Diabetes and depression — 'anger turned inward'

There has been a lot of discussion recently about the links between diabetes and depression and I am certainly seeing more of this in my clinic in recent months. Is that my heightened awareness from my reading, the patients’ heightened awareness from their reading online or in print, or a true increase in the association?

Some time ago I heard someone describe depression as “anger turned inward” and I can certainly detect a lot of anger in patients newly referred for diabetes management. Taking care of this directly is beyond my expertise but I don’t ignore it either. In particular I mention the potential effects of “stress” hormones such as epinephrine and cortisol as counter-regulatory hormones with respect to glycemic control and suggest to the patient and referring colleague that counseling might be in order.

No doubt antidepressants may play an important role in the management of endogenous depression but be careful what you wish for. Many of these therapies result in weight gain which is counterproductive for many of our patients. Several of them also interfere with sexual function such as ejaculation difficulties or anorgasmia. Many male patients with advanced type 2 diabetes have erectile dysfunction which is troubling enough without adding to the problem with new medication. Adding medications also reduces compliance with existing therapies.

One thing that certainly helps is the satisfaction patients experience as fasting and post-prandial blood glucose comes under control and they can ultimately turn this into a progressive decrease in HbA1c levels. If only we could achieve that in a greater proportion of our patients despite our best efforts at education.

I would appreciate it if some readers could weigh in on your own experience with diabetes and depression and the steps you are taking to tackle these competing conditions.