Being diagnosed with diabetes is a major life stress. It requires a large number of physical and mental accommodations. The individual must learn about a complex system of dietary and medical interventions. Lifestyle, work, and school schedules may have to be altered. This can consume a lot of energy for both the individual and his or her family. Just as important, are the psychological adjustments. One must adjust to a new view of oneself. For those who liked to see themselves as invincible, this may be particularly difficult.
Several studies suggest that diabetes doubles the risk of depression compared to those without the disorder.2 The chances of becoming depressed increase as diabetes complications worsen. Research shows that depression leads to poorer physical and mental functioning, so a person is less likely to follow a required diet or medication plan. Treating depression with psychotherapy, medication, or a combination of these treatments can improve a patient's well-being and ability to manage diabetes.
Causes underlying the association between depression and diabetes are unclear. Depression may develop because of stress but also may result from the metabolic effects of diabetes on the brain. Studies suggest that people with diabetes who have a history of depression are more likely to develop diabetic complications than those without depression. People who suffer from both diabetes and depression tend to have higher health care costs in primary care.
Sexual difficulties may begin early in a person's life, or they may develop after an individual has previously experienced enjoyable and satisfying sex. A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act. The causes of sexual difficulties can be physical, psychological, or both.
Emotional factors affecting sex include both interpersonal problems (such as marital or relationship problems, or lack of trust and open communication between partners) and psychological problems within the individual ( depression , sexual fears or guilt, or past sexual trauma).
Among men with type 2 diabetes, depressive symptoms represent the most important factor contributing to the risk of erectile dysfunction (ED), according to investigators in Italy and in California. Other modifiable risk factors also play a part, they report.
In fact, the authors point out, there appears to be a vicious cycle, in which depression may instigate the development of ED, while the ED symptoms perpetuate the symptoms of depression. Thus, ED in diabetic patients is not related entirely to organic factors.
Dr. Antonio Nicolucci, from Consorzio Mario Negri Sud in S. Maria Imbaro in Italy, and his associates point out that, as the incidence of diabetes grows, prevention of ED will require strategies that address modifiable risk factors.
For their study, they had men with type 2 diabetes complete questionnaires every 6 months for 3 years. Five hundred men reported ED at the start of the study, and an additional 192 developed the disorder during follow-up.
The investigators noted higher prevalence of high blood pressure (46 percent versus 32 percent) and lipid abnormalities (23 percent versus 13 percent) among men who complained of ED.
Other characteristics linked with the development of ED were older age, longer duration of diabetes, worse metabolic control, and history of smoking. The researchers also observed higher incidence of the eye disease retinopathy, the nerve disease neuropathy or heart and vascular disease in ED sufferers. Those with ED were more likely to be treated with insulin or diuretics.
As noted, organic causes were not the only issues associated with increased risk. Depression as well as poor physical and psychological well being were also associated with erectile problems.
Summing up, Nicolucci and his associates note, "erectile problems are not necessarily an inevitable outcome of the aging process since they are also related to modifiable risk factors such as poor metabolic control and cigarette smoking" and total cholesterol levels.
At this point in time, it is well accepted that psychological factors and psychiatric conditions can affect the course of medical illnesses. There is some suggestion that the stress of depression itself may lead to hyperglycemia in diabetics. The interaction between cardiovascular disorders (such as heart attack and high blood pressure) and depression has been extensively studied. Anxiety and depression can also affect other conditions including irritable bowel syndrome, headache and skin diseases. Treatment of anxiety and depression may lead to a better medical prognosis and well as a better quality of life.
Often, individuals with depression do not realize that they are depressed. It is easy to attribute the symptoms of depression to the diabetes. This is particularly difficult since depressed diabetics may have poorer glucose control. Sometimes a spouse or close friend can give good feedback.
However, medical professionals or mental health clinicians may be the best ones to determine what is the diabetes and what is due to depression. A psychiatrist has had medical training before specializing in mental health. He or she can sort out the diagnosis, communicate with your regular doctor and help coordinate the treatment of the depression with treatment of the diabetes.
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