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High prevalence of Psychiatric illnesses are found in diabetic patients. There is 71% lifetime prevalence of Psychiatric disorder in Diabetic patients, most common is depressive and anxiety disorders. Depression is a major public health problem and so is Diabetes, causing disability and distress to patients and their families, and results in socio-economic loss. A history of major depression was found in 33% of the patients: despite high prevalence of depression in people with Diabetes, it is frequently unrecognized and untreated. Are Depression and Diabetes Linked?

Yes. Studies indicate that people with Diabetes may be two to three times as likely to become depressed as people without Diabetes. Why? If you consider that a feeling of helplessness is one of the most common causes of depression, it is easy to understand how the frustration and unpredictability of blood sugar control could lead to feeling helpless despite one’s best efforts.

There is a difference between clinical depression and common sadness or grief. The main difference is in time and intensity. Clinical depression is more than the normal response of feeling down for a couple of hours or days. It is more dramatic and it takes you down further and longer.

A psychologist would diagnose clinical depression if a patient had five or more of these symptoms for at least two weeks:

• Depressed mood (feeling sad or empty) most of the day, nearly every day
• Markedly diminished interest or pleasure in all, or almost all, activities of the day, nearly everyday
• Significant weight loss when not dieting or weight gain (more than 5% of body weight in a month), or decrease or increase in appetite nearly everyday
• Trouble sleeping or sleeping too much nearly everyday
• Feeling agitated or sluggish nearly everyday
• Fatigue or loss of energy nearly everyday
• Feeling worthless or excessively or inappropriately guilty nearly everyday
• Diminished ability to think or concentrate or makes decisions, nearly everyday.
• Recurrent thoughts of death (not just a fear or dying) or suicides, or suicides attempt or plan to commit suicide.

We know from studies that about two-thirds of doctors fail to recognize depression. It may be because they didn’t ask or the patient didn’t tell. In any case, if you think your patient fulfills the above criteria you should initiate appropriate anti-depressant therapy. Research indicates that professional counseling, sometimes in combination with anti-depressant medication, is a very effective treatment for depression. Onset of complications increase the intrusiveness of disease which inturn increase the depressive symptomology.3

Prevalence of Depression in Diabetes Mellitus

From 39 studies having a combined total of 20,218 subjects. The principal conclusion of the review is that doubles the odds of depression. The Odds ratio (OR) of depression is more consistent across studies than is the prevalence, which varies by sex, study design, subject source, and method of depression assessment. The overall OR estimate generalizes across community and clinical settings despite differences in prevalence rates between these settings. Both clinicians and epidemiologists can expect individuals with DM to be twice as likely to be depressed than otherwise similar nondiabetic individuals in similar settings (i.e., individuals selected by similar procedures, of the same sex, and assessed with comparable depression assessment methods). In contrast, the prevalence estimate must be adjusted for moderators such as sex.

Aggregate estimates based on all of the eligible studies indicate that major depression and elevated depression symptoms were present, respectively, in 11 and 31% of individuals with depression. The odds of depression were significantly higher in women than in men with depression (OR = 1.8), a pattern that mirrors the female preponderance of depression observed in epidemiological surveys of the general population. The findings are similar to the unadjusted rates reported in other medical illnesses and in an earlier review of the DM literature by Gavard et al.9 that include 18 studies. These investigators found that major depression was present in 14.7% and elevated depression symptoms in 26% of diabetic patients. Thus, as many as one in every three individuals with DM (at least in those participating in clinical studies) has depression at a level that impairs functioning and quality of life, adherence to medical treatment, and glycemic control, and increase the risk of DM complications.

The prevalence of depression varied systematically as a function of the method used to identify depression cases and the study design. Furthermore, in both controlled and uncontrolled studies, the depression rates were approximately two to three times higher in studies that used self-report measures versus diagnostic interviews. It is likely that the two approaches identify somewhat different but overlapping samples of depressed individuals. Diagnostic interviews identify major depressive disorder but exclude other clinically relevant presentations. Self-report measures also identify most cases of major depressive disorders. Self-report measures may identify a broader (e.g., dysthymic disorder, or minor or subsyndromal depression) or symptoms that reflect comorbid psychiatric illness (e.g., anxiety or substance-abuse disorders) or general distress.