Depression and Type 2 Diabetes—Symptoms or Disease?

According to studies, people with diabetes are three to four times as likely to have major depression than people in the general population. Why should this be?


John McManamy, author of Living Well with Depression and Bipolar Disorder,” says: “For many years it was thought that depression was a complication of diabetes, which may well be the case. More recent research, however, points to depression as a possible cause or trigger.

“A Kaiser Permanente study of some 1,680 subjects found that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About 84% of people with diabetes reported a higher rate of earlier depressive episodes.

“A 2004 Johns Hopkins study tracking 11,615 initially nondiabetic adults aged 48–67 over six years found that ‘depressive symptoms predicted incident Type 2 diabetes.’…Women, in particular are at greater risk, according to other studies.” And another study shows that this risk, among both men and women, persists even after controlling for weight, caloric intake, smoking, and economic factors.

What Causes Depression?
So does depression cause diabetes, or does diabetes cause depression? The reality is deeper than that. In my book, Diabetes: Sugar-coated Crisis, I argue that Type 2 diabetes and depression are best considered different symptoms of the same disease. This disease may go by the names insulin resistance, metabolic syndrome, or powerlessness.

In his book, Overcoming Depression, British psychologist Paul Gilbert writes that depression is a natural response to having a lack of power in your life. (Gilbert called another book Depression: The Evolution of Powerlessness.) Gilbert asks and answers the question, “Where does depression come from? What good does it do?” It must do some good, because it causes a lot of harm, and yet we still have it. Depression genes would be long gone from our gene pool if they didn’t help us in some way.

Gilbert’s answer is that “Depression keeps us out of battles that we know we cannot win.” Consider how a depressed chimpanzee or monkey acts: “downcast, nonthreatening, withdrawn.” This behavior may feel terrible, and it may keep the chimp from getting much food or any mates. But it will keep him or her from getting beaten up by more powerful chimps. When you lack power, depression can save your life. And if depression keeps you out of losing battles, what about being sick? That will keep you on the sidelines, depressed and frustrated, perhaps, but safe.

So the less power you have, the more likely you are to be depressed and to have Type 2 diabetes. As I explain in my book, power can come from resources (like money, education, living in a good neighborhood), from support (the help of friends, family, professionals, congregation, others), or from self-concept (self-confidence, self-esteem, having positive goals and reasons to live). The best way to treat depression is through empowerment.

Next week, I’ll talk more about how to treat depression and why treating the condition is important. In the meantime, what have been your experiences with depression?

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  • Jon S.

    About 10 years ago I was finally diagnosed with depression and anxiety disorder. Since then I have been on several different medications and seen three different psychiatrists. The question that I could never get answered was “why me?”. I had always enjoyed my job(s) (twice retired now), have a wonderfully supportive family, an awesome family doctor, have been active in Church activities but always had that dark cloud lurking inside me. Thirteen months ago, I was diagnosed with Type 2 diabetes and thought “yep, just my luck”. Then I read this article. BINGO. It’s big piece of the great puzzle that I have finally been able to come to grips with most of the time. I am enjoying live now more than ever before.

  • paperprincess

    Empowerment is definitely the answer to treat depression.
    I have suffered from chronic pain for the last 12 years and was recently diagnosed with diabetes. It runs in my family and my numbers have been riding the fence for a while now. We finally stepped over the line.
    I treated the diagnosis the same way I treated my chronic pain. I read everything I could find on the net, bookmarked the ones I didn’t have time to read and talked to everyone I could about it. I read box labels, and I subscribe to a gazillion newsletters and magazines.
    I’m learning and now know things I can do. My body isn’t in control when it comes to the diabetes, I am. I’m the one controlling my blood sugar. Knowing that gives me a sense of power and that makes me feel good.
    I still have my moments, but the pity parties and depressive moods don’t last near as long as they did before I started reading and learning.

  • Barbara

    Is there any correlation with depression and Type 1 Diabetes?

  • pepdot

    Wow – which does come first the chicken or the egg. Before being diagnosed with diabetes my weight depressed me …. a GREAT deal. After being diagnosed – the thought of diabetes depressed me almost as much as the inability to control my blood sugar .. my weight.

    NOTHING I tried worked or made sense – what seemed like control one day .. didn’t work the next day and nothing I did helped me lose weight.

    I’ve been on Byetta for 2+ months now and my readings are perfect … I’m losing weight and not a mystery I’m not depressed about anything ….
    Absolutely powerless / helplessness – if what you are told to do does NOT work – after awhile you quit trying – that’s just human nature. Once you quit trying your future with diabetes is a harsh reality.

    Before controlling I just accepted that my life would be severly shortened since I could not manage my diabetes – THAT’s depressing. I’m empowered and in control now so thusly don’t feel depressed.

  • ewhitt

    I am a very open, outgoing and gregarious diabetic. This has been a change that I didn’t
    understand at first until I read that it was
    part of the disease. It makes me want to be
    comatose…not go out…not see anyone….just
    sleep and withdraw….and that is just so not
    like me before. I have always been large but
    that hasn’t stopped me from enjoying my life.
    However, depression has and the thing is the
    inactivity feeds the diabetes….catch 22…

  • Bluebird

    WOW! Will your blogs ever stop hitting me between the eyes? I retired a year and a half ago from a job I had loved for 25 years. The last year I worked was horrible and I hated every minute of it. I placed the blame entirely on a vice president who was attempting to control every minute of our working life (I was in outside sales). The week after I retired I was told I definitely had Type 2 Diabetes. I wonder if this was a coincidence? Was I actually suffering from depression? (probably) I had never dreamed that these two things could be connected.

    Since Dr. Bernstein’s book came into my life I am back in control. Thanks a million to you, David. WOW! You teach me so much. THANKS AGAIN!

  • Burbot

    Depression as well as other psychiatric illnesses are due to chemical imbalances in the brain. Depression can range in degree from “the blues” to life-threatening “clinical depression.” Sometimes behaviorial and dietary changes are enough to improve the condition but often mood stabilizers, tranquilizers, and psychotropic medicines need to be considered. The combination of medication and life-changes is generally most effective for severe depression. How do I know This? I have a condition called schizoaffective disorder of the depressive type. Without medication I could well end up in a hospital. I had this condition long before my diabetes type 2. Now, I also have an arthritic back, central obesity and sleep apnea. Every reason to be depressed you might say, but my depression and psychosis were there long before the other condtions. True depression is no laughing matter as it can lead to suicide. Believe me, I know.

  • Ellen

    I wonder if a generell sadness or being upset about marital and other problems causes a rise of blood sugar. is that in anyway connected?
    I had a feeling whenever I get really upset about something that my Blood Sugar rises to over 200. I have Type 2 Diabetes and are treated with Metformin and Glimiperide and my Blood Sugar is normally around 120 but it seems when I get upset i start sweating and then I know my Bloos Sugar is rising and sure enough if I test it, its around 200. Is that a coincidence or is that realty that I have to control better.



  • David Spero RN

    Hi Ellen,

    I don’t think sadness raises your blood glucose, but stress does. If your sadness comes along with feelings like “I’m no good,” or “it shouldn’t be like this,” or “something terrible is happening,” that would raise your glucose by increasing insulin resistance.


  • paul

    I have diabetes2 i feel depressed a lot of the time, dont want to do anything just sleep most of the time.I lost my job a year ago and feel pretty worthless and no benefit to anyone.My work mates soon forgot me after working with them for over fourteen years.I do wonder sometimes does anyone care if i live or die or would i be missed i doubt it.

  • David Spero RN


    Get some help with this please — find a friend, a clergy person, or a professional you can talk with. Get involved in helping other people — a youth program, visiting shut-ins, feeding people, anything that makes you feel good. Remember to get some sunshine and some physical movement every day.

    You will feel better soon,