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Depression and Diabetes: A Deadly Combination

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Diabetes is a chronic and serious illness that, if left untreated, can lead to a slow and horrible death. Type 1 and Type 2 are the two varieties of this disease.

In Diabetes insulin, which is a hormone, is produced by the Pancreas. The importance of insulin is that it pushes glucose into the cells comprising our bodies. Without glucose, the cells would die and we would perish. Glucose comes from the food that we eat. Our digestive system breaks down sugars and starches into glucose. When the pancreas is not working correctly, the result is too much glucose in the blood stream. Too much glucose is dangerous because it can damage body organs such as the Nervous System, Kidneys, Eyes and other organs leading to hear disease, high blood pressure and death.

Type 1 Diabetes begins to occur during childhood and is characterized by the fact that the pancreas fails to produce enough insulin.

Type 2 Diabetes is the most common type and usually starts between the ages of 40 and 60. Obesity and lack of exercise appear to be the major causative factors in Type 2 Diabetes.

A Study recently completed at Johns Hopkins University has provided an answer to a nagging question about the relationship between Depression and Type 2 Diabetes. The question was the old one: "which came first question, the chicken or the egg?" In other words, does Type 2 Diabetes cause depression, or does depression cause Type 2 Diabetes? The results of the study show that the answer runs both : Depression causes Type 2 diabetes and Type 2 Diabetes can cause depression. The question is why?

Depression as a cause of Type 2 Diabetes:

The researchers at Johns Hopkins suggest that depressed people live the type of life style that leads to Type 2 Diabetes. This life style includes such things as: 1. Avoiding exercise, 2. Smoking, 3. Over eating, 4. Gaining a lot of excess weight.

During many years of private practice I have treated a number of people who suffered from Type 2 Diabetes. I also spent some time working on the medical side of the house in various hospitals rather than only the psychiatric side.

It soon became clear to me that Type 2 Diabetes involves serious emotional issues. Whether in private practice or in the hospital, those afflicted with this kind of diabetes were depressed people who also seemed to have some personality disorder types of problems.

For example, these were people who were obese and had been for many years prior to the onset of the illness. The patients were able to describe a life style devoid of exercise and comprised of over eating foods rich in sugars and starches. In all of the cases with which I was familiar, there were long standing and chronic family, economic and emotional problems going all the way back to childhood. It was not just that they were depressed now that they were ill but had suffered from depression for most of their lives. Consequently, they had always lived sedentary and passive lives except for their indulgence in the unhealthiest types of food.

Now that studies confirm the fact that Type 2 Diabetes and Depression both cause and reinforce one another it raises the question of what might happen if depression is treated early? In other words, could we prevent and therefore reduce the numbers of diabetics through an aggressive program of identifying and treating depression, even as early as childhood?

This is a complex issue because, in my opinion, it goes beyond depression into the personality disorders. What was striking to me about diabetic patients was their resistance to any type of help. Even those patients with poor blood circulation (a result of diabetes) and in danger of losing limbs through amputation, there was a stubborn refusal to alter diet and life style. I believe that part of this was due to denial but part of it was a life long and repetitive pattern of behaving in self destructive ways.

In my practice there was the example of a person, diagnosed with Type 2 Diabetes who refused to change eating habits, go on anti depressant medications or stay in psychotherapy for more than a couple of months. The last I heard was the diabetic disease was progressing with increasingly debilitating consequences.

Your comments are welcome and encouraged

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