Diabetes Diagnosis Increases Psychiatric Disorder Risk

KONICA MINOLTA DIGITAL CAMERAI understand that scientific studies must be completed so that it can become more than anecdotal evidence. These studies need to be published in reputable academic journals, showing the researchers have followed the proper protocols to get to the conclusion.

But for this latest study, I could have saved everyone a lot of time and money.

This starkly titled study was published on February 3, 2015 in ADA’s Diabetes CareRisks of Psychiatric Disorders and Suicide Attempts in Children and Adolescents With Type 1 Diabetes: A Population-Based Cohort Study.

A large study in Sweden assessed children diagnosed with T1 diabetes and their healthy siblings over a longitudinal study (and also combined a comparison to the general population). Upshot? Here it is:

Children with type 1 diabetes are at high risk of psychiatric disorders, which seems to be a consequence of the disease rather than due to a common familial etiology. The results support recommendations on comprehensive mental health surveillance in children with type 1 diabetes, especially in recently diagnosed children.

In their research, the investigators found the risk for psychiatric morbidity tripled in the first six months of diagnosis. Even long-term, it was still twice as high for the entire observation period compared to the control subjects. I could have told them that.

No Surprise

For a child, a Type 1 diabetes diagnosis is traumatic. (Yes, it’s traumatic for the whole family. Let’s focus on the kid right now and what she/he thinks.) You go from being fine (or your concept of fine) to being told that you have an incurable disease that you can, at best, manage well enough to avoid major complications. Of course, you’ll have to be diligent, stab yourself with needles and lancets, and despite your best efforts, you may still get complications. You tell me if that would send you to your happy place…

I was diagnosed in 1983. Less than 24 hours after my Type 1 diabetes (it was called juvenile diabetes back then) was confirmed, I was in Joslin Clinic’s inpatient Diabetes Treatment Unit where I spent 11 days being indoctrinated. I was too busy learning about insulin and exchanges and sick day rules to really think about what the long-term impact on my life would be.

When it overwhelmed me, it wasn’t in the first six months. In my experience, my medical team and my family worked hard to prepare me for the long slog ahead to the best of their abilities. I know that I was loved and that I was educated in my disease. It took a year and a half, away from my family for an extended period of time on my own.

After the “novelty” of this diagnosis wore off, my head went to very dark places. I would have gone spelunking because I was a teenage girl, but diabetes gave me exclusive entry to depths that most kids don’t reach. Instead of crying over a crush, I was crying over a shortened life span and all those complications that everyone’s grandmother had. Guilt over blood sugars and A1Cs and feeling judged had me questioning my self-worth. My inability to get my blood glucose levels under control (thank you, puberty) for very long played a part in how I felt day-to-day. How the hell was I going to do this every day for the rest of my life?

We Can’t Do This Alone, But We Are Alone

898781_96304223I’ve never kept my bouts of depression a secret. It is liberating to talk about the things that scare you, as long as you know you feel safe. I have had some incredible medical professionals who have led me out of the dark places. I have some wonderful fellow T1 talkers who shine the light on the strong connection between T1 and depression. We can’t do this alone. It’s exhausting. And terrifying.

You can have the best cheerleaders on your team, but they’re not going to win the game for you.  (That’s as close to a sports metaphor as you’ll get on this blog. Go team!)

 

Parents go through their own private hells when a child is diagnosed and I encourage any family to get counseling to talk through the tough times. (Think about the siblings who can become jealous because the T1 kid gets all the attention. I’m grateful that my brother wasn’t like that – at least that I know about.)

But in the end, it’s us. We are alone. The Type 1 child, no matter how protected, loved, educated, watched over… when we close our eyes at night, we think. And dream. And wonder. Sometimes, we travel to dark places. Some of us don’t want to come back. And that’s when it’s crucial that we have people who help us.

Researchers needed to do the studies to tell the medical community what we’ve been telling them for years. It’s not all in our heads. We are at risk simply because we have diabetes. We need a holistic medical team for every T1 child (and dare I say it, T1 adult): someone to teach us how to use insulin and count carbs and someone to teach us how to live our lives with diabetes in a healthy way – body and mind.

If you (or someone you know with Type 1 diabetes, especially those who are newly diagnosed) need help, please… talk with your medical team about your thoughts. There are options and support groups and professionals… For your children who have been diagnosed, please understand that no matter how much love you show them, they may need outside help that you can’t give. That’s OK. Really, it is. 

The Other Invisible Disease

“Get on a plane and just disappear.”

That was the first thought that popped into my head that morning, eighteen years ago.

Get in the car, get to the airport, purchase a ticket, and go.

Where?

It didn’t matter.

Do what when you got there?

Didn’t matter.

Nothing mattered.

From the outside, my life appeared fine and dandy. A successful career, family close by, disposable income, and a sweet loft apartment.

I was miserable.

Invisible

Much like diabetes, depression is invisible – and misunderstood.

Those who say: “Snap out of it. You’ll feel better tomorrow,” or “What’s to be depressed about?” may not be aware of the biopsychosocial model of depression.

The biopsychosocial model (abbreviated “BPS”) is a general model or approach positing that biologicalpsychological (which entails thoughts, emotions, and behaviors), and social (socio-economical, socio-environmental, and cultural) factors, all play a significant role in human functioning in the context of disease or illness.

Even if you look like you have it all together, if there is a biological maelstrom inside your body, you’re already behind the eight ball. A decrease in the amount of neurotransmitters that help the synapses in your brain (and keep those synapses firing on all cylinders) can be part the depression component. Studies have shown that individuals prone to depression have different brain structures or overactive portions of parts of the brain. No one can control brain structure or the amount of neurotransmitters coursing through our bodies. It’s pure biology.

There are other factors: how one deals with stress, what kind of stress the person lives with or is given, triggers for stress, how we perceive the world and even where we live. The biology of our body/brain plus the outside influences can send the average individual into a spiral. “Snapping out of it” just isn’t that simple.

Sinking

Very few people knew I was sinking. While I was isolating myself, I told everyone that I was swamped with work. (I worked from home, so it wasn’t like anyone could tell that I wasn’t.) In truth, work started piling up. I traveled often, but kept putting off trips. Phone calls weren’t returned to clients and if they really needed a response, it was via email so I wouldn’t have to talk. I didn’t want to talk to anyone.

New Year’s Eve was spent alone, after turning down a few invitations to go out and celebrate. Celebrate what? Another year of feeling miserable? It’s not like anything was going to change. Why bother? I ate leftovers and played video games online.

I felt hollowed out, like I was a pumpkin carved and discarded. Things that once brought joy brought nothing. No emotion. Apathy. I cried myself to sleep at night. I barely ate. Even when I was forced to go out, I was the snarly, sarcastic bitch in the group of people. (There’s always one, right?) I preferred just being alone, because no one could see how lackluster I had become. Misery doesn’t love company. Misery wanted to be left alone.

That morning, I got up and made coffee, sat on the windowsill, and sobbed. I wanted to run away and if I wanted to truly do so, I could. I could just disappear. But I didn’t have anywhere to run to. And I would still be miserable.

Dancing with Depression

1392779_35393316I made a phone call and within two hours, I was sitting in a psychiatrist’s office with a prescription in my hand and a diagnosis of “severe” depression. Over the next few months, that office became a refuge and a place to share my thoughts about my life and my future.

Diabetes was discussed in depth: the suffocation I felt when I thought about living with this disease for the rest of my life, the damage that I had done with diabulimia, how I felt that I could never settle down with someone because I didn’t want to burden him, and the day to day grind with a chronic illness. We talked about how diabetes and depression were often intertwined (for the reasons mentioned above). We talked about how I needed to find some peace with the war I was waging with my diabetes.

Cognitive behavioral therapy is often used to help those with depression in conjunction with medications. The first antidepressant that the psychiatrist prescribed caused night sweats, nightmares, and paranoia… so I was quickly switched to another popular one: Prozac. (It is found that those with eating disorders should shy away from Prozac, as it suppresses appetite. I’m no longer on it…)

I slowly stopped sinking and stopped looking for the nearest exit from a room to get away. I began talking to people and clients again and one day, I laughed, startling myself. I hadn’t laughed spontaneously in months. My life wasn’t better, but it was sucking less.

But the dance with depression wasn’t over. I made a very big mistake. I eventually felt so good and so even keel that I decided I didn’t need to take the antidepressants anymore.

I tapered off the medication that had kept me buoyant while I moved several states away. I sold most of my possessions and decided that I would start anew with a fresh attitude, accepting an offer to move into my parents’ home in Florida to soak up sunshine and continue my career. My parents were traveling all summer, so I had the house to myself.

Perfect. New job, new acquaintances, new life… same old me.

Deeper Than Before

Unlike last time, I was interacting with people and going out. I was gregarious and downright charming. I was dating and making friends.

And then I just collapsed internally.

On a sweltering day in late August, I stood in a fashionable business suit in the middle of downtown and called my father on his cell phone.

“Help.”

That was pretty much all I could get out before I began to quietly sob. The conversation was quick and my father made me promise that my next call would be to a psychiatrist for an emergency session.

He flew home from his vacation the next day. I only left the house to go to the doctor for a few weeks. I took a medical leave of absence from the new job I hated and never went back. After I began feeling emotionally better and the medication finally kicked in, the real work began.

It Never Ends

The real work is this: an understanding that some people have one or two depressive episodes in life, others never get clinically depressed, and others (like me) have dysthymia/ persistent depressive disorder which is the medical term for “chronic depression”.

It’s quite popular amongst those with a chronic health condition. (Thanks, Harvard, for giving me this great quote and link to the research.)

At least three-quarters of patients with dysthymia also have a chronic physical illness or another psychiatric disorder such as one of the anxiety disorders, drug addiction, or alcoholism.

1441982_78749740For people like me, understanding that I am more susceptible to depression due to a chronic illness – or biology  – neither of which I can run away from, actually helps. Spending time with therapists who understand the weight of living with a chronic illness and working through cognitive behavioral therapy (CBT) techniques has made a difference. A book I recommend, if you’re interested in CBT is The Feeling Good Handbook. It’s pretty amazing and the workbook aspect of it really helps to make the exercises customized just for you.

And antidepressants? Yes. Please. After a few misses, I have found a drug combination that works wonderfully. Just like I take insulin daily for diabetes, which is a chronic illness, I take antidepressants daily for the other chronic illness. I’ll take them both daily for the rest of my life.

Just like diabetes, I have my sucky days, even with medication. They don’t last long and they’re not soul crushing like before. I talk about what makes me frustrated or depressed with those close to me and it helps. If I feel like I need to seek professional help, I go. It’s hard to take the first step, but it’s worth it.

Invisible

I’ve had times in my life that I didn’t want to share my diabetes diagnosis. I look fine, so why bring it up, right? Keep diabetes invisible and no one is the wiser. Except that doesn’t work.

No one seems to want to talk about a depression diagnosis, as if talking about it makes you seem weaker. Keep depression invisible and no one will think you are weak. That doesn’t work either.

We don’t talk about depression mixed with diabetes enough. The community is only now beginning to understand that living day-to-day feeling frustrated and sad and angry and despondent is part of diabetes that contributes to depression. This month is Mental Health Month and people with diabetes have opened up about the fight to stay healthy – body and mind. There are some wonderful posts about “diapression”, which is the term that has been coined to connote diabetes and depression. I urge you to review the Diabetes Advocates page on depression and diabetes for these posts and resources.

It took me almost the entire month to get up the guts to think about how these two chronic illnesses have made an impact on my life. Thanks to Scott Strange of Strangely Diabetic for reminding me that we all need to talk about this.

If You Have Diabetes and Feel Depressed

Do you have the symptoms of depression, like the ones I mentioned above? If you do, breathe, then pick up the phone and call someone who you trust. Tell them about how you feel.

It’s OK to ask for help. You will be OK. There are ways to treat this and you just need to take the first step. (Let me know if you can’t tell anyone. Send me a message at the perfectd [at] gmail.com and I’ll get you to the resources. You should never, ever feel alone.)

* After posting this, a few comments made me realize that I never clarified that the major depressive episodes I’ve had were almost twenty years ago. They make them no less relevant for me – or you – today.

But for those who expressed their worries… I’m good now and have been for quite a while. Antidepressants and good therapists keep me sane. So does the DOC.

And the bitchy moments I have? Can’t blame that on anything but my personality these days. Turns out you can be happy AND bitchy. You say bitchy like it’s a bad thing. 🙂