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[IP] Re: Depression

This article was on this list about a year ago, I think it's time to re-run

YOU KNOW YOU HAVE DIABETES WHEN . . .               (by Marcella Tardy)
. . . Your 'honey' calls you 'sweetie' and you get upset.

   "Is there anything diabetes doesn't affect?" you may ask forlornly. The
short answer is: 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 inter- view 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? (Before home BG tests there was no
way to know. A level can change in 10 min.) 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 three years she was a broadcast journalist with WTWO-TV.

   Her move into psychology owes in part to firsthand experience with the
emotional trials and pitfalls of diabetes. She was diagnosed with the
disease at age 12. "It was 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 for

   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."  Keeping
diabetes a secret from schoolmates wasn't possible, she said. "After you
have  been carted off a time or two by the paramedics (because of low  BGs),
you do get a reputation for being different," she said. "I grew 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 & 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 times people are misdiagnosed."

   Likewise, depression is significantly more common in people with
diabetes. "Seven to eight percent of the general population will experi-
ence 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 clini- cal depression
may also exhibit diminished interest or pleasure in activi- ties, a state
called anhedonia. A depressed person would also have four or more of the
following symptoms: a significant appetite change, fati- gue, 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, loss of

  "It's important to realize that diabetes doesn't necessarily cause
depression and depression doesn't cause diabetes," Johns said, but diabetes
may be a precipitating factor to depression. 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 exer- cise 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'd 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 depres- sion, anxiety
or any other emotional problem. There are extremely effec- tive treatments;
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 indi- vidual 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. (For
naturally-occurring chemical or hormonal imbalances.)

   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 unnecessarily."

   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 care-
ful 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

  The biggest descent came when she developed gastroparesis, a mal- function
of the nerves that control the digestive tract, which can cause 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 acknowl- edges, 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 waiting for (complications) to come; I'm
going to maximize every minute I'm blessed with. That was one of the reasons
I went into this field; 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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