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Depression and Diabetes threaten Eyesight

A five-year study indicates that diabetic patients who suffer from depression are more likely to develop a serious complication known as diabetic retinopathy.

A disease that causes damage to the eye’s retina, diabetic retinopathy, strikes when diabetes is not handled properly. It is also the leading cause of blindness in patients between 25 and 74 years old.

Study co-author and director of health services and psychiatric epidemiology at the University of Washington Medical School in Seattle, Dr. Wayne Katon said that the study controlled for obesity, smoking, sedentary lifestyle and HbA1 c (a blood test that measures a person’s average blood sugar levels over 2 to 3 months) levels, and still found that depression was associated with an increased risk of retinopathy.

Upon studying 2,359 patients with diabetes enrolled in the Pathways Epidemiologic Study and further assessing their levels of depression using the Patient Health Questionnaire-9 (PHQ-9), a self-reported survey of depression symptoms, it has been suggested that “psychobiologic changes associated with depression such as increased cortisol levels and activity of blood-clotting factors may be linked to the development of retinopathy,” according to Dr. Katon.

Over the five-year follow-up period, 22.9 percent of the patients who had PHQ-9 scores that ranked as “major depression” developed diabetic retinopathy, compared with 19.7 percent of the patients without depression. With a five-point increase on the PHQ-9 score, patients’ risk of having diabetic retinopathy increased by up to 15 percent.

However, Dr. Todd Brown, an assistant professor of medicine at the division of endocrinology and metabolism at Johns Hopkins University related that multiple explanations might account for these findings—some related to biological changes and some due to behavioral social issues (e.g. decreased physical activity and poorer utilization of health care).

He added, “The big question with all of this is whether identifying and treating depression in patients with diabetes will change clinical outcomes… and currently, there are no universal recommendations for depression screening among patients with diabetes.”

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