Diabetes and Depression: A Tale of Two Chronic Conditions
Kate* stepped into my office looking completely exhausted. She sat down and burst into tears: “I feel sad and hopeless all the time; and I can’t get myself out of bed. What’s going on!?"
Kate was diagnosed with diabetes six years ago. While her control was great in the beginning, she said that she had recently “fallen off the wagon" by binge-eating, forgetting to test, and ghosting her personal trainer. As a result, her sugars were skyrocketing. She desperately wanted to know how she could get her life back on track.
The Emotional Side of Diabetes
Depression is one of the most common psychological disorders.
Unfortunately, it’s even more common in people with diabetes.
What do the stats say? People with type 2 diabetes get depression twice as often as non-diabetics, while people with type 1 diabetes are three times as likely to develop it. In this article, we cover everything that you need to know about diabetes and depression, give you some pointers for recognizing depression, and how to get the right support.
What Is Depression?
Depression is a mental illness that affects a person's body, brain, and behaviors. The main feature of depression is a deep and unrelenting fog of sadness. People sometimes also suffer irritability and find it difficult to enjoy activities that they once took pleasure in. Other signs of clinical depression include:
- Trouble sleeping, or sleeping too much
- Big shifts in appetite
- Either losing or gaining body weight
- Concentration difficulties
- Poor self-esteem
- Low energy
- Feeling guilty or worthless
- Suicidal thoughts and at times, suicide attempts
How Diabetes Can Increase Depression
Why are people with diabetes so vulnerable to developing clinical depression?
Diabetes is a chronic medical condition that taxes your coping resources. Think about it: there’s the stress and expense of testing and medicating, of maintaining a healthy lifestyle, and of possible long-term complications. Managing diabetes is a 24-hour job; there are no holidays. For people who are already vulnerable to depression, the burden of diabetes can be the straw that breaks the camel’s back.
Diabetes and depression are also connected on a biological level. Specifically, people with high blood sugar experience changes in the brain areas that are connected to mood and thinking. In other words, diabetes is linked to changes in a person’s brain that makes them vulnerable to clinical depression.
What Can You Do?
The good news is that depression is treatable. Options for treatment include:
Therapy: Speaking with a trained mental health professional can help. Cognitive-behavior therapy, mindfulness-based cognitive therapy, and psychodynamic therapy are all approaches that can help people with diabetes to thrive.
Medication: If your depression is having a real negative impact on your life, your psychiatrist might recommend starting an antidepressant (such as Prozac or Celexa).
Support groups: Getting together with other diabetics can really help when it comes to managing depression and diabetes. Contact your nearest national diabetes organization to find out whether there are any support groups close to you.
Lifestyle coaching: Sometimes, it can take a little bit of extra support to get your diet and exercise schedule on track. A therapist or diabetes coach can help you work towards your goals in this regard, which will help you manage your depression and diabetes at the same time.
The Importance of Mental Health Care for Diabetics
If you have developed depression in addition to your diabetes, getting mental health support is vital. Why? This will help you avoid the sort of vicious cycle that so many people with diabetes and depression find themselves in.
For example, when Kate came to see me, her depression made it so much harder for her to feel hopeful, optimistic, and motivated about her diabetes care. When she tested and saw her sugars running high, this made her feel even more discouraged. This made it harder for her to eat healthily and exercise frequently. As time passed, her blood-sugars got more and more uncontrolled and she became more and more depressed.
Once Kate started treatment for her depression, she slowly started feeling a bit more hopeful. She stopped beating herself up as much when her control wasn’t perfect. From this new frame of mind, she was able to start mustering up the motivation to make small changes to her day-to-day routine. After a few months of therapy and antidepressant medication, Kate’s Hba1c was reduced dramatically and she was enjoying her life again, without any severe depressive symptoms sabotaging her efforts.
Are Depression and Diabetes Distress the Same Thing?
Sometimes known as ‘diabetes burnout’, diabetes distress is the term used to capture the emotional impact of living with diabetes. It is different from depression. For starters, diabetes distress is not a mental illness. Instead, it is an appropriate response to the challenges of living with diabetes. People with diabetes distress tend to:
- Worry about the future and the possibility of developing complications
- Feel paralyzing guilt when their sugars are off
- Feel stressed out and ashamed about having diabetes, in part due to the stigma involved
- Worry about the financial cost of caring for their condition
- Feel exhausted and overwhelmed with everything they need to keep doing to look after themselves
- Skip medication doses or neglect to test themselves
- Binge-eat
- Feel misunderstood by their doctors, which makes them less likely to open up and follow recommendations
Clearly, diabetes distress and depression share a lot of similarities. They can even occur at the same time. However, they are not the same thing and they require different treatments. This makes it that much more important to tease the two apart.
Get the Help That You Deserve
People don’t often talk about the emotional side of living with diabetes. The frustration that you get when you see that your blood sugars are off the charts. The fear of long-term complications. The feelings of stigma and judgement from other people. The sheer exhaustion that comes from constant monitoring and medication, day-after-day and year-after-year.
However, these feelings are not a sign of weakness. If you’re worried that you might be struggling with depression on top of your diabetes, speak to your specialist or a psychologist in order to get the treatment you deserve. Treating the depression equips us to better manage our diabetes and live our lives to the fullest.
*The name used in this article is a pseudonym