Tanya Caylor

 

Managing type 2 diabetes isn’t easy. Especially around the holidays. If you’re also battling depression, a common problem for people with diabetes, it’s even tougher.

That’s the bad news. The good news is that taking antidepressants tends to help people who are battling both diabetes and depression do a better job of controlling their blood sugar.

 

Researchers involved in a 2016 study published by the journal Family Practice couldn’t say whether treating patients’ depression helped lower their blood sugar levels, perhaps by making it easier for them to follow a healthy diet and exercise plan, or if it was the other way around – that achieving better blood sugar levels gave them a morale boost that helped reduce symptoms of depression.

 

Either way, the difference was dramatic: of the patients in the study flagged as battling depression, those prescribed antidepressants were twice as likely to keep their blood sugar under control, the researchers found.

 

In the study, patients were considered to be receiving treatment for depression if they received a prescription for any one of 19 drugs in four classes of antidepressants. The study didn’t measure patient adherence to the prescribed antidepressants, nor did it look at which drugs were most effective in treating depression.

 

How They Work

 

Generally speaking, most antidepressants work by increasing the levels of certain brain chemicals believed to elevate mood. These chemicals – typically serotonin, dopamine, or norepinephrine – act as neurotransmitters in the brain’s communications network. After they do their job of sending a message between nerve cells, these neurotransmitters are reabsorbed into the brain’s nerve cells. Antidepressants block this reabsorption process, making more of the chemical available.

 

Different classes of antidepressants target different chemicals. Selective serotonin reuptake inhibitors (SSRIs), for instance, target serotonin. This class of antidepressants contains some of the most widely prescribed antidepressants, including Lexapro, Paxil, Prozac and Zoloft.

 

Serotonin and norepinephrine reuptake inhibitors (SNRIs) block the reabsorption of both serotonin and norepinephrine. The most widely used SNRIS include venlafaxine (Effexor), duloxetine (Cymbalta) and levomilnacipran (Fetzima).

 

It’s important to ask your doctor about the potential side effects of any antidepressant prescribed. Generally the potential benefits outweigh the risks, but people who have type 2 diabetes tend to have more risk factors. Some SNRIs, such as venlafaxine, desvenlafaxine and levomilnacipran, may raise your blood pressure, for instance. Some tricyclic antidepressants (TCAs) are thought to cause weight gain, as does another class of antidepressant known as monoamine oxidase inhibitors (MAOIs). TCAs, among the earliest antidepressants, are not prescribed as frequently as more modern drugs because they tend to have more side effects. However, some people do respond well to this class of drug but not others.

 

New Drug in the Pipeline

 

 

A new form of antidepressant currently being fast-tracked for potential FDA approval is being hailed as a breakthrough in depression treatment. Johnson & Johnson’s esketamine is a nasal spray formulation of ketamine, a psychedelic street drug known as “Special K” that is also used as an anesthetic in surgery. Unlike traditional antidepressants, ketamine appears to block a receptor called NMDA, which is activated by the neurotransmitter glutamate.

 

The drug is making waves not only because it involves a new pathway in antidepressant brain circuitry, but because early evidence indicates that a much smaller dosage than what is typically used in anesthesia has been shown to relieve severe, treatment-resistant depression. Off-label use of the anesthetic, administered via IV drip at an increasing number of ketamine clinics nationwide, has soared in recent years, with patients desperate for relief paying hundreds of dollars per session.

 

Unfortunately, ketamine is not without risks that may make it a deal breaker for many people with type 2 diabetes. When used as an anesthetic, it has been linked to elevated heart rate, blood pressure, and blood glucose. To help address concerns with the explosion in ketamine clinics, a 2017 consensus statement issued by the American Psychiatric Association recommended that the screening process at such clinics include an in-depth look at each patient’s medical and psychiatric records, along with a thorough explanation of both the risks and limitations of ketamine treatment.

 

Other Ways to Control Blood Sugar

 

Luckily, drugs are not the only option for treating depression in people with type 2 diabetes. A study called Program ACTIVE II has shown that regular exercise with a personal trainer is another promising avenue for treatment, and one that has the added benefit of helping manage diabetes symptoms in the process. In the study, participants assigned to 12 weeks of guided exercise were reported to be significantly more likely to be free of major depression symptoms compared with a control group. The exercise group also averaged a 0.7 percent reduction in their A1C levels.

 

“Our study is the first to demonstrate that exercise guided by a personal trainer and performed by participants in their communities is effective in treating both depression and diabetes,” said lead study author Mary de Groot, associate professor of medicine and acting director of the Diabetes Translational Research Center at Indiana University, in a 2017 news release.

 

But no matter what type of depression treatment your doctor recommends, the important thing is that you discuss whatever struggles you may be having during office visits. It’s important to keep your doctor updated on your state of mind, because depression can wreck make even the best diabetes management plan.

 

Recognizing this need, the American Diabetes Association now encourages doctors to refer patients with depression symptoms to mental health professionals who are specially trained in the special challenges faced by people with type 2 diabetes. The ADA has even partnered with the American Psychological Association to create special training opportunities for mental health professionals.

 

“As more collaborative efforts like these take place, the psychosocial side of diabetes can be more adequately and appropriately addressed,” said Korey Hood, a member of the development team behind the ADA’s Mental Health Provider Diabetes Education Program.

 

“People with diabetes need compassionate clinicians, who are aware of the lifelong challenges of living with diabetes and the impact mental health has on diabetes management,” said Hood, a professor in both pediatric endocrinology and psychiatry at Stanford University.

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