Older Women with Diabetes and Depression Have
Twice the Risk of Death
Both
problems linked to unhealthy behaviors such as smoking, poor diet and a
sedentary lifestyle
Jan. 3, 2011 Older women suffering with diabetes and depression have a
significantly increased risk of death from heart disease, as well as an
increased death risk from all causes, over a six-year period, according
to a report in the January issue of Archives of General Psychiatry,
one of the JAMA/Archives journals.
Depression affects almost 15 million U.S. adults each year and more than
23.5 million U.S. adults have diabetes, according to the report. About
20 to 25 percent of patients with diabetes also have depression nearly
twice as many as those without diabetes. Diabetes and its complications
are leading causes of death around the world.
A
study of 78,282 older women aged 54 to 79 was conducted in 2000 by
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and her
colleagues. The women were participants in the Nurses Health Study.
The women were classified as having depression if they reported being
diagnosed with the condition, were treated with antidepressant
medications or scored high on an index measuring depressive symptoms.
Reports of type 2 diabetes were confirmed using a supplementary
questionnaire.
During six years of follow-up, 4,654 of the women died, including 979
who died from cardiovascular disease.
Compared with women who
did not have either condition, the results were:
● those with depression had a 44 percent increased risk of
death,
● those with diabetes had a 35 percent increased risk of death
and
● those with both conditions had approximately twice the risk
of death.
When considering only
deaths from cardiovascular disease,
● women with diabetes had a 67 percent increased risk,
● women with depression had a 37 percent increased risk and
● women with both had a 2.7-fold increased risk.
Participants with a greater than 4 inch increase in
waist size from baseline to the third follow-up visit had a 70 percent
higher risk of type 2 diabetes
"The underlying mechanisms of the increased mortality risk associated
with depression in patients with diabetes remains to be elucidated," the
authors write.
"It is generally suggested that depression is associated with poor
glycemic control, an increased risk of diabetes complications, poor
adherence to diabetes management by patients and isolation from the
social network."
In
addition, diabetes and depression are both linked to unhealthy behaviors
such as smoking, poor diet and a sedentary lifestyle, and depression
could trigger changes in the nervous system that adversely affect the
heart.
"Considering the size of the population that could be affected by these
two prevalent disorders, further consideration is required to design
strategies aimed to provide adequate psychological management and
support among those with longstanding chronic conditions, such as
diabetes," the authors conclude.
This study was supported by a National Institutes of Health grant.
Read below to learn
more about Diabetes, Depression and Depression in the Elderly
About Diabetes (MedlinePlus NIH)
Diabetes is a
disease in which your blood glucose, or sugar, levels are too high.
Glucose comes from the foods you eat. Insulin is a hormone that helps
the glucose get into your cells to give them energy. With
Type 1 diabetes, your
body does not make insulin. With Type 2 diabetes, the more common type,
your body does not make or use insulin well. Without enough insulin, the
glucose stays in your blood.
Over time,
having too much glucose in your blood can cause serious problems.
It can damage your eyes,
kidneys,
and nerves.
Diabetes can also cause heart disease, stroke and even the need to
remove a limb. Pregnant women can also get diabetes, called gestational diabetes.
Symptoms of Type
2 diabetes may include fatigue, thirst, weight loss, blurred vision and
frequent urination. Some people have no symptoms. A blood test can show
if you have diabetes. Exercise, weight control and sticking to your meal
plan can help control your diabetes. You should also monitor your
glucose level and take medicine
if prescribed.
Depression is a
serious medical illness that involves the brain. It's more than just a
feeling of being "down in the dumps" or "blue" for a few days. If you
are one of the more than 20 million people in the United States who have
depression, the feelings do not go away. They persist and interfere with
your everyday life. Symptoms can include
● Sadness
● Loss of interest or pleasure in activities you used to enjoy
● Change in weight
● Difficulty sleeping or oversleeping
● Energy loss
● Feelings of worthlessness
● Thoughts of death or
suicide
Depression can
run in families, and usually starts between the ages of 15 and 30. It is
much more common in women. Women can also get
postpartum depression
after the birth of a baby. Some people get
seasonal affective disorder
in the winter. Depression is one part of
bipolar disorder.
There are
effective treatments for depression, including
antidepressants and talk
therapy. Most people do best by using both.
Depression is a
medical illness in which a person has persistent feelings of
sadness,often with
discouragement and a lack
of self-worth.
Depression in
the elderly is a widespread problem, but is often not recognized or
treated.
About Depression and Senior Citizens
Of
the 35 million Americans age 65 and older, about 2 million
suffer from full-blown depression. Another 5 million suffer from
less severe forms of the illness.
Everyone feels blue or sad
now and then, but these feelings don't usually last long and
pass within a couple of days. When a person has depression, it
interferes with daily life and normal functioning, and causes
pain for both the person with depression and those who care
about him or her. Doctors call this condition "depressive
disorder," or "clinical depression."
Important life changes that
happen as we get older may cause feelings of uneasiness, stress,
and sadness. For instance, the death of a loved one, moving from
work into retirement, or dealing with a serious illness can
leave people feeling sad or anxious. After a period of
adjustment, many older adults can regain their emotional
balance, but others do not and may develop depression.
Depression is a common
problem among older adults, but it is NOT a normal part of
aging. In fact, studies show that most older adults feel
satisfied with their lives, despite having more physical
ailments. However, when older adults do suffer from depression,
it may be overlooked because they may be less willing to talk
about feelings of sadness or grief, and doctors may be less
likely to suspect or spot it.
If left untreated,
depression can lead to suicide.
Feelings of
isolation or loneliness as children move away and their spouse and close
friends die
Loss of
independence (problems getting around, caring for themselves, or
driving)
Multiple
illnesses
Struggles with
memory loss and problems thinking clearly
Elderly people
often use alcohol to self-treat depression, but this may make symptoms
worse.
Depression can
be a sign of a physical illness. It can be a psychological reaction to
the illness, or directly caused by the physical illness.
Physical
illnesses that increase the risk for depression include: thyroid
disorders,
Parkinson's disease,
heart disease, cancer, and
stroke.
Symptoms of
depression may occur as part of dementia (
Alzheimer's disease).
Symptoms of
depression are also a side effect of many drugs commonly prescribed for
the elderly.
Many older
people will not admit to feeling depressed, for fear that they will be
seen as "weak" or "crazy." Some older people will not report their
depression because they believe that feeling sad is "normal," or that
nothing can be done about it.
Symptoms
Many of the
usual symptoms of depression may be present in the elderly. See:
Depression - major for
more details.
Depression in
the elderly may be hard to detect. Common symptoms such as fatigue,
appetite loss, and trouble sleeping can be part of the aging process or
a physical illness. As a result, early depression may be ignored, or
confused with other conditions that are common in the elderly.
Clues to
depression in the elderly may include:
● Being more confused or forgetful.
● Eating less. The refrigerator may be empty or contain spoiled food.
● Not bathing or shaving as often. Visitors may notice smells of
urine or stool. Clothes may be dirty and wrinkled.
● Not taking care of the home.
● Stopping medicines or not taking them correctly.
● Withdrawing from others. Not talking as much, and not answering the
phone or returning phone calls.
Exams and
Tests
A discussion of
your symptoms,
physical exam, and blood
and urine tests will help determine if a physical illness is causing the
depression.
Sometimes your
primary care doctor will send you to an expert in depression, such as a
psychiatrist, to help with diagnosis and treatment. This may be
especially useful for telling the difference between depression and
normal grieving, which occurs more often in this age group.
Treatment
See:
Depression - major for
more information about medications and other therapies used to treat
depression.
The first step
is to address any physical illnesses and stop taking any medications
that may be making your symptoms worse.
If these steps
do not relieve the depression, antidepressant medications and talking
through problems (psychotherapy) with a psychologist, psychiatrist, or
other therapist is usually helpful.
Antidepressant
drug therapy should be carefully monitored for side effects, which can
be more common in the elderly. Doctors usually prescribe lower doses of
antidepressants for older people, and increase the dose more slowly than
in younger adults.
To better manage
depression at home, elderly people should:
● Exercise regularly, seek out pleasurable activities, and maintain
good sleep habits.
● Learn to watch for the early signs of depression, and know how to
react if it gets worse.
● Minimize alcohol use and avoid illegal drugs. These substances can
make depression worse over time, and they may also impair judgment about
suicide.
● Surround themselves with people who are caring and positive.
● Talk about their feelings to someone they trust.
● Take medications correctly and learn how to manage side effects.
Outlook
(Prognosis)
Depression
usually responds to treatment. If it is not detected, depression can
lead to complications. The outcome is usually better for people who have
access to social services, family, and friends who can help them stay
active and engaged.
Possible
Complications
The most
worrisome complication of depression is suicide. Depression and older
age are both risk factors for suicide. Men account for most suicides
among the elderly, and divorced or widowed men are at the highest risk.
Families should pay special attention to elderly relatives who live
alone.
Other
complications include reduced functioning at work and in social
relationships.
When to
Contact a Medical Professional
Call your health
care provider if you feel persistently sad, worthless, or hopeless, or
if you cry often. Also call if you are having trouble coping with
stresses in your life and want to be referred for talk therapy.
Go to the
nearest emergency room or call your local emergency number (such as 911)
if you are thinking about suicide (taking your own life).
If you are
caring for an aging family member and think they may have depression,
contact their health care provider.
Prevention
Staying
physically, mentally, and socially active may help reduce the risk of
depression in older age.
References
Cassano P, Fava
M. Mood disorders: major depressive disorder and dysthymic disorder. In:
Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts
General Hospital Comprehensive Clinical Psychiatry.
1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 29.
Unutzer J.
Clinical practice: late-life depression. N Engl J Med.
2007;357:2269-2276.
Of
the 35 million Americans age 65 and older, about 2 million
suffer from full-blown depression. Another 5 million suffer from
less severe forms of the illness.