Diabetes can be a difficult condition to accept and it is not uncommon for mental health issues such as depression to occur before or following a diabetes diagnosis.
Depression is a feeling of sadness that will not go away, and it can seriously affect quality of life. If you have been feeling hopeless for more than a week you are suffering from depression.
Signs and Symptoms of Depression
Ongoing sad, anxious, or empty feelings
Feeling guilty, worthless, or helpless
Feeling irritable or restless
Loss of interest in activities or hobbies once enjoyable, including sex
Feeling tired all the time
Difficulty concentrating, remembering details, or making decisions
Difficulty falling asleep or staying asleep, a condition called insomnia, or sleeping all the time
Overeating or loss of appetite
Thoughts of death and suicide or suicide attempts
Ongoing aches and pains, headaches, cramps, or digestive problems that do not ease with treatment.
Having diabetes can leave you feeling completely alone — and that there is no one who can help you or understand what you are going through.
“Depression is common in anyone with a chronic disease, but it is particularly common in patients with type 1 diabetes,” says Jennifer Goldman-Levine, PharmD, a diabetes educator and associate professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences in Boston.
Depression and Diabetes: Understanding the Link
Studies have shown that if you have diabetes, you are at increased risk of becoming depressed — in fact, you might have double the risk, according to one study. The exact reasons aren’t fully understood, but the stresses associated with having diabetes are thought to play a part.
In addition to possibly increasing your risk for depression, diabetes may make symptoms of depression worse. The stress of managing diabetes every day and the effects of diabetes on the brain may contribute to depression. In the United States, people with diabetes are twice as likely as the average person to have depression.
At the same time, some symptoms of depression may reduce overall physical and mental health, not only increasing your 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 you to ignore a special diet or medication plan needed to control your diabetes, worsening your diabetes symptoms. Studies have shown that people with diabetes and depression have more severe diabetes symptoms than people who have diabetes alone.
Diabetes-associated stresses may include:
Feelings of isolation, since only 5 to 10 percent of the diabetes community has type 1 diabetes (the majority have type 2)
Feeling overwhelmed by the many things you have to do to manage your diabetes
Worrying about diabetes-related complications such as nerve damage
Loss of your sense of control when your blood sugar levels are out of control
Tension between you and your doctor
People with diabetes also have an elevated risk for anxiety disorders compared with the general population. It has been found that people with schizophrenia have higher rates of hyperglycemia and type 2 diabetes than the general population.
Causes underlying the link between mental health conditions and diabetes are complex and thought to be two-way. Evidence suggests that a combination of biological, psychosocial, environmental and behavioural factors may all be involved.
Getting a chronic illness diagnosis can be a very stressful time for a person and can trigger behavioural/mental health symptoms. Equally someone with existing behavioural health difficulties can find it more difficult to manage the physical symptoms of a co-morbid, chronic illness such as diabetes. However, depression may also develop for physiological reasons such as the metabolic effects of diabetes on the brain.
STRESS AND DIABETES
Occasional stress is normal. You’re bound to experience stress if you have a lot on your plate at work or in your personal life. There may also be a link between stress and diabetes. Managing blood glucose and other aspects of diabetes can be time-consuming and stressful. Stress can make you:
feel anxious, moody, or nervous
experience upset stomach or diarrhea
have an increased heart rate
Stress not only makes everyday life less enjoyable, but it can also make diabetes more difficult to manage. You may experience an increase in blood pressure, as well as high blood glucose, or sugar (hyperglycemia).
When you’re stressed, your blood sugar levels rise.
Stress hormones like epinephrine and cortisol kick in since one of their major functions is to raise blood sugar to help boost energy when it’s needed most. Think of the fight-or-flight response.
You can’t fight danger when your blood sugar is low, so it rises to help meet the challenge. Both physical and emotional stress can prompt an increase in these hormones, resulting in an increase in blood sugars.
People who aren’t diabetic have compensatory mechanisms to keep blood sugar from swinging out of control.
But in people with diabetes, those mechanisms are either lacking or blunted, so they can’t keep a lid on blood sugar.
When blood sugar levels aren’t controlled well through diet and/ormedication, you’re at higher risk for many health complications, including blindness, kidney problems, and nerve damage leading to foot numbness, which can lead to serious injury and hard-to-heal infections.
Prolonged elevated blood sugar is also a predecessor to cardiovascular disease, which increase the risk of heart attacks and strokes.
Lifestyle changes can help alleviate stress and prevent it from taking over your life. Regular deep breathing exercises can help you relax. Mastering such techniques can also make it easier to cope in stressful situations.
It’s a good idea to check blood glucose levels more frequently when you’re ill or under stress and to drink plenty of fluids as so as not to get dehydrated.
Stress may also be effectively managed by making regular time for yourself. A diabetes support group can also help decrease stress by creating an outlet for sharing your experiences with others who understand what you’re going through.
Try progressive relaxation therapy, in which you practice tensing and relaxing major muscle groups in sequence. A study published in the journal Diabetes Care showed that just five weekly sessions of a relaxation therapy can reduce blood sugar levels significantly.
Learn cognitive behavior therapy. In addition to learning to relax, this therapy helps you re-evaluate what is worthy of your aggravation in the first place by helping you change your behavior and teaching you to view life through more appropriately colored glasses.
Talk to a therapist. Talking about your problems is a reliable way to alleviate the stress that stems from them.
Step back from the situation. If you can, remove yourself from the stressor.
Keep up your healthy eating and exercise routine. Exercise can help lower blood sugar, so a stressful phase is not the time to forgo physical activity.
Eliminate caffeine. Caffeine can impair your body’s ability to handle sugar and increase the amount of stress hormones, which may increase blood sugars.
Ask your doctor about an antianxiety medication. It isn’t ideal, but it can help during a crisis.
Take up a relaxing hobby. If reading, knitting , pottery or gardening calms you down, join a class or find a workshop. But if you stress over every imperfection in your project, save the hobby for a less stressed-out time, and take a hot bath instead.
CONSEQUENCES OF DEPRESSION & STRESS FOR DIABETICS
Studies suggest that people with diabetes who have a history of depression are more likely to develop diabetic complications than those without depression. Equally the chances of becoming depressed increase as diabetes complications worsen.
Research shows that depression leads to impaired physical and cognitive functioning, therefore a person is less likely to follow a required diet or medication plan.
It is common symptom of people with depression to lose interest and motivation in looking after themselves and their health. Even at mild levels, depression can adversely affect glycemic control and a person’s ability to perform diabetes self-care.
Anxieties may be triggered by the burdens of having a chronic disease and by diabetes-specific factors such as having to inject insulin and living with the threat of acute diabetic symptoms and long-term complications. Another revealing statistic is that diabetes is a leading cause of illness and death for people affected by schizophrenia-related disorders.
Ongoing stress and anxiety can lead to severe health consequences. Unmanaged stress can cause:
insomnia and sleep deprivation
In the long-term, chronic depression can also lead to severe problems, including:
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How is chronic depression treated in people who have diabetes?
Depression is diagnosed and treated by a health care provider. Treating depression can help you manage your diabetes and improve your overall health. Scientists report that for people who have diabetes and depression, treating depression can raise mood levels and increase blood glucose control. Recovery from depression takes time but treatments are effective.
At present, the most common treatments for depression include:
Cognitive behavioral therapy (CBT), a type of psychotherapy, or talk therapy, that helps people change negative thinking styles and behaviors that may contribute to their depression
Selective serotonin reuptake inhibitor (SSRI), a type of antidepressant medication that includes citalopram (Celexa), sertraline (Zoloft), and fluoxetine (Prozac)
Serotonin and norepinephrine reuptake inhibitor (SNRI), a type of antidepressant medication similar to SSRI that includes venlafaxine (Effexor) and duloxetine (Cymbalta).
Some antidepressants may cause weight gain as a side effect and may not be the best depression treatment if you have diabetes. These include:
Monoamine oxidase inhibitors (MAOIs)
Paroxetine (Paxil), an SSRI6
While currently available depression treatments are generally well tolerated and safe, talk with your health care provider about side effects, possible drug interactions, and other treatment options.
Not everyone responds to treatment the same way. Medications can take several weeks to work, may need to be combined with ongoing talk therapy, or may need to be changed or adjusted to minimize side effects and achieve the best results.
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