How Depression Affects Your Diabetes Self- Management
Of all the medications people living with diabetes are commonly prescribed, antidepressants could be the most valuable.
Depression is a common problem for people living with type 2 diabetes, and with good reason: managing the disease at times can be overwhelming.
It should come as no surprise, then, that studies show nearly a third of people living with diabetes exhibit symptoms of depression, with more than one in 10 meeting the criteria for major depressive disorder.
That’s the bad news. The good news is people with diabetes who take antidepressants medication have significantly greater success in controlling their blood sugar levels than those who have been diagnosed with depression but are not receiving treatment.
Researchers involved in a 2016 study published by the journal Family Practice couldn’t say whether treating patients’ depression helped lower their blood sugar levels, perhaps by making it less daunting for them to follow a healthy diet and exercise plan, or if it was the other way around – that achieving better blood sugar levels gave them a morale boost that helped reduce symptoms of depression.
In the study, patients were considered to be receiving treatment for depression if they received a prescription for any one of 19 drugs in four classes of antidepressants. The study didn’t measure patient adherence to the prescribed antidepressants, nor did it look at which drugs were most effective in treating depression.
Generally speaking, most antidepressants work by increasing the levels of certain brain chemicals believed to elevate mood. These chemicals – typically serotonin, dopamine, or norepinephrine – act as neurotransmitters in the brain’s communications network. After they do their job of sending a message between nerve cells, these neurotransmitters are reabsorbed into the brain’s nerve cells. Antidepressant medication block this reabsorption process, known as reuptake, thereby making more of the chemical available.
Different classes of antidepressant medication target different chemicals. Selective serotonin reuptake inhibitors (SSRIs), for instance, target serotonin. This class of antidepressants contains some of the most widely prescribed ntidepressant
medications, including Lexapro, Paxil, Prozac, and Zoloft.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer class of antidepressant that blocks the reabsorption of both serotonin and norepinephrine. It
includes antidepressant medication such as venlafaxine (Effexor), duloxetine (Cymbalta),
and levomilnacipran (Fetzima).
It is the mental healthcare professional’s job to assess whether the benefits of a particular antidepressant medication outweigh the risks for people with diabetes which in the case of type 2 diabetes may be much more complicated. Some SNRIs, such as
venlafaxine, desvenlafaxine and levomilnacipran, may raise blood pressure, for instance. Some tricyclic antidepressants (TCAs), are linked to weight gain.
A new form of antidepressant medication currently being fasttracked for potential FDA approval is being hailed as a breakthrough in depression treatment. Johnson & Johnson’s Esketamine is a nasal spray formulation of ketamine, a psychedelic street drug known as “Special K” that is also used as an anesthetic in surgery. Unlike traditional antidepressants, ketamine appears to block a receptor called NMDA, which is activated by the neurotransmitter glutamate.
The drug is making waves not only because it involves a new pathway in antidepressant medication brain circuitry, but because early evidence indicates that a much smaller dosage than what is typically used in anesthesia has been shown to relieve severe, treatment-resistant depression.
Unfortunately, ketamine is not without risks that may make it a deal breaker for many patients with type 2 diabetes. When used as an anesthetic, it has been linked to elevated heart rate, blood pressure and blood glucose. A 2015 study in the International Journal of Clinical and Experimental Medicine found that diabetic rats treated with ketamine had an increased risk of hyperglycemia. To help address concerns with the growing number of ketamine clinics, a 2017 consensus statement issued by the American Psychiatric Association recommended that the screening process at such clinics include an in-depth look at each patient’s medical and psychiatric records, along with a thorough explanation of both the risks and limitations of ketamine treatment.
Luckily, drugs are not the only option for treating depression in type 2 diabetes patients. A study called Program ACTIVE II has shown that regular exercise with a personal trainer is another promising avenue for treatment, and one that has the added benefit of helping manage diabetes symptoms in the process. In the study, participants assigned to 12 weeks of guided exercise were reported to be significantly more likely to be free of major clinical depression symptoms compared with a control group. The exercise group
also averaged a “clinically meaningful” 0.7% reduction in their A1c levels.
“Our study is the first to demonstrate that exercise guided by a personal trainer and performed by participants in their communities is effective in treating both.