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Depression and Diabetes

What you need to know—bad news and good—about the diabetes depression link.


Diabetes Depression

By the dLife Editors

Depression can strike anyone, but people who have diabetes appear to be at greater risk. In fact, studies suggest that people who have type 2 diabetes have a much as double the risk of depression as people who don’t. The rate of depression is thought to be at least three times higher in people with type 1 diabetes than in people without diabetes.

In a vicious cycle, people with depression may be at greater risk for developing diabetes. Thus, the strong diabetes depression link.

As diabetes complications get worse, it is common for depression to increase as well, which can lead to a lack of proper self-care.

You have to live with diabetes, but you do not have to live with debilitating depression. Treatment for depression helps people manage symptoms of both diseases, thus improving the quality of their lives.

What Is Depression?

Depression isn’t just feeling “down” or being sad in response to a loss or challenge life throws at you. It’s a mood disorder that causes ongoing, persistent symptoms that disrupt your life, affecting how you feel, think, and handle daily activities, such as sleeping, eating, or working.

While depression is serious, it’s also treatable. And since depression can affect nearly every aspect of a person’s well-being, it’s important to get help.

Symptoms of Depression

People experience depression differently. The severity, frequency, and duration of symptoms vary depending on the person and his or her particular illness.

Symptoms of depression most commonly include:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, early-morning awakening, or oversleeping
  • Changes in appetite
  • Thoughts of death or suicide, or suicide attempts
  • Restlessness, irritability
  • Physical discomforts, such as headaches, aches and pains, or digestive discomfort that doesn’t respond to treatment.

If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, basic caring for yourself, childcare, or your social life, talk to your doctor.

Types of Depression

People experience depression in different ways, and there are different types of depression.

Major Depressive Disorder. Symptoms of major depressive disorder, aka major depression or “clinical depression,” are severe and persist for most of the day, nearly every day, for at least two weeks. They include either a depressed mood or the loss of interest in nearly all activities, plus at least several others from the list above. Untreated, episodes often last three to six months, though in about 20 percent of people with major depression, episodes last two years or longer. At least half of people who have one episode of depression eventually have another.

Dysthymia, aka persistent depressive disorder. This is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.

Perinatal depression. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery—the more widely known postpartum depression. The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.

For more on postpartum depression, visit https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml.

 Seasonal affective disorder. People with seasonal affective disorder (SAD) experience depression every year at the same time, typically in the late fall or early winter when there is less natural sunlight. The depression can be accompanied by social withdrawal, increased sleep and weight gain.

To learn about seasonal affective disorder go to https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml.

Psychotic depression. This occurs when a person has severe depression plus some form of psychosis, such as having delusions or hallucinations. The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

What Causes Depression?

Depression is a complicated condition that is thought to be caused by a combination of factors, including genetic, biological, environmental, and psychological. It is more common among women than among men.

According to the National Institute of Mental Health, risk factors include:

  • Personal or family history of depression
  • Major life changes, trauma, or stress
  • Certain physical illnesses and medications

The Diabetes-Depression Link

The reason for the link between diabetes and depression is unclear. It may be due to the stress of having diabetes, by behaviors that contribute to both conditions or by shared underlying biological mechanisms.

Some symptoms of depression may reduce overall physical and mental health, not only increasing the risk for diabetes but making diabetes symptoms worse. For example, overeating may cause weight gain, a major risk factor for diabetes. Fatigue or feelings of worthlessness may cause people to ignore a special diet or medication plan needed to control their diabetes. Studies have shown that people who have both diabetes and depression have more severe diabetes symptoms than people who have diabetes alone.

How Is Depression Treated?

The first step to getting appropriate treatment is to visit a primary care doctor or mental health specialist. Certain medications, and some medical conditions such as a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities.

The most common treatments for depression include:

  • One type of psychotherapy for depression is cognitive behavioral therapy (CBT), a type of talk therapy that helps people change negative thinking styles and behaviors that may contribute to their depression.
  • A selective serotonin reuptake inhibitor (SSRI), a type of antidepressant medication such as citalopram (Celexa), sertraline (Zoloft), and fluoxetine (Prozac)
  • A serotonin and norepinephrine reuptake inhibitor (SNRI), a type of antidepressant medication similar to SSRIs, such as venlafaxine (Effexor) and duloxetine (Cymbalta)

Exercise also may help someone with depression feel a bit better (and has benefits for blood sugar control, too).

The doctor may refer you to a mental health professional, who should discuss with you any family history of depression or other mental disorder and get a complete history of your symptoms. You should discuss when your symptoms started, how long they have lasted, how severe they are, whether they have occurred before and if so, how they were treated. The mental health professional may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide.

Depression, even the most severe cases, can be effectively treated. The earlier treatment begins, the more effective it is.

Sources

“Epidemiology of depression and diabetes: a systematic review.” https://www.ncbi.nlm.nih.gov/pubmed/23062861Accessed 3/19/17National Institute of Mental Health, “Depression: What You Need To Know”
https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml
Accessed 3/19/17

“Risk for Recurrence in Depression”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2169519/
Accessed 3/19/17

National Institute of Mental Health, “Postpartum Depression Facts”
https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml
Accessed 3/19/17

Medscape, “Dysthymic Disorder”
http://emedicine.medscape.com/article/290686-overview?pa=MFJYvBwEoIYpPvqR2rg2%2B5YPi4fG7HQnZD4FDx2RCxCd4GAGG73NGdxNVOOEEb53eWfHYPGPHq%2Flc6nC1RdnI2oJls9WfyZninzoyGTER64%3D

Cochrane, “Exercise for depression”
http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depression
Accessed 3/19/17

“Diabetes and Depression”,
Current Diabetes Reports
June 2014, 14:491

https://link.springer.com/article/10.1007/s11892-014-0491-3

Updated March 2017.

Depression and Diabetes
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