Damara N. Gutnick, MD
Primary Care Physician
Bellevue Hospital Center
Q. If I have diabetes, why do I need to be concerned about depression too?
A. Although we still don't understand why, we know that the relationship between diabetes and depression goes both ways. Diabetic patients are more likely to be depressed, and people with severe depression are more likely to have diabetes. We also know that worsening depression is associated with poorer control of blood sugar and with greater risk of complications like foot ulcers, amputations, kidney failure, eye problems, heart attack and stroke. This poorer control of blood sugar may be because patients with depression are less motivated to take prescribed medication or make the changes in diet and exercise that will keep their diabetes manageable.
Q. What causes depression?
A. Depression is an illness that is caused by a chemical imbalance of neurotransmitters in the brain. The imbalance can be triggered by excessive stress, extraordinary life occurrences, or it might just occur spontaneously and not be related to any recognizable event.
Q. How would I feel if I had depression?
A. You may experience difficulty sleeping, have poor appetite or overeat. You might also have trouble concentrating or reading, feel fatigued or have low energy. People who are depressed often experience low self-esteem and have little interest or pleasure in doing things. In more serious cases, they can have thoughts about hurting themselves. If you feel this way, you should seek the help of a healthcare professional immediately.
Q. What should I do if I feel depressed?
A. Everyone can feel depressed once in a while. That does not mean you have depression. That's why it's important to talk to your doctor or healthcare provider right away. If you are diagnosed with depression you'll be able to consider available treatments that can help make you feel better. If you have active thoughts of suicide you can also call 1800-LIFE-NET at any time of the day or night for guidance on how you can get immediate help.
Q. If I have depression, can my regular diabetes doctor diagnose it?
A. At HHC hospitals and health centers, all primary care physicians are trained to use a simple list of nine questions, called a PHQ-9 questionnaire, to determine the presence and frequency of the various symptoms of depression. Your diabetes doctor or his or her medical assistant should be able to help you complete this questionnaire. The higher the score on the questionnaire, the more likely it is that a patient has a major depressive disorder. Your diabetes doctor can then determine if you need additional care and support from another specialist at HHC. It is important to note that the PHQ-9 is only a screening test for depression and doesn't replace a doctor's judgment and experience while making the diagnosis of depression.
Q. Can depression be treated with medication, counseling, or both?
A. The best treatment approach for depression depends on how severe it is, the type of depression, and patient preference. Patients with severe depression usually do better with a combination of medication and counseling. Medication acts to correct the chemical imbalance that causes the depression. Counseling supports a patient to self-manage their disease.
Patients with diabetes and depression may benefit from a counseling method called Brief Action Planning. Using this technique, patients are encouraged to make a specific and personal action plan for their health. For example, a diabetic patient may decide to make a dietary change - like cutting down on rice in their diet. The counselor will work with the patient to ensure that their plan is specific and can be realistically achieved.
Q. Would anti-depressant medication have a bad interaction with the medication I take for my diabetes?
A. None of the anti-depressant medications that are routinely prescribed by our doctors today will have a negative interaction with diabetes medications. But, always ask your doctor or pharmacist when a new drug is prescribed or when you plan to use over the counter medications.
Q. What else do I need to know about anti-depressant medication?
A. You won't start feeling the benefits of the medication for three to five weeks. These medications may have side effects that may last several weeks, such as nausea, diarrhea, sexual dysfunction, anxiety, or fatigue. Ask your doctor to learn which side effects may be expected and what steps to take to minimize those side effects. For example, if a side effect is fatigue, a dose before bedtime may alleviate the symptoms. And if the side effects of one medication are too difficult, ask your doctor about a substitute.
Q. If I start treatment for depression, will I need it for a long time?
A. Patients with depression can have multiple recurrent episodes during their lives. That's why it's often recommended that patients continue antidepressant medications for 6-12 months after the depression is in remission. Patients who've had three or more depressive episodes during their lives may need more extended treatment. But every patient is different. That's why the decision to continue or discontinue antidepressant medications should be made in consultation with your physician. It is also important to know that stopping an antidepressant medication abruptly can sometimes lead to uncomfortable side effects. So speak to your doctor before stopping your medication.