Depressive disorders in patients with diabetes mellitus
Each of us experiences a depressed state of mind from time to time. We usually associate this with some very specific event, unpleasant circumstances, or weather. Most people feel better in the summer, when it is sunny and warm. Poor tolerance of the changing seasons of the year can be one of the reasons for a bad mood. Deeper situational changes in the emotional state can occur when serious problems at work, in the family, illness or death of a loved one.
For most of us, depression and bad mood are the same thing. In fact, this is not the case. A bad mood is a normal reaction of a person to an unpleasant event. Depression (more information about depression and its symptoms can be found on the website stop-depression-meds.com) is a disease that manifests itself as a change in the mental and physical state of the body.
Mental health disorders and, first of all, depressive states, are increasingly attracting the attention of doctors. According to WHO data, one in four patients of the general medical health network (24%) has various mental disorders, and one in five (21%) has depressive spectrum disorders. According to a long-term population study in territorial polyclinics in several, approximately 30% of people who seek help from district doctors have disorders that meet the criteria for a depressive episode, and when taking into account anxiety disorders, this number reaches 50%. A high prevalence of mental disorders is observed in patients with diabetes mellitus, neurological, gastrointestinal and cardiovascular diseases. They are especially common after a myocardial infarction, stroke, heart surgery, and heart failure.
Research shows that the combination of anxiety, depression, and cardiovascular disease is not accidental. There is evidence that depressive disorders are an independent risk factor for the development of coronary heart disease, arterial hypertension, microvascular complications of diabetes mellitus and increase the likelihood of repeated cardiovascular disasters. It turned out that depression among patients with diabetes occurs in 24-46% of cases, and this combination worsens the life prognosis. Even a low-level depressed mood increases the likelihood of cardiac death, and the mortality rate in patients who have suffered a myocardial infarction and suffer from depression is 3-6 times higher than in post-infarction patients with a normal emotional background. All this points to the importance of the problem.
Today, a number of mechanisms of the influence of anxiety and depression on the incidence and outcomes of cardiovascular diseases have been established. It is shown that stress, anxiety, and depression affect the endothelial function of blood vessels, activate the processes of inflammation, platelet aggregation, and thrombosis, increase the activity of the sympathetic nervous system, the level of epinephrine, norepinephrine, and cortisol in the blood, and disrupt the metabolism of ώ-3 fatty acids and folic acid. These mechanisms contribute to atherogenesis and thrombosis.
Patients with diabetes mellitus almost always develop certain emotional and mental disorders. Especially often depressive disorders are observed in elderly people with type 2 diabetes. Their severity depends on the personal qualities of a person, the activity of his life position, and efficiency. The presence of concomitant diabetes mellitus depression hinders the patient’s adaptation, negatively affects the course of the underlying disease, worsens the implementation of medical recommendations, including those related to diet, taking hypoglycemic drugs, self-monitoring of blood sugar levels. The very fact of making a diagnosis of diabetes, a painful condition, the need to take medications and changes in lifestyle-all this leads to mental asthenization of many patients, a decrease in the quality of life.
Asthenia (translated from the Greek “impotence”, “lack of strength”) is a universal reaction of the body to any excessive loads that threaten to deplete energy resources. In this regard, mild asthenia, which occurs, for example, in students at the end of the examination session, is rather a defensive reaction and disappears on its own. Another thing is asthenia as a pathological condition that does not pass after a full rest. Its manifestations are weakness, lethargy, increased fatigue, decreased performance and concentration. At the same time, fatigue does not depend on the amount of load and does not pass on the background of rest. There is emotional instability, irritability, fears, decreased appetite and weight loss, some may experience tachycardia, shortness of breath, increased sweating, fluctuations in blood pressure. Sometimes this condition is referred to as chronic fatigue. Almost any disease can cause asthenia, including a banal cold. In most cases, it is an integral part of the picture of anxiety and depressive disorders.
Anxiety – a feeling of anxiety, nervousness, premonition of trouble, internal tension for no apparent reason. Because of disturbing thoughts, which can not be eliminated, the concentration of attention, performance, sleep is disturbed. Because of anxiety, there is a need to do something all the time, restlessness and fussiness. There are various phobias (fears) and fears for the health, life of loved ones and their own. However, patients with anxiety disorders come to the doctor with complaints of palpitations, pain in the heart, chills, shortness of breath, a feeling of lack of air, a feeling of “nausea”, convulsions, and others. With the most thorough medical examination, it is not possible to identify a serious or even any somatic disease that corresponds to the complaints. Patients with anxiety symptoms are 6 times more likely to visit a cardiologist, 2 times more likely to visit a neurologist, and 1.5 times more likely to be hospitalized. Anxiety often precedes depression chronologically.
Depression (from the Latin depressum “to lower”, “to suppress”) is a neuropsychiatric disorder characterized by a depressed mood and a negative, pessimistic assessment of oneself, one’s position in the surrounding reality, the past and the future. At the same time, the physical condition is disturbed. Depression is diagnosed if the patient has more than four of the following criteria within 2 weeks:
- depressed mood for most of the day;
- reduced interests and ability to experience pleasure;
- reduced energy (increased fatigue);
- inability to concentrate;
- disorders of appetite and sleep;
- decreased sexual desire;
- a dark vision of the future;
- reduced self-esteem and self-confidence;
- ideas of guilt;
- suicidal thoughts and intentions.
How to deal with negative emotional experiences?
Many people advise you to change your lifestyle – to give up overtime, night work, irregular working hours, try to normalize sleep and wakefulness, alternate periods of work with full rest. You should not make too high demands on yourself.
The positive effect is an increase in physical activity: walking, dosed workouts in the gym, fitness, swimming, football, basketball, tennis. Exercise will make you concentrate on your own body, and the production of endorphins will lead to an improvement in mood.
Food should be varied and complete in terms of protein, fat, carbohydrates, vitamins and minerals. You should limit the use of caffeine, sweet and fatty foods, do not drink alcohol, which acts depressingly. Protein-rich foods are recommended. It is necessary to relieve stress with proven methods: relaxation, meditation, massage, thermal treatments, walks in nature during the day and in sunny weather. You can visit the solarium (but do not abuse artificial sunlight). Sedative herbs can also help: oregano, St. John’s wort, lemon balm, lavender, wormwood, motherwort.
Traditionally, vitamins, amino acids and minerals are used in the complex of preventive and therapeutic measures. In the human body, with the participation of these substances, mediators are synthesized – the main carriers of signals in nerve cells. It is with disorders in the exchange of neurotransmitters that mental health disorders are associated. Of particular importance is the hidden deficiency of B vitamins, antioxidants (vitamins C and E), abnormal levels of magnesium and iron.
The neurotransmitter serotonin is often called the “happiness hormone” and requires vitamin B6 (pyridoxine) to form it. The normal content of serotonin in the brain causes a good mood, a surge of strength and cheerfulness, a lack – a decrease in mood and “autumn depression”. A correlation was found between depression and vitamin B6 deficiency. Pyridoxine preparations are successfully used in the treatment of various types of depression, including those caused by the use of birth control pills, monthly hormonal fluctuations in women and menopause. It is believed that in such situations, there is a violation of the metabolism of the amino acid tryptophan, from which serotonin is formed with the participation of vitamin B6.
Vitamin B1 (thiamine) is involved in the synthesis of another neurotransmitter, acetylcholine. Its deficiency is manifested by insomnia, decreased mood, memory and intelligence. A lack of niacin (vitamin B3) is associated with feelings of anxiety and fear, anxiety, despondency and depression. There are known examples of successful treatment of severe depression with folic acid drugs. With its lack, the formation of serotonin is disrupted. Vitamin B12 (cyanocobalamin) also has a reputation as an antidepressant. Mental problems may be the first signs of a deficiency of this vitamin. Many experts recommend taking vitamin B12 to all patients with nervous disorders. The same can be said about vitamin C. Even a small deficiency is accompanied by chronic fatigue. Daily supplementation of vitamin C helps to overcome depression.
B vitamins are closely related to each other and are used in a complex. One original study evaluated the effect of a 3-month intake of a standard vitamin and mineral complex on quality of life, anxiety, and depression in patients with type 2 diabetes. The treatment did not affect blood glucose, glycated hemoglobin, or insulin levels, but was accompanied by a decrease in anxiety and depression, which the researchers assessed using standard questionnaires and scales. The level of mental health and quality of life of the observation participants significantly improved.
Depressive disorders are a common mental pathology detected in patients with diabetes mellitus. Depression hinders the achievement and maintenance of long-term diabetes compensation and worsens its prognosis. Despite the fact that with depressive disorders, it is most often necessary to prescribe special medications, change the lifestyle, taking vitamin and mineral complexes can bring undeniable benefits, contributing to more effective treatment of diabetes, improving the physical and emotional state, as well as improving the quality of life of patients with diabetes. It is important not to forget that if you have any suspicions about possible depression, you should consult a doctor to confirm or refute them.