Depression makes diabetes worse, and new studies show that diabetes can also lead to depression. How can we break these links and become happier and healthier?
Depression is a condition that can be brought on by factors such as life difficulties and stresses, which can change the chemistry and even the structure of our brains. According to psychologist Paula M. Trief, PhD, symptoms of depression include, among others, feelings of deep sadness, hopelessness, or worthlessness, loss of interest in things, fatigue, difficulty concentrating, insomnia or sleeping too much, loss of appetite, aches and pains, thoughts of suicide, or suicide attempts.
Diabetes researcher Sirimon Reutrakul, MD, says, “Studies show that untreated depression is related to worse patient outcomes, including poorer diabetes self-care, blood glucose control, and diabetes complications.”
A deeply sad person will probably not take the time and effort to manage his diabetes well. Why bother? But treating depression can improve diabetes management.
In a paper presented at the American Academy of Nurse Practitioners conference, Arizona researchers Kristel McGhee, DNP, and Katherine Kenny, DNP, reported that “recognition of depressive symptoms, in conjunction with appropriate follow-up and treatment, led to improved hemoglobin A1c (HbA1c) levels” in three studies. Depression was also “linked to inadequate glycemic control” in seven studies.
The life stresses that raise the risk of diabetes can also raise the risk of depression. In a study published in the Archives of Internal Medicine, Dr. Frank Hu, MD, PhD, MPH, professor of nutrition and epidemiology at the Harvard School of Public Health in Boston, found that, “People who are depressed have elevated levels of stress hormones such as cortisol, which can lead to problems with glucose…metabolism, increased insulin resistance, and the accumulation of belly fat — all diabetes risk factors.”
This is one reason people with harder lives tend to have more Type 2 diabetes and more depression.
Further, according to Dr. Hu, “There is long-term stress and strain associated with diabetes management [which] can lead to decreased quality of life and increased probability of depression.”
This strain is often called diabetes distress or diabetes burnout. As psychologists William Polonsky, PhD, CDE, and Lawrence Fisher, PhD, wrote, “In the face of a complex, demanding, and often confusing set of self-care directives, patients may become frustrated, angry, overwhelmed, and/or discouraged.”
Remember that much depression is physical. Many studies have found that higher glucose levels can make people depressed, even without associated stress and sadness. When our bodies don’t feel good, our minds likely will not either. As we age and as diabetes goes on we may experience losses of health and energy that can cause grief and depression.
I’m experiencing that reaction now because of recurring urinary tract infections (a complication of multiple sclerosis [MS]). I feel tired and weak much of the time, and I notice it’s hard to keep up a good mood when I feel sick. However, there are things any of us can do to treat depression.
Managing diabetes depression
You may have gotten used to depression, but your body will feel better without it, and your diabetes will likely improve, too. On DiabetesSelfManagement.com, recreation therapist and health writer Cynthia Mascott suggested, “If you feel that diabetes has taken an emotional toll on you, you may want to consider asking your physician for a referral to a mental health counselor who has worked with chronic illnesses.”
“Begin keeping a journal to track your feelings,” she continues. “You may also want to identify stressors in your life and try to identify solutions to decrease your stress. Also, try to reframe your negative thoughts about having diabetes.”
This reframing is what they teach in cognitive behavioral therapy (CBT). In a recent study of people with Type 2 diabetes from Appalachia, people who got CBT from a community practitioner were 12 times more likely to have partial or full remission of depression than those whose care did not include CBT.
Physical activity also heals depression. It gets you moving when you feel stuck. In the Appalachian study, people helped with an exercise program were more than five times more likely to recover from depression. Those who had both interventions did even better.
Social support also reduces depression and diabetes distress. Cynthia Mascott says, “Join a diabetes support group, which most local hospitals host.” Support groups can give you coping strategies as well as emotional support.
Religious practice, prayer, and/or meditation have been found to reduce depression in small studies. I would think the content of the religion would make a difference here. A belief that you’re going to Hell isn’t going to cheer many people up. A belief that you have a close connection with God or with all life might be helpful, though.
Sleep is important for mental health. A study from Thailand found that people with Type 2 diabetes who go to bed early and wake up early have less depression than people with later hours.
Key point — don’t ignore your mind. If you’re sad, or if you have any of the symptoms of depression mentioned here, make some changes. Get some help.