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Treating diabetes driven depression in women


In recent research, doctors observed that male diabetics cope better and manage their diabetes more effectively than women. They not only have lesser depression and anxiety but more energy and better positive well being.

  • In that same research doctors summarized that female diabetics need to develop a more positive attitude towards the disease and its management.
  • This is crucial, especially in those responsible for tasks such as take care of family and cooking, which make it difficult for them to follow their own medication, exercise, take care of feet and check blood sugar and eating schedules.
  • Women must develop a more positive attitude towards the disease and its management.1

Helping women cope with total care

The research is clear that there is a connection between depression and diabetes and diabetes and depression in a “chicken and egg,” relationship.

IMG_0116Researchers from the University of Pennsylvania Department of Medicine confirm, “There is a link between depression and diabetes – as depression is a risk factor for diabetes, diabetes also increases the risk for the onset of depression. Not only is depression common in patients with diabetes, but it also contributes to poor adherence to medication regimens, which often results in worsening diabetes management.”2

Recent research from the San Francisco VA Medical Center says nearly 25% of diabetics report symptoms of fatigue, depression, and problems of sleep and high rates of shortness of breath, nausea and constipation.

The researchers suggest that caring for the disease as well as secondary symptoms to create better quality of life should be part of diabetes management. 3,4

As noted in the study above and other research, many studies have shown that diabetics are at higher risk for depression and that part of that reason is that the patient may suffer from the mental fatigue of the daily caring for themselves.

This has lead researchers to suggest natural and alternative therapies that can help patients cope with their depression better.

Research suggests natural and alternative therapies can help patients cope with their depression better

In one study, investigators examining previously published studies found improvements in self-care behaviors and reductions in clinical risk in persons with type 2 diabetes who received care from licensed naturopathic physicians.

Improvements were noted in:

  • self-monitoring of glucose, diet, self-efficacy, motivation and mood following initiation of lifestyle counseling for patients with inadequately controlled type 2 diabetes. Study participants also experienced reductions in blood glucose.4

At the Magaziner Center for Wellness, we thoroughly assess each patient’s physical state and treat any triggers of depression without the use of medication. To begin, we look at food sensitivities and allergies – as reactions to wheat, for example, and other elements have been linked to depression. If such sensitivities are detected, we work with the patient to modify diet and environment to eliminate the element’s negative impact. We also look at exposure to mold and other environmental irritants, such as building materials and household chemicals, which often harm the nervous system and impact mood.

Depression has been linked to problems or imbalances in the brain with regard to the neurotransmitters serotonin, epinephrine, norepinephrine, GABA and dopamine. We analyze the urine to test the levels of these neurotransmitters, and use blood tests to look at levels of key amino acids. We also review the levels of fatty acids, namely Omega-3 fatty acids, and test for deficiencies in trace minerals such as intracellular magnesium and zinc, and vitamins including B-12, as low levels of any of these have been linked to depression. This comprehensive analysis enables us to treat the disorder using nutritional supplementation.

We rule out that the patient is not suffering from excessive tissue levels of heavy metals or chemicals such as pesticides or solvents.  These substances can have an adverse impact on the nervous system and contribute to depression.

We also use Ondamed – an advanced biofeedback technology – to help identify and repair areas of cellular imbalance and tissue inflammation. Ondamed uses pulsed electromagnetic frequency to help put the body back in energetic balance and restore a sense of relaxed calm and clearer thinking.

Lastly, we encourage our patients to seek out – and stick with – stress reduction techniques to help manage, and in most cases, drastically reduce, their depression and related symptoms. Consistent exercise should be included to help stimulate mood-elevating endorphins.

1. Siddiqui MA, Khan MF, Carline TE. Gender differences in living with diabetes mellitus. Mater Sociomed. 2013;25(2):140-2. doi: 10.5455/msm.2013.25.140-142.
2. H. R. Bogner, K. H. Morales, H. F. de Vries, A. R. Cappola. Integrated Management of Type 2 Diabetes Mellitus and Depression Treatment to Improve Medication Adherence: A Randomized Controlled Trial. The Annals of Family Medicine, 2012; 10 (1): 15 DOI: 10.1370/afm.1344
3. Sudore R, et al. Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study Journal of General Internal Medicine DOI: 10.1007/s11606-012-2132-3 August 3, 2012
4. San Francisco VA Medical Center, University of California, San Francisco and Kaiser Permanente, news release, Aug. 7, 2012

Can estrogen treat depression?

New research from the University of Glasgow describes the difficulty in understanding and treating depression in menopausal and post-menopausal women. Despite the challenges these difficulties represent, empirical evidence (what the doctors and patients see outside of clinical studies) suggests that estrogen therapy for women with mood and depression disorders is beneficial and should be considered for patients.1

Why is it difficult to understand depression in these women?

The difficulties come from doctors’ ability to understanding the complex role of sex hormones, such as estrogen and their delicate function in helping to balance levels of neurotransmitters, brain chemicals implicated in clinical depression.

  • Depression has been linked to problems or imbalances in the brain with regard to the neurotransmitters not only of serotonin, but of epinephrine, norepinephrine, GABA and dopamine.

At the Magaziner Center for Wellness, we analyze the urine to test the levels of these neurotransmitters, and use blood tests to look at levels of key amino acids. We also review the levels of fatty acids, namely Omega-3 fatty acids, and test for deficiencies in trace minerals such as intracellular magnesium and zinc, and vitamins including B-12, as low levels of any of these have been linked to depression. This comprehensive analysis enables us to treat the disorder using nutritional supplementation.

Duke University explores Serotonin and Estrogen

In a recent study, researchers from Duke University say mice with low levels of serotonin — a crucial brain chemical implicated in clinical depression — are more vulnerable than their normal litter-mates to social stressors.

Following exposure to stress, the serotonin-deficient mice also did not respond to a standard antidepressant, fluoxetine (Prozac), which works by boosting serotonin transmission between neighboring neurons.

These results may help explain why some people with depression seem unresponsive to treatment with selective serotonin reuptake inhibitors (SSRIs), the most common antidepressant drugs on the market today. The findings also point to several possible therapeutic strategies to explore for treatment-resistant depression.

  • It is well documented that estrogen deficiency increases the risk of anxiety and mood disorders. Serotonin is a hormone and categorized as a neurotransmitter. It is an important part of the delivery or “transmitting” system of our nerve impulses.
  • Proper serotonin levels are crucial when looking at depression because serotonin strongly influences a “calming,” “happy,” “sense of well-being,” by regulating our moods.
  • Serotonin levels are so important that prescription anti-depressants are often developed to help regulate and increase the serotonin levels in the brain. Unfortunately these drugs come with a long-list of side effects.2

Depression and Alzheimer’s Link in post-menopausal women – the need for estrogen

New research lead by Oregon Health and Sciences University doctors examined the factors that make Alzheimer’s Disease more prevalent in women who show increased incidence of depression.

The bullet points of this research:

  • Women with estrogen deficiency in middle age and the postmenopausal period are at increased risk for  onset of depression and Alzheimer’s Disease.
  • The researchers show that ovarian steroids, particularly estrogen, are crucial for serotonin neuron function and health. In the absence of estrogen, serotonin neurons are endangered and deteriorating toward apoptosis (cell death). The possibility that this scenario may proceed or accompany Alzheimer’s Disease in postmenopausal women seems likely.3

Estrogen Therapy and bio-identical hormones (BHRT)

The decision to use estrogen therapy in instances of depression are complex and require a consultation with our doctors. During the consultation we may discuss the use of  bio-identical hormones (BHRT), namely estrogen therapy. Visit these pages on our site to learn more about bio-identical hormones and the treatment of depression.

1 Sassarini DJ. Depression in midlife women. Maturitas. 2016 Dec;94:149-154. doi: 10.1016/j.maturitas.2016.09.004. Epub 2016 Sep 16.

2 Sachs BD, Ni JR, Caron MG. Brain 5-HT deficiency increases stress vulnerability and impairs antidepressant responses following psychosocial stress PNAS 2015 112 (8) 2557-2562

3 Bethea CL, Reddy AP, Christian FL. How Studies of the Serotonin System in Macaque Models of Menopause Relate to Alzheimer’s Disease. J Alzheimers Dis. 2016 Sep 20.

Depression makes knee pain worse – even after surgery

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A new study from a combined research team from the University of Southern California and Duke University suggests that if you have knee pain related to osteoarthritis and you have high to medium expectations that your treatment will work (this is any treatment) you will have better results. In contrast, patients with interpersonal problems associated with pain coping did not benefit much from the treatment.1

There has been a number of studies released recently which sought to make knee pain treatment more successful by examining the patient’s mental health before the treatments.

Much of this research is being conducted to help sought out knee replacement patients who may not benefit from the procedure because of depressive cycles or anxiety disorders. This is suggested in new research from the University of Iowa that says that in patients recommended to knee replacement, both pain intensity and pain-related distress demonstrated significant relationships with anxiety, depression, and catastrophizing. The investigators suggest  brief psychological interventions for pre-surgical knee replacement patients to help makes the surgery more successful.2

In a study from the University of Oslo researchers found that 1 in 5 knee replacement patients still had pain when walking. These patients had higher preoperative pain, fatigue, and depression scores.3

In recent research, doctors found that patients with knee osteoarthritis  often experience considerable physical disability with worsening symptoms linked to depression. Some of the research seeks to determine the “chicken or the egg,” if  depression causes more pain or more pain causes depression. Likely it is cyclical. Each causes the other with worsening effects if not treated.

Studies suggest women with knee osteoarthritis suffer more than men from this depression/pain cycle. Further, in the study cited below, researchers looked at the link relationships that exist between women’s perceived health status and the physical, emotional and perceptual factors knee osteoarthritis/depression may cause. This was suggested in another paper to be released in December 2016 from Canadian doctors at McMaster University.4

Long-term pain is typical in patients we see here in our Cherry Hill, New Jersey office and is a signal that the patient may be suffering from depression. In these patients we provide a nn-surgical treatment plan and after a consultation, address problems of depression.

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1 Broderick JE, Keefe FJ, Schneider S, Junghaenel DU, Bruckenthal P, Schwartz JE, Kaell AT, Caldwell DS, McKee D, Gould E. Cognitive behavioral therapy for chronic pain is effective, but for whom?
Pain. 2016 May 25.

2. Noiseux NO, Callaghan JJ, Geasland KM, Embree JL, Rakel BA. Relationships among pain intensity, pain-related distress, and psychological distress in pre-surgical total knee arthroplasty patients: a secondary analysis. Psychol Health Med. 2016 May 24:1-12. [Epub ahead of print]

3. Lindberg MF, Miaskowski C, RustøEn T, Rosseland LA, Cooper BA, Lerdal A. Factors that can predict pain with walking, 12 months after total knee arthroplasty. Acta Orthop. 2016 Dec;87(6):600-606.

4. Wood TJ, Thornley P, Petruccelli D, Kabali C, Winemaker M, de Beer J. Preoperative Predictors of Pain Catastrophizing, Anxiety, and Depression in Patients Undergoing Total Joint Arthroplasty. J Arthroplasty. 2016 Dec;31(12):2750-2756. doi: 10.1016/j.arth.2016.05.056.

Treating systemic inflammation as depression therapy

Doctors at Emory University School of Medicine have made a connection between inflammation and depression:

  • “About one third of people with depression have high levels of inflammation markers in their blood. New research indicates that persistent inflammation affects the brain in ways that are connected with stubborn symptoms of depression, such as anhedonia, the inability to experience pleasure.”1

German researchers have made a connection between inflammation, depression and newly diagnosed diabetic patients.

“Depressive disorders represent a frequent comorbidity of both type 1 and type 2 diabetes. Inflammation-related processes have been implicated in the development of both diabetes and depression.”2

We are going to take a look at a fascinating paper that appeared in the journal Nature. The goal of the paper was to explain the role of inflammation in depression and how inflammation may prevent treatments from working.

Here is the abstract:

“Crosstalk between inflammatory pathways and neurocircuits in the brain can lead to behavioural responses, such as avoidance and alarm, that are likely to have provided early humans with an evolutionary advantage in their interactions with pathogens and predators.

However, in modern times, such interactions between inflammation and the brain appear to drive the development of depression and may contribute to non-responsiveness to current antidepressant therapies.”3

What does this mean for the patient with depression? It means there is an understanding that if we treat inflammation at the nervous system pathways  we can successfully treat depression.

The paper being explored in this article confirms what other investigators are confirming. That is the strong suspicion that the onset of depression may involve low-grade inflammation and endothelial dysfunction (damage and diseases of the inner lining of the blood vessels) as a causative factor.4

In highlights the Nature paper suggests:

  • The relationship between inflammatory pathways and the brain may drive depression and contribute to non-response to antidepressant medication.3
  • Increased levels of inflammatory cytokines ( i.e., growth factors that exert influences of other cells telling them what to do – signalling pathways) as well as activation of different immune cell subsets has been detected in the brain and peripheral blood of a subgroup of patients with depression. C-reactive protein (CRP), tumour necrosis factor, interleukin-1β (IL-1β) and IL-6 appear to be the most reliably elevated inflammatory markers in the peripheral blood of subjects with depression.3

Most are familiar with CRP (C-reactive protein) a molecule produced in the body that is used as a non-specific marker of inflammation. This molecule can be measured in the blood and, although it doesn’t identify the source of inflammation, (infection, injury or virus), its levels rise in response to inflammation in the body. Many chronic conditions are associated with the inflammatory response to injury. There are practitioners and researchers who are beginning to see chronic inflammation as a single disease 3

Here is an important factor in the inflammatory response that we have discussed before – the Gut – Brain connection. See Probiotics for psychiatric illness | New research

  • Inflammation by stress-induced, non-pathogenic stimuli (not a disease), including damage-associated molecular patterns as well as microbial-associated molecular patterns elaborated from the gut microbiome, may drive peripheral inflammatory responses, which are then transmitted to the brain by trafficking of activated monocytes. In very simple terms the bad bacteria in the gut is causing inflammation which is causing depression.3
  • Inflammation impacts several neurotransmitter systems in the brain, including serotonin, dopamine and glutamate pathways, as well as the kynurenine pathway, which generates the neurotoxic metabolite quinolinic acid.3

A point of explanation, increased levels of quinolinic acid has been linked to depression, autism, and in conflicting evidence seizures.

The findings of this and other research bolster the case that the high-inflammation form of depression is distinct, and are guiding researchers’ plans to test treatments tailored for it. 1

At the Magaziner Center for Wellness, we thoroughly assess each patient’s physical state and treat any triggers of depression without the use of medication. To begin, we look at inflammatory factors such as food sensitivities and allergies

If such sensitivities are detected, we work with the patient to modify his/her diet and environment to eliminate the element’s negative impact with includes modifying the inflammatory response.

We also look at their exposure to mold and other environmental irritants, such as building materials and household chemicals, which often harm the nervous system and impact mood and impact inflammation.

General guidelines recently suggested by Lauren Whitt, Ph.D from the University of Alabama at Birmingham offered suggestions on fighting inflammation with food. These foods can accelerate the anti-inflammatory response:

• Citrus fruits – Vitamin C and Vitamin E as essential antioxidants
• Dark, leafy greens – High in Vitamin K
• Tomatoes – The fruit’s red pigment, lycopene, is a potent antioxidant
• Wild-caught salmon – Contains a rich concentration of omega-3 fatty acids

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1  FelgerJC, et al. Inflammation is associated with decreased functional connectivity within corticostriatal reward circuitry in depression Molecular Psychiatry advance online publication 10 November 2015; doi: 10.1038/mp.2015.168

2 Herder C, Fürstos JF, Nowotny B, et al. Associations between inflammation-related biomarkers and depressive symptoms in individuals with recently diagnosed type 1 and type 2 diabetes. Brain Behav Immun. 2017 Mar;61:137-145. doi: 10.1016/j.bbi.2016.12.025. Epub 2016 Dec 29.

3 Miller AH, Raison CL Nature Reviews Immunology 16, 22–34 (2016) doi:10.1038/nri.2015.5

4 van Dooren FE, Schram MT, Schalkwijk CG, Stehouwer CD, Henry RM, Dagnelie PC, Schaper NC, Associations of low grade inflammation and endothelial dysfunction with depression – The Maastricht Study. Brain Behav Immun. 2016 Mar 9. pii: S0889-1591(16)30049-6. doi: 10.1016/j.bbi.2016.03.004. [Epub ahead of print]