Diabetes and Depression – a Deadly Mix, Needs a Fix!

Today, depression is the leading cause of ill health and disability worldwide. According to the latest estimates from the World Health Organization (WHO), globally more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health burden. Lack of support for people with mental disorders coupled with a fear of stigma, prevents many from accessing the treatment they need to live healthy, productive lives. The associated health risks are extremely huge and significant in people with depression. WHO has identified strong links between depression and other non-communicable diseases including type 2 diabetes. No wonder this has been very well recognized in the global forum in that this year’s World Health Day (7th April) is aptly campaigned with the theme slogan - “Depression: Let’s talk” – says Dr. M. Balasubramanyam, Dean of Research Studies & Senior Scientist at the Madras Diabetes Research Foundation, India.

Diabetes and Depression – Two-way Relationship with vicious ramifications

Meta-analysis studies report that the prevalence of major depression in people with diabetes was 11% and the prevalence of clinically relevant depression was 31%. Higher prevalence of depression in diabetics has been observed in many countries all over the world. The available data regarding the prevalence of depression in type 2 diabetes patients in India are limited. The Chennai Urban Rural Epidemiology Study [CURES] of the Madras Diabetes Research Foundation (MDRF), India has reported a prevalence of 23% depression in patients with type 2 diabetes and the prevalence of depression was significantly higher (from 28 to 48%) among diabetic subjects with macro and microvascular complications. Overall, studies have demonstrated that individuals with diabetes are more likely to have depression than in individuals who do not have diabetes.

Diabetes and depression represent a two-way relationship. Depression leads to diabetes & diabetes leads to depression. If you have both it is hard to get the desired relief in either diabetes or depression management. Diabetes and depression are the two villains, which can rob us our genuine right to lead a healthy life. The only way we can strive to beat either of the problems is to administer greater control on our diet and being physically fit through our exercise regime, in addition to appropriate treatment from the health care providers.

Depression can be prevented as well as treated

People with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide. It’s good to know that depression can be prevented and treated. For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery. A better understanding of what depression is, and how it can be prevented and treated, will help reduce the stigma associated with the condition, and this will lead to more people seeking help. There are effective treatments for moderate and severe depression. Health-care providers may offer psychological treatments (such as behavioural activation, cognitive behavioral therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]).

Deeper science is needed to understand the link between diabetes and depression

“Depression might be associated with a high rate of developing serious medical co-morbidities of non-communicable diseases (NCDs) viz., cardiovascular disease, stroke, dementia, osteoporosis, diabetes, and the metabolic syndrome” – says Balasubramanyam. While these are conditions that typically occur late in life, it appears that depression might accelerate these NCDs through a biological mechanism of “accelerated aging” – he adds. At present the mechanisms linking diabetes and depression are not entirely clear. Much more research is needed to further delineate the relationship between these two comorbid conditions. Recent studies imply that both diabetes and depression could be mechanistically linked to hypothalamic-pituitary-adrenal axis alterations, metabolic dysregulation in relation to glucose and lipid homeostasis, excitotoxicity, oxidative stress, a proinflammatory milieu, altered levels of neurotrophic factors and accelerated cell aging. Definitely, this is a ‘thrust and challenging area of research for the future’ – says Balasubramanyam. Identifying appropriate biomarkers at the interface of diabetes and depression will pave way for novel and new therapeutic applications. ‘In addition, lifestyle modifications such as structured exercise, yoga and meditation should be adopted to prevent as well as treat diabetes and depression’ – concludes Balasubramanyam.

Dr. M. Balasubramanyam, PhD, MNASc, FAPASc is Dean of Research Studies & Senior Scientist at the Madras Diabetes Research Foundation (MDRF) in Gopalapuram, Chennai, India. He has a special interest in disease biology; molecular pathogenesis of diabetes and its vascular complications including diabetic retinopathy; vascular biology and signaling studies on VSMC; clinical significance and subclinical relevance of cellular and molecular alterations in metabolic diseases; mechanisms of accelerated senescence (ageing) and telomere biology; insulin signaling & proteomics; epigenetics; RNAi and miRNA, gut microbiome (metagenomics) and metabolomics aspects of diabetes, unraveling mechanisms of hyperglycemic memory, calcium & redox signaling, proinflammation, oxidative stress, ER stress, AGE pathway and biomarker(s) identification; role of endocrine disruptors in diabetes; bioprospecting herbal molecules; complementary medicine including molecular benefits of yoga; non-invasive point-of-care (POC) clinical measures and medical devices.
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