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The bad news is you may be at risk for diabetes. The good news is there is something you can do about it.

"One plus one equals much more than two when you add diabetes and depression."

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 Depression and Diabetes

Not only is depression is one of the worst illnesses known to humankind, it is also implicated in another of one of the worst illnesses known to humankind - diabetes. For someone with a severe case of diabetes, the disease can amount to a slow and painful execution extending over years and decades. For many years it was thought that depression was a complication of diabetes, which may well be the case. More recent research, however, points to depression as a possible cause or trigger.

What We Know About Depression and Diabetes

A Kaiser Permanente study of some 1,680 subjects found that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About 84 percent of diabetics also reported a higher rate of earlier depressive episodes.

A 2004 Johns Hopkins and other centers study tracking 11,615 initially nondiabetic adults aged 48-67 over six years found that "depressive symptoms predicted incident type 2 diabetes."

According to an evaluation of 20 studies over the past 10 years, the prevalence rate of diabetics with major depression is three to four times greater than in the general population. While depression affects maybe three or five percent of the population at any given time, the rate is between 15 and twenty percent in patients with diabetes, according to the American Diabetic Association. Women, in particular are at greater risk, according to other studies.

Whether a cause or an effect, the combination of diabetes and depression can be deadly. "One plus one equals much more than two when you add diabetes and depression," says Patrick Lustman, PhD, professor of medical psychology in the department of psychiatry at Washington University School of Medicine in St Louis. "Because of physiologic and behavioral interactions between diabetes and depression, each becomes more difficult to control, increasing the risks of cardiovascular disease, diabetic retinopathy causing blindness, neuropathy and other complications."

Dr Lustman also mentions obesity as a risk factor for macrovascular disease. Unfortunately, depressed people tend to eat more and exercise less, which results in weight gain and sabotages efforts at controlling blood sugar levels. One study found that depressed adults with diabetes had significantly higher body mass indexes than nondepressed adults with diabetes.

Another study found that depression in diabetics was a greater risk factor for heart disease than high blood sugar.

But if depression can trigger diabetes or make it much worse, it stands to reason that effectively managing one's depression can help bring one's diabetes under control. Dr Lustman and his colleagues have tested that proposition in a number of studies:

In 1997, in a placebo-contolled study, Dr Lustman found that diabetic patients responded well to the tricyclic antidepressant, nortriptyline The drug both worsened glucose levels in nondepressed patients and improved the levels in those who were depressed.

In 1998, he tried cognitive behavioral therapy and diabetes education (with no drugs) on a group of patients with type 2 diabetes and major depression, and concluded it to be an effective treatment.

Most recently, at an annual meeting of the American Diabetes Association held in June 2000, Dr Lustman made public his findings on his latest study. One group of 30 patients was given a daily dose of Prozac, the other a placebo. It was expected that the Prozac would help lift the depression in his test subjects. What he also found was the drug demonstrated a significantly greater improvement in blood sugar levels.

According to Dr Lustman, this result may be possible because an antidepressant dampens the body's response to the hormone, cortisol, which is released during times of stress.

The NIH has convened a panel to pursue more clinical trials. Someday, we will know a lot more about the role depression plays in diabetes. In the meantime:

If you suffer from depression, it pays to consider yourself at risk for diabetes and act accordingly. No smoking gun has been found, but that is the fault of science, which has been delinquent in tracking down mind-body connections. Compliance with your medications, good diet, sleep, exercise, and avoidance of stress is both good depression-management as well as possible diabetes prevention.

If you suffer from diabetes, ask your doctor for a depression screening at once. While we may not know for sure if depression can cause or trigger diabetes, we do know that depression can make diabetes a lot worse. If a screening reveals you do have depression, do not hesitate to treat your depression with both antidepressants and talking therapy.

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Lisa (July 3, 2004):  My personal experience with diabetes and depression.
If I exercise daily my depression is gone. No exercise depression returns. If I don't exercise my blood sugar levels increase and I have the depression including serious cognitive changes.

Question: Do high glucose levels cause depression? Every time same result. I am 48 years old and have the same result every time for 20 years. If I take a break just two days the depression returns. Second question. Could I be going through withdrawal from endorphins post exercise. Depression returns within 48 hours of no exercise.

McMan (July 3): Your own experience is your best guide, Lisa. Obviously you need the daily exercise. There's any number of reason why this could be happening, but that's not important - the point is it's happening and you know how to avoid it. High glucose can result in sugar highs that quickly turn into sugar crashes. The high sugar can trigger high insulin in your system that results in cravings for even more sugar.

Jo Lynn (Aug 1, 2004):  My heart goes out to anyone who wrote a message at this site, detailing his or her pain and/or experiences.  I have joined the few but miserable masses of those with diabetes and bipolar illness (5 in my family have it).  As probably most folks have done, I've spent exhaustive hours doing research on both subjects and discovered the following:

1.  Re: bipolar -- it doesn't go away.  A "more normal" state can be achieved on lithium orotate. (www.vrp.com) with few (maybe a headache until your body gets used to it) or no side effects.  I take 4 (the maximum amount) little highly-bioavailable capsules a day.  It's a self-regulating situation with very-little-to-no toxic side effects, unlike the lithium citrates or lithium carbonates that destroy your liver--you know the ones MDs want to hand out like candy.

Since I tend to be a little vocal (you can tell by the length of this email response), I have gotten bolder with announcing my problem, gradually, as the situation presents itself to do so.  Some people are still taken back by it, of course, but I have also been informed it explains some of my behavior, incongruencies, and highs and lows.  I'm still accepted (amazing!) by most, and avoided by some (that's their problem).  And, since I am in a highly scrutinized position (pastor's wife), it was not an easy choice to make.  But, I did, and I'm glad.  No regrets there.  I actually feel free for having done so.  It's not a "sin," and I refuse to have it treated as such.  It's a disease, pure and simple.  It's just that I don't have an amputation and I am not sitting in a wheelchair; therefore, it's not visible, and thus, it's scary to some.  They'll get over it or die with it on their minds.

2.  Re: diabetes -- I don't swallow being stuck with this for the rest of my life.  Again, after spending hours in research, I stumbled on a method that is proving to work for me.  After a recent hospitalization and a HMG A1C through the roof, I decided (this time for sure) that MDs do NOT always know what they're doing, or if they do, they should be ashamed because their motivations are strictly for their financial portfolios (pharmaceutical stocks) and NOT the patient (I've been a medical transcriptionist for years, and I've read some things I cannot even talk about, but, let's just say, I do not have a great deal of confidence in the broad spectrum of the medical profession--not like I'd like anyway). 

If someone were to ask me how I'm conquering my diabetes, I would tell them about Dr. Hulda Clark (www.drclark.net), about "zapping" parasites, and about ingesting Everclear (my addition to the regimen—see below).  Sounds strange huh?  Well, purportedly, Dr. Clarke (a physiologist and cellular biologist--NOT MD), scientifically observed that all diabetics she treated had two things in common--a pancreatic fluke (Eurytrema) and the simultaneous presence of wood alcohol in their system.  After killing the fluke (in the pancreas) with "zapping" and/or herbs, and removing the sources of wood alcohol (bottled drinks, toothpaste, cosmetics, etc.), the patients normalized and the diabetic symptoms were relieved.  Well, that sounded great, and I tried it and though beginning to get some relief, I decided to see if there was an antidote for the wood alcohol,and Idiscovered it was grain alcohol. Dr.Clark is a big proponent of grain alcohol for the purpose of external antiseptic, and it is wonderful for that.

Now, ethanol is some nasty-tasting stuff, and to drink any of it, you need to water-dilute the dog out of it (1 fifth Everclear poured into in a gallon jug, then filled the rest of the way up with distilled water), but it really does help, just taking a water-diluted tablespoon or two at night in a little more water before going to bed (this would not be advised at all for someone with an alcohol addiction).  Even if I mess up and drink an occasional coke now, my sugar doesn't go up.  Finding something to deal with the wood alcohol presence in the body was important to me because I probably will never completely give up coke, cosmetics or toothpaste.  Okay—maybe I won’t tell the congregation about the Everclear just yet—but my use is medicinal, not recreational.  If recreational drinking is your problem, don’t do this.

One more thing:  I found this great product on the internet (supposedly it was advertised on TV but I haven't seen it there) called Carboslim (www.dietbargains.com) that contains a world of good stuff for diabetics if there is no sensitivity to the ingredients:  Gymnema sylvestre ("sugar blocker" on your taste buds and in the sugar receptor sites of your intestines), chromium (be sure you're not sensitive--some bipolars have problems with too much chromium and vanadium aggravating mania), green tea, and an amylase inhibitor (wheat-based “starch blocker”) that inhibits the function of alpha-amylase in the stomach, an enzyme that takes starchy carbs and turns them into fat.  Taking Carboslim, most starches just pass through the body like fiber and are not absorbed, and this product produces much, much, much less gas than the kidney bean-based version of "starch blockers" and is many, many, many times more effective.  Before I started using this stuff, I couldn't eat a piece of bread without my sugar zooming up.  But now, after being on this product for a while, I barely get a rise, if at all.

There's more, of course; there always is (like ionic Silver, research on calcium cascading in bipolar illness, why lithium works, etc.), but I've probably worn out my email welcome, so I'll end. I wish the very best to anyone going through the bipolar/diabetes thing.  It's a moment-to-moment struggle some times, but the days get better if you don't give up, if you keep trying to find what works for you.  Hope I helped somebody.  God bless.

June 2/20:  Very interesting reading the articles having been type 1 diabetic for over 35 years:  Depression was not diagnosed until after my 1st child  's arrival, but looking back at my life I would say I had definitely had it before.  Now I suffer from Major Depression and have both medication and talk psychotherapy - it helps immensely, but resources are limited and its all very expensive!  Bad sugars make you feel worse, but it is one of the biggest chicken or egg questions I've experienced.

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Patrick Lustman:  One plus one equals more than two.