Medical researchers define the relationship between diabetes and depression as "bi-directional," which is science-speak for "vicious cycle."
A recent study, published in the Archives of Internal Medicine, found that women who had diabetes were nearly 30 percent more likely to have depression, and those who took insulin were more than 50 percent more likely to be depressed.
Living with any chronic illness can be demoralizing and stressful, but the particular challenges of diabetes—the daily monitoring and required changes in lifestyle, along with the guilt and shame some patients feel—make people with the disease especially vulnerable to depression, whose hallmarks include persistent low mood, lethargy, inability to concentrate, feelings of worthlessness and sometimes even suicidal thoughts.
Obesity, inactivity and poor eating habits are risk factors for both diabetes and depression and contribute to their tendency to overlap. Plus, if you're depressed and low on energy, you may neglect to take your medications properly or forget to test your blood glucose regularly, which can take a serious toll on your health. "It's a two-way street with depression and diabetes. They are highly interwoven," says Hillary Bogner, M.D., assistant professor of family medicine and community health at the University of Pennsylvania. "Fortunately, simply being aware of the connection between them allows you to take actions to stave off depression."
Master the Three Crisis Points for Diabetes and Depression
Depression is most likely to hit at one of the three classic crisis points during the course of diabetes. The first occurs when you're diagnosed. Maybe you've had symptoms and suspicions about your health, but the confirmation that you've got a chronic, potentially debilitating illness can send you reeling. "In addition to the shock that comes with any serious diagnosis, you've got to incorporate all kinds of new behaviors into your life," says Sherita Golden, M.D., an endocrinologist at the Johns Hopkins University School of Medicine in Baltimore. "You have to prick your fingers, think about what you eat and when, keep on top of your blood sugar and possibly give yourself insulin injections." The intrusiveness of all of that can make you feel overwhelmed, resentful and paralyzed.
Another predictable crisis point is when you experience periods of metabolic instability or changes in your medication regimen. Especially if you've been doing everything you can to stay healthy, these shifts can make you feel out of control and guilty. Finally, depression can take hold if you develop a complication, such as neuropathy or retinopathy.
The best way to maintain emotional equilibrium at each point is to be proactive, says John Zrebiec, LICSW, director of behavioral health at the Joslin Diabetes Center in Boston. "Learn as much as possible about diabetes and the natural progression of the disease, set realistic goals for yourself and seek support from your family, friends and health-care providers."
Defeat Your Enemies: Shame and Blame
More than other chronic conditions, diabetes tends to create feelings of blame, shame, guilt and low self-worth, all of which are often tied to how well you're managing the physical manifestations of the disease. "People with diabetes sometimes interpret their blood-glucose readings as a measure of their moral integrity," says Zrebiec, who suggests instead thinking of these readings as a compass to help you find direction rather than a pass/fail test that can result in bad feelings.
The fact is, no one thing causes depression; it's a complicated illness with emotional as well as physical components. What's critical for patients with diabetes is to realize that being depressed is not a sign of personal weakness. Imbalances in brain chemicals known as neurotransmitters—specifically serotonin, dopamine and norepinephrine—are known contributors, for example, but it's still hard to avoid thinking you could just "snap out of it" if you tried hard enough.
"You need to think of depression as just one of the many side effects of diabetes, like having protein in your urine, for example," says Golden. "And, as with other side effects, there are effective treatments."
Use the Right Tools
Ideally, your physician screens you regularly for depression symptoms, but not all doctors do this as a matter of course. While being depressed can make it difficult to take action, the sooner you talk to your doctor, the sooner you will get relief.
Psychotherapy, which can focus on thoughts, feelings, interpersonal relationships, day-to-day problems or issues from the past, is a mainstay of treatment, along with antidepressant medications, though a combination of both is currently considered most effective.
A well-trained therapist can help you look at the problems that bring on depression and help you find ways to relieve them, over the short term and the long term. Support groups can help you feel less alone and also allow you to learn which coping tools work for other people and might be right for you. Your doctor may already work with mental-health professionals on a diabetes treatment team to whom he can refer you; your local American Diabetes Association is another good resource.
Exercising for at least 30 minutes a day has also been proven to boost mood. While getting out of bed can feel like a monumental task if you're depressed, daily exercise will seem less daunting if you choose an activity that you truly enjoy, or once did. Take it slowly at first—even walking around the block is progress if you've been sedentary—and consider enlisting a friend or joining a walking group to stay accountable.
Bogner and her team encourage patients to socialize with friends and family and engage in activities that they used to find pleasurable. "Even though it can be hard to do these things when you're depressed," she says, “sometimes emotions respond when behaviors are changed first."
From our sister publication, Diabetes Focus, Fall 2011