I’ve been depressed the past few days. I’m coming up on my 34th birthday, and somehow I’m only seeing my areas of failure — bands that never made it, opportunities I didn’t take advantage of, career choices I wish I could take back. You get the idea. It’s not any kind of exceptional depression, just your garden-variety “getting-close-to-middle-age” depression that we all feel from time to time.
This particular depression has nothing to do with diabetes, but it got me to thinking about an interesting topic: diabetes and depression. I don’t have the statistics right in front of me, but I do remember hearing somewhere that depression tends to run at higher rates for people with diabetes. And that’s not surprising. Diabetes can be a frustrating thing. If severe complications come along, diabetes can be an absolutely debilitating thing. It’s not hard to see how depression might fit into the equation.
Of course, “Depression” (with a big d) and “depression” (with a little d) are two different things. Little-d depression is a passing feeling of sadness, being stuck, or skepticism about the future. Big D is much more serious and has its roots in deeper trauma and biochemistry. Big D is itself a chronic condition.
Diabetes and the little d
We all experience little-d depression at points in our lives. This kind of depression is what I’m complaining about right now. Underneath, I know that this is how I’m feeling today, and it will pass, just as all emotions do. And while I am feeling somewhat apathetic about things (it hasn’t been my best day as a therapist), it would be a little dramatic to say I’m feeling utterly hopeless.
Nevertheless, even little d can have an impact when it comes to diabetes. One of the really annoying things about diabetes is the fact that it never gives us a rest. We can’t take a day off. And if we do take a day off, or a week off, our numbers can start bouncing all over the place and then we’re left with another week of rebalancing to get ourselves back in check. Taking that day off is really never worth it. But it can be hard to remember that when we’re feeling depressed. It can be temping to just say, “screw it, I want some ice cream, I don’t want to wait for my number to come down, and everything sucks, anyway”.
Now, we know what we’re doing when we get into this trip. I know right now that my feelings of depression are just thoughts floating around in my head, and the truth is that my life is just the same as any other life, with some good, some bad, and some filler. But it’s still hard to let go. So the question for us Diabetians is this: How do we remain committed to our diabetes care when we’re in one of our spells of feeling stuck, pessimistic, and not caring?
In my case, the answer to this question is “habit.” We hear a lot about bad habits, but a habit can be great thing. Having a habit of checking your blood glucose, calculating your insulin, and being conscientious about your own self-care is a wonderful thing. If that habit is deeply ingrained enough, it can keep going even when we have a day of not caring about anything. Even as I write this, I don’t particularly care what my number is, feeling generally depressed and all, but I’m so used to the habit of checking it, calculating my insulin, and waiting for lunch if I’m higher than normal, that I’ll still do it even if everything feels pointless.
The Big D
Clinical depression is a serious chronic condition. Unlike its little brother, clinical depression can stay around indefinitely. It has its roots in a person’s biochemistry and is linked to an actual decrease in dopamine and other brain chemicals that lead to feelings of joy and happiness.
This impact on brain chemistry is a huge deal. With little d, we can feel depressed but there’s still an underlying voice that knows this feeling is just a feeling. When I’m stuck in little d depression, a half-hour of meditation will usually knock it right out. I get back in touch with that inner voice, and stop indulging in self-pity. But clinical depression can silence that inner voice, and that’s when things can get dangerous. Once that inner voice is silenced, there is no counterbalance. An overwhelming sense of hopelessness sets in, and it can cause someone to stop caring, period
This spells big trouble for diabetes care. After all, we take care of ourselves in order to remain healthy and have a future. Clinical depression sometimes takes away any hope for the future. If there is genuinely no hope for the future, there ceases to be a reason to care for ourselves in the present. And once we have lost any reason to care for ourselves in the present, control goes right out the window.
The process of treating clinical depression is obviously much more involved than little d. Clinical depression requires therapy, often requires some medicine, and necessitates some real work on the part of the individual. The usual rules still apply — exercise increases the same chemicals depression is limiting, so that’s always a good idea. A contemplative practice like meditation always helps clear our heads — it won’t be enough by itself, but it is a great tool along with therapy. Having a support system around you is incredibly important, as well. Knowing that you can fall back on the support of others who care about you means you don’t have to battle that hopelessness alone. Finally, for people who struggle with clinical depression and diabetes, finding a diabetes support group is a great idea. This kind of support group can keep you going you when you’re just not feeling up to the challenge of dealing with diabetes.
If any of you have struggled with diabetes and serious depression, or little-d depression, please share your thoughts and experiences. Working with these feelings is always a challenge, and no two people react the same. So share your stories for what has helped you get through the tough days and stay on top of diabetes even when you’d really rather just take the day off.