Don't sugarcoat it: Diabetes and depression

The act of presenting something unpleasant in a more appealing way is known by the idiom of sugarcoating. It is a way to soften the truth. This term originated from the actual coating of bitter pills with sugar. A practice we still do today in pharmacy with many products. For example, the Advil brand of ibuprofen has an outer coating to make it easier to swallow and it reduces the bitter taste. Sugar is another term often used to discuss diabetes. Karen's grandmother would always tell her "she had sugar in her blood," but never used the word diabetes to describe the condition. How does this relate to depression? According to the National Institutes of Health, 20.1 million Americans have been diagnosed with major depressive disorder (depression). This translates to 10.3% of women and 6.2% of men living in the United States. Three of the top 10 prescribed medications in the country are used to manage depression including sertraline (Zoloft) and fluoxetine (Prozac). Similar to depression, diabetes affects 11.6% of the population in the United States with an additional 8.7 million who are living with diabetes, but have not been diagnosed by a healthcare provider. In America, it is estimated that 1.2 million people are diagnosed with Type 1 and 2 diabetes each year. The Centers for Disease Control and Prevention notes individuals with diabetes are 2 to 3 times more likely to have depression. Depression is not just a low mood. It can be a loss of interest in things you usually would enjoy, having trouble concentrating, or even sleeping too little or too much. Depression can result when patients are struggling to keep their diabetes under control. Additionally, struggling with depression can make it more difficult to have the motivation to make healthy lifestyle choices and follow diabetes prescribed regimens. Like diabetes, it is estimated that a significant number of individuals never get diagnosed with depression or seek active treatment for help. This can translate into 1 out of every 2 patients seeking treatment for their depression. A study in the Journal of Affective Disorders evaluated results from the 2014-2019 National Ambulatory Medical Care Survey for the coexistence of diabetes and depression. The study reported depression is more prevalent in those with diabetes than in those without diabetes. Women are more likely to have both diabetes and depression at a rate of 15.4% when compared to women with depression without diabetes (13.7%). Within the study results, men with diabetes were reported to have a rate of depression at 9.1%. The more alarming statistic from the survey is the small number of patients with diabetes who get screened for depression. The study reported less than 6% are screened at healthcare visits. Patients without diabetes are more likely to get screened for depression than those with diabetes. The authors of this study concluded the lower rates of screening are unacceptable and depression screening should be included in diabetes care. There are several validated surveys to evaluate one's risk of depression. Two of the more commonly used scales include the Patient Health Quesionnaire-9 (PHQ-9) and the Beck Depression Inventory (BDI). Talk to your healthcare provider about using these instruments for depression screening. Some things to help improve your mental health outside of medications includes getting active with regular exercise, talking to family or friends, developing a strong support group, or taking a break to do something you enjoy. Talk to your healthcare provider about implementing these changes, and the possibility of starting a medication to help with these symptoms. If you are concerned about yourself or a loved one, you can call 1-800-662-4357, a confidential mental health information number. Jocelyn Smith is a student pharmacist at Ohio Northern University.