Everybody tends to feel down at one point or another in
their lives, but what happens when that feeling lasts for
weeks at a time? This could be a major sign of clinical
depression.

Depression can affect your mood, thoughts, behavior, and body and can lead to problems at school, work, or home. Depression affects the way you communicate with others, and the way you think and feel about life in general. Depression may also lead to alcohol or drug abuse as well as other addictions.

Many risk factors can contribute to clinical depression. Some of these factors include one's biology (body's function), medications, family history (genetics), situation (i.e. death of a loved one, divorce, etc.) and other co-occurring illnesses such as stroke, heart disease, cancer, or diabetes.

Researchers have found that major depression is significantly more common in patients with diabetes than in the general population. In fact, studies indicate that people with diabetes (Type 1 or Type 2) are twice as likely to become depressed as compared with non-diabetes groups, and women with diabetes suffer more from depression than men with diabetes. Approximately 15% - 20% of adults with diabetes, both type 1 and 2, suffer from depression (Lustman PJ, et al. Depression in Adults with Diabetes. Semin Clin Neuropsychiatry 1997). Increased health care use and costs for people with diabetes who have depression is 4.5 times higher than for individuals without depression ($247 million versus $55 million). (Deyi Zheng, E, & Simpson, K. Diabetes Care 2002; 25(3), pp. 464-470)

Depression can become a serious paralyzing factor in
caring for one's diabetes. It can cause people to just
want to "give up" or "not care anymore" about things
like taking their blood sugar levels. It can also cause unhealthy eating patterns, not taking one's medications, lack of motivation to exercise or good self-care for diabetes. Ask your physician, psychologist, social worker or other mental health professional for help.

What are the symptoms of clinical depression*?

- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Changes in appetite (loss or increase of appetite)
- Weight fluctuations (extreme weight gain or weight loss)
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
- Use of alcohol or drugs to feel "better"

*It is natural to briefly experience some of these symptoms from time to time. However, if you have been encountering a number of these symptoms for two weeks or more and they are having a detrimental effect on your personal or professional life, you may be experiencing a more serious form of depression.

If you are experiencing any of these symptoms talk with your doctor, nurse, counselor or other health/mental health professional.

What is the treatment for depression?

If diagnosed, depression is treatable. Relief of depression is associated with improved glycemic control. Exercise greatly improves diabetes control as well as releases more endorphins, the body's chemical compounds that improve mood and fight pain. However, if you are already physically active, exercise may not relieve your depression symptoms.

Your health care team will need to make a proper assessment in order to decide the best method of treatment for depression. Treatment can consist of antidepressant medication, psychotherapy, cognitive/behavioral therapy, interpersonal therapy, or any combination. Besides taking doctor prescribed drugs (antidepressants) and having psychotherapy, other steps can be taken to relieve depression symptoms.

The following resources may be useful to you:

RI Council of Community Mental Health Centers, Inc. 272 Exchange St, Providence (401)273-0900

Samaritans Emergency Line [Suicide prevention] (401)272-4044 www.samaritansri.org

Suicide Prevention [HEALTH site]

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