Diabetes Complicates Depression and Anxiety Therapy: Increased Use of Atypical Antipsychotics Brings Weight, Glucose Metabolism, and Lipid Liabilities

By Sherman, Carl | Clinical Psychiatry News, March 2007 | Go to article overview

Diabetes Complicates Depression and Anxiety Therapy: Increased Use of Atypical Antipsychotics Brings Weight, Glucose Metabolism, and Lipid Liabilities


Sherman, Carl, Clinical Psychiatry News


News reports of an epidemic of diabetes are not exaggerated: An estimated 21 million Americans are affected with the metabolic disorder.

Many will require psychiatric care. Diabetic patients are twice as likely as the general population to suffer from depression, and individuals with depression are at comparably higher risk of developing type 2 diabetes. Although anxiety disorders have been less studied in this regard, some surveys have found the prevalence of generalized anxiety disorder (GAD) among people with diabetes to be 14%--well above the norm--with increased rates of specific phobias as well. It has been widely publicized that schizophrenia and some drugs used to treat it are associated with a heightened risk for type 2 diabetes.

One condition often compromises management of the other. "People with diabetes who are depressed are less likely to adhere to their diet or to exercise, and more likely to smoke. They have higher [body mass indexes] and more lapses in medications needed to control their condition," said Dr. Wayne J. Katon, professor of psychiatry at the University of Washington, Seattle.

Anxiety may likewise impair self-care among those with diabetes, said Dr. Eduardo A. Colon, vice chief of psychiatry at Hennepin County Medical Center, Minn., and professor of psychiatry at the University of Minnesota, Minneapolis.

"These patients are less able to cook for themselves, go grocery shopping, do glucose testing. An anxious patient who has had an episode of hypoglycemia may refuse to lower his blood sugar to an adequate level because tighter glucose control makes further episodes more likely," he said.

From a biologic perspective, disturbance of the hypothalamic-pituitary axis in depression can increase secretion of cortisol and catecholamines, which has a negative impact on insulin sensitivity and glucose regulation, Dr. Colon said.

For whatever reason, psychiatric comorbidity negatively affects the course of diabetes. Dr. Katon's study of 4,800 diabetics found a cross-sectional association with a higher number of diabetes complications, and over a 3-year period, depression was associated with a twofold increase in mortality, "even after we controlled for the greater initial severity of disease in depressed versus nondepressed diabetic patients," Dr. Katon said.

The treatment of psychiatric disorders in the context of diabetes represents a challenge. "These patients already have a medical condition that's complicated to manage, and the difficulty can be compounded by antidepressants," said Dr. Alan M. Jacobson, director of mental health programs at the Joslin Diabetes Center and professor of psychiatry at Harvard Medical School, Boston.

"One needs to take both disorders into account in selecting psychotropics and titrating them to their optimal level," he noted.

Tricyclics can increase blood sugar levels, and selective serotonin reuptake inhibitors reduce them. "Patients should be encouraged to test their blood sugar more often when starting an antidepressant or changing the dosage, and make adjustments in insulin or oral agents accordingly," Dr. Jacobson said.

Concurrent diabetes may compromise adherence to a psychotropic regimen: A patient who is already taking several drugs (a regimen will frequently address cardiovascular risk as well as diabetes) and making the life changes required by diabetes management may find it difficult to accommodate treatment for another disorder, Dr. Katon said.

Little controlled research has been done on this issue, but it appears the standard drugs for anxiety and depression are reasonably safe and effective for those with diabetes. Choosing among them may mean matching diabetes manifestations against psychotropic effects and side effects.

For example, weight control is of particular concern in diabetes, and sexual dysfunction is common as well. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Diabetes Complicates Depression and Anxiety Therapy: Increased Use of Atypical Antipsychotics Brings Weight, Glucose Metabolism, and Lipid Liabilities
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.