If you have both diabetes and depression, you have a lot of company. Researchers estimate that people with diabetes are three or four times more likely to have depression than the average person. While depression affects somewhere around 5 percent of the general population at any given moment, the rate is about 15 to 20 percent for people with diabetes. If you have diabetes complications, your risk of depression is even higher. Furthermore, if you have depression, your risk of developing diabetes may also be higher.
Depression is a state of very intense, long-lasting sadness or despair—not just “feeling blue” for a short time or feeling sad because of a sad event in your life. Depression is sadness so severe that it becomes difficult, or even impossible, for you to continue the responsibilities of your daily life, such as working, taking care of and spending time with family and friends, going to school, or even doing the things you usually enjoy. Depression often has physical symptoms as well, such as changes in appetite and sleeping habits.
What Is the Relationship Between Diabetes and Depression?
For many years, people thought that it was obvious that depression was the result of having diabetes. For example, when I was in nursing schoolin the late 1970’s, I have a distinct memory of hearing one of my instructors tell my class that depression and diabetes seemed to go hand-in-hand. “After all,” she said, “Who wouldn’t be depressed? You have to give yourself shots every day. You have to restrict your eating, and you never get to eat a real dessert. And no matter what you do you’re still at risk of having an amputation, going blind, or losing your kidneys.”
But, of course, many people with diabetes handle their self-management without
getting depressed and more recent research has shown us that the relationship
between diabetes and depression is more complex than people once thought. While
it is true that some people become depressed because of the stress of having
and treating diabetes, other people have an episode of severe depression several
months or years before they have high blood glucose and diabetes. Researchers
speculate that the stress of severe depression causes an increase in insulin
resistance, just as other kinds of stress do, which in turn raises blood glucose
in people who are prone to diabetes. It looks as if diabetes and depression
may be linked together by heredity that make people prone to both.
Whichever comes first, when you have diabetes and depression together, they often make each other worse. When you are depressed, you may not have energy to do all the things involved in good diabetes care, like being physically active, eating properly, and taking medications at the right times. For some people, depression increases appetite, which means it’s easy to overeat. Furthermore, as mentioned above, the stress of depression increases insulin resistance, and makes the blood glucose higher. And when blood glucose is high, you may feel fatigued and pessimistic, and have difficulty concentrating. In fact, high blood glucose feels a lot like depression, and makes the feelings of depression worse, which in turn make the high blood glucose worse, and so on, in a never-ending downward spiral.
How Can You Get Help?
If you recognize yourself or someone you love in this description, please realize that there is hope. The negative spiral is not an inevitable slide, even
if it feels like that. The fact is that depression can be successfully treated. And you can do something today to break the negative cycle.
First, ask yourself whether emergency treatment is necessary. If you or a person you love is thinking about suicide and has a plan for how to carry it out, then you need to get to the emergency room immediately. Four other possible sources of help are:
• You could call your doctor and ask for help.
• You can find out whether your community has a suicide prevention hotline by calling information, or by looking in the front of your local phone book.
• You could call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
• You could call the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433).
It does not matter which of these you try first. What matters is that you reach out to ask for help.If you or someone you love is depressed but not in immediate danger, for example if you are having trouble fulfilling basic responsibilities and enjoying life, then finding treatment for the depression is a high priority. In general, both antidepressant medication and talk therapy (such as cognitive-behavioral therapy) are effective treatments for depression. Furthermore, research has shown that the combination of medication and talk therapy is much more effective together than you would expect by just adding their effects. It’s as if 1+1=3 or 4. So it’s worth the effort of finding ways to get both kinds of treatment.
A good place to begin looking for help, as mentioned above, is to talk with your doctor. Most doctors have many patients who have needed help with depression. Your doctor can probably refer you to a mental health professional, or your diabetes educator, home care nurse, other health care professionals or a clergy member can also refer you for help. You can also talk with others who have struggled with depression. If you don’t know anyone, consider going to a meeting of your local chapter of the National Alliance for the Mentally Ill. There you will not only find people who can tell you about your local mental health services, but you will also find a rich resource for support and information. To find your local chapter, you can either go to www.nami.org, or call 1-800-920-NAMI (1-800-950-6264).
We don’t know everything about diabetes or depression, but we do know one thing: both can be treated. You may be surprised at how much better you feel.
According to the U.S. National Institutes of Mental Health, depression is usually diagnosed when a person has four or more of the following symptoms lasting two weeks or more:
• Ongoing sad, anxious or empty feelings
• Feelings of hopelessness
• Feelings of guilt, worthlessness, or helplessness
• Feeling irritable or restless
• Loss of interest in activities or hobbies that were once enjoyable, including sex
• Feeling tired all the time
• Difficulty concentrating, remembering details, or makingdecisions
• Unable either to go to sleep or to stay asleep (insomnia), may wake in the middle of the night; or may sleep all the time
• Either overeating or loss of appetite
• Thoughts of suicide or making suicide attempts
• Ongoing aches and pains, headaches, cramps or digestive problems that do not go away and do not have a diagnosable cause
If the person is thinking about suicide, treatment is considered a medical emergency.
Ann S. Williams is an RN, with a PhD in Psychology, and has worked as a diabetes educator for 20 years. She has specialized in teaching independent diabetes self-management for blind people and writes and speaks frequently on this topic for other health care professionals. She was the founder and past chair of the Disabilities Specialty Practice Group of the American Association of Diabetes Educators, and remains an active member of that group.