person suffering clinical depression may also exhibit 
diminished interest or pleasure in activities, a state called anhedonia. A 
depressed person would also have four or more of the following symptoms: a 
significant appetite change, fatigue, feelings of hopelessness, sleep 
disturbances (either insomnia or oversleeping) poor concentration, recurrent 
thoughts of death or suicide, or body movements exhibiting either restless 
agitation or ponderous slow-motion.
    "It's important to realize that diabetes doesn't necessarily cause 
depression and depression doesn't cause diabetes, but it may be a 
precipitating factor," Johns said.
Either way, it can compound the sufferer's health problems. "The reason the 
emotional side of diabetes is so vital is because once you develop something 
like depression, it can have a negative influence on the way we handle this 
disease," Johns said. "You may not be as motivated to follow your exercise 
routine, to follow your diet."
    And so, a vicious circle is created. 
    "This is why as health professionals, we address this aspect," Johns 
said. "I would encourage anyone with depression to get help from a mental 
health professional. If you have a cavity in your mouth, you get treated for 
it so you don't have to suffer unnecessarily. Likewise with depression, 
anxiety or any other emotional problem. There are extremely effective 
treatments so people don't have to suffer with those either." 
    Cognitive Behavioral Therapy, in which the therapist guides patients in 
coping and communications skills, usually provides the quickest and most 
effective psychological treatment for anxiety and depression, she said. Johns 
uses a motivational interviewing technique, asking the individual a series of 
questions that will help him or her decide what kinds of goals to work on. 
For some patients, medications may be necessary. 
    Either way, she said, no one with diabetes should suffer needlessly. 
"People are realizing it's not weak people who seek help, but people who want 
to maximize the quality of their lives and people who don't want to suffer 
    Johns has herself ridden the blues elevator to the bottom floor. Despite 
her efforts over most, but not all, of her life thus far to maintain careful 
control of her blood sugar, she began developing complications - including 
proliferative retinopathy (in 1992, her doctors threw up their hands and told 
her to prepare to go blind. For once the diabetes was unpredictable in her 
favor and the eye disease stopped its advance), the early stages of kidney 
disease and mild neuropathy (in her case, foot numbness). 
    The biggest descent came when she developed gastroparesis, a malfunction 
of the nerves that control the digestive tract, which can cause the sufferer 
to experience frequent vomiting, persistent diarrhea and constipation. 
    "That was the time I was more depressed," Johns said. "I lost the 
functioning of my body -- You do have a lot of loss with diabetes. 
    "I would go to doctors and they would tell me they couldn't do anything," 
she said. They prescribed drugs. The drugs didn't work. "For four months, I 
could not eat solid foods. I was living on whole milk and Ensure Plus. I lost 
a third of my body weight," she said. "They thought I was dying."
    Johns managed to halt the advance of her complications with even tighter 
control, made more achievable through the use of an insulin pump. Johns also 
stays active. She works out with weights and runs, walks and practices kick 
boxing for aerobic exercise.
    But, she acknowledges, getting or not getting complications depends a lot 
on the luck of the draw from the gene pool. And so, some people whose blood 
sugars run regularly high may never suffer complications or suffer them only 
in mild form, while others who have managed magnificent control of their 
blood sugars may still develop complications.
    "I don't sit around and wait for (complications) to come," she said. "I'm 
going to maximize every minute that I'm blessed with.
    "That was one of the reasons I went into what I went into. I knew I could 
be a psychologist whether I could see or not. I can do this in a wheelchair 
or I can do this blind." 
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