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The Complex Connection Between Depression and our Bodies

Diabetes, chronic pain and eating disorders are all linked to depression.

Major depressive disorder is a mood disorder that affects more than 15 million adults in the United States. Individuals with depression may not even report depressive signs and symptoms and instead present to their physician for somatic or physical symptoms such as headaches, abdominal pain, muscle pain, and fatigue. Individuals may also complain of irritability or problems concentrating. Adolescents with major depressive disorder may present with a decline in school performance, substance abuse, irritability or social withdrawal and elderly individuals often present with confusion or a decline in general functioning. This disorder may be difficult to initially diagnose, as many individuals may not show the clear-cut signs and symptoms of depression. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), at least five of the following symptoms must be present within a two-week period with at least one of the symptoms being depressed mood. Additionally, these symptoms must cause apparent distress in social and occupational functioning.

  • Sleep disturbance
  • Loss of interest in activities
  • Feelings of guilt
  • Loss of energy
  • Difficulty concentrating
  • Change in appetite
  • Psychomotor agitation
  • Sadness
  • Suicide ideations

Although depression is considered a mental health disorder, it is tightly intertwined with our physical health and often commonly co-occurs with other mental health disorders.

The link between diabetes and depression

Diabetes is often a lifelong disorder that is either diagnosed in childhood or adulthood and can have chronic effects on many of the body’s organs. Diabetes, when not controlled affects the brain, eyes, feet, digestive tract, and is also known to cause delayed wound healing. Diabetes is also tightly linked to depression. Individuals with diabetes are two to three times more likely to have depression than people without diabetes, according to the U.S. Centers for Disease Control and Prevention.

"The incidence of major depressive disorder amongst individuals with diabetes is significantly greater than the general population," said the study's corresponding author, Vincent Chin-Hung Chen, Professor, of Chiayi Chang Gung Memorial Hospital and Chang Gung University in Puzi, Taiwan. "Diabetes and depression each independently contribute to increasing total mortality."

Diabetes can be a complicated disease and individuals with this disorder must strictly control their blood sugar through insulin and/or oral hypoglycemic medications while adopting a strict diet. This results in a drastic lifestyle change and can lead to long-term stress and a decreased quality of life, which can lead to depression.

Alternatively, individuals who have been diagnosed with depression, often have higher levels of the stress hormone cortisone, which can cause problems with glucose metabolism in the body thereby increasing insulin resistance and the accumulation of belly fat; all risk factors for the development of diabetes.

When individuals have both depression and diabetes simultaneously it also becomes a problem as so much of the treatment for diabetes is self-care and individuals who have depression may not take good care of themselves. These individuals may have a hard time exercising, following a strict diet, taking their blood sugar and administering their medication. As a result, each illness can worsen without paying proper attention to the emotional and physical aspect of diabetes.

If an individual’s diabetes is uncontrolled, even if they are strict with their diet and insulin regimen, they may be struggling with depression. It is extremely important to address the emotional and mental side of diabetes; in other words to adopt a “whole person” approach.

The link between chronic pain and depression

Chronic pain is a persistent, agonizing sensation that can last for weeks, months or even years and by definition, is pain that has been present for at least 12 weeks in duration. Chronic pain can present in many different forms such as stabbing, throbbing or aching in nature and can be intermittent, persistent; mild, or intense. It can sometimes begin as a result of an injury or illness, but oftentimes it arises without a clear etiology. Chronic pain, unlike more acute pain that resolves within days or weeks, tends to cause more emotional and lifestyle challenges because of its duration and its unpredictability. According to statistics, there are 100 million Americans who suffer from chronic pain and over 1.5 billion individuals suffer from chronic pain worldwide. Low back pain is the most common form of chronic pain and chronic pain is the number one cause of disability in the United States. Chronic pain, as a stress state, is one of the critical factors for determining depression, and their coexistence tends to further aggravate the severity of both disorders. Clinical studies have revealed that chronic pain, as a stress state, often induces depression and that up to 85% of individuals with chronic pain are affected by severe depression. Unfortunately, to date, neither the corresponding pathophysiological mechanisms of chronic pain and depression nor their mutual correlation has been identified, which poses a huge challenge for the treatment of pain accompanied by depression. Lifestyle modifications such as yoga, modified exercise, and physical therapy can help manage chronic pain while also helping with depression. Although opioids are the first-line for certain types of pain, specifically cancer-related pain, the potential of opioid addiction is tremendous and unfortunately, opioid addiction is highly linked to depression. As a result, it may be wise to look at other treatment options for individuals who are struggling with chronic non-cancer pain as they are at an increased risk for developing depression. Tricyclic antidepressant drugs are traditional antidepressant drugs, commonly including amitriptyline, imipramine, nortriptyline, and desipramine. These antidepressants are also known to help with chronic pain, in particular, neuropathic pain.

As stated above, depression itself can also present with chronic pain, in particular headaches, abdominal pain and joint pain and therefore depression should be considered in individuals who have vague pain without a clear underlying reason.

The link between eating disorders and depression

Depression occurs in approximately half of women who meet the criteria for anorexia nervosa. Eating disorders can result in a severely malnourished state, which can lead to physiological consequences such as poor mood states or feelings of worthlessness, which can lead to depression. Alternatively, depression itself can result in eating disorders such as anorexia nervosa, binge eating disorder, and bulimia nervosa.

Eating disorders are triggered by severe underlying stress and many individuals use disordered eating behaviors such as binging and self-induced purging as ways to self-treat their depression, however, these poor coping behaviors are known to worsen the depression while causing extreme harm to the body. For example, life stressors, like the demands of puberty, the death of a loved one, a divorce, and physical or sexual abuse, can lead to depression. For many individuals, eating disorders are a way to exercise control over a life that’s become unmanageable. Ritualistic eating patterns and extreme weight loss can become a poor coping mechanism to suppress overwhelming emotional pain associated with depression.

Anorexia nervosa and depression are known to certain neurological factors, which include the following:

  • High levels of cortisol, a hormone that the body produces in stressful situations
  • Low levels of serotonin, a hormone that’s responsible for mood regulation
  • Low levels of norepinephrine, a neurotransmitter that plays a role in emotions and moods
  • High levels of vasopressin, which has also been linked with obsessive-compulsive disorder

Living a healthy life with depression

Depression, although is a mood disorder, can have multiple long-lasting effects on the body and physical ailments such as heart disease, diabetes, an autoimmune disorder, and cancer can also lead to depression as these medical disorders require major lifestyle modifications. Depression is also highly linked to substance abuse disorders and eating disorders. Depression a “whole person” disorder as it can potentially affect every organ system and as a result practicing the correct self-care tips, attending therapy and taking antidepressants are incredibly important to live a full happy life, even if you have been diagnosed with depression. Living with depression is possible.