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Depression and diabetes

People with diabetes are twice as likely to experience depression as the general population and the risk is higher for women than for men. As many as one in three people with diabetes suffer a significant loss in their quality of life due to their depression. People with diabetes and depression are also far more likely to have poorer blood glucose management.  There are many similarities between diabetes and depression. Both are simple to diagnose yet often go undiagnosed. Both can affect important personal relationships, leaving you feeling irritable and run down.  Disruptions to sleeping and eating patterns (including comfort eating) are common to both. Both are manageable conditions that only get worse if ignored. And both can leave people feeling weak, helpless and alone. Yet,significantly, the report, Diabetes: State of the Nations 2005, published by Diabetes UK, has highlighted the lack of recognition and psychological support for people with diabetes.

So what exactly is depression, how are these two conditions linked and what can people with diabetes do to be aware of depression and address it before it becomes serious?

Depression or just a bit down?

For practical purposes, it’s important to be able to distinguish between feeling ‘a bit down’ and feeling depressed. The symptoms of depression are:

• persistent sad, irritable or ‘empty’ mood
• loss of interest in activities once enjoyed, including sex
• significant change in appetite or body weight (gain or loss)
• difficulty sleeping, waking very early (feeling sad) or oversleeping
• feelings of worthlessness, helplessness, guilt
• decreased energy, fatigue, feeling ‘lacklustre’
• restlessness and irritability
• difficulty concentrating and remembering
• recurring thoughts of death or suicide.

If five or more of these factors are present every day for more than two weeks and interfere with daily routines such as work, diabetes self-care, childcare or social life, it is important that you visit your GP or discuss it with your healthcare team. Depression won’t just go away. It needs to be treated – by antidepressants, therapy (counselling, cognitive behavioural therapy or psychotherapy), or by a combination of therapy and antidepressants.  It’s also important to be aware that depression can be mild, moderate or severe. Your GP will diagnose whether or not you have depression, determine how severe it is and decide on the appropriate treatment for you.

Treating depression

Antidepressant drugs

If appropriate, your GP may prescribe one of the many different kinds of antidepressant available. Generally, it can take a few weeks before the benefits of antidepressants are felt. Different people react differently to different antidepressants, so your GP may have to try more than one to find which works best for you. Depending on the severity of your depression, you may need to take antidepressants for a few weeks, a few months or even a period of years. Your GP will regularly monitor the situation with you, and you should never stop taking antidepressants abruptly or without consulting your GP.

Talking therapies

• Cognitive behavioural therapy teaches you how certain thinking patterns are causing your symptoms
• Counselling and psychotherapy explore your current concerns, past patterns, needs, relationships with others and offer time and space to reflect on your own solutions and resources.
• Complementary therapies such as acupuncture, aromatherapy and herbal medicine can be effective; they should not be seen as substitutes for conventional medicine or treatment but as additions to it. Always inform your GP and pharmacist of any non-prescription treatments you are taking, like homeopathic remedies and supplements. Diabetes UK does not recommend complementary or alternative therapies as they are not evidence based.

Time to adapt

It must be stressed that diabetes does not physically cause depression (though there is some early evidence to suggest depression upsets metabolism and may increase the risk of Type 2 diabetes). That said, diabetes can lead, or contribute, to feelings of depression as you adapt to the lifestyle changes demanded by the
condition. Though adapting is a normal process, knowing what to expect should help you get through it more easily:

• For several months after diagnosis, and periodically from then on, it’s normal to be fed up with your diabetes, the demands of healthy living and regular visits to your GP or clinic.
• It’s common to experience powerful emotions – shock, confusion, numbness, anger, resentment, guilt, blame and self-blame – and to be constantly on the lookout for the worst that could – not, necessarily, will – happen.
• Gradually, as you learn what you’re dealing with, you regain confidence and selfassurance.  Having, probably, drifted between despair and hopefulness several times, the ground beneath you is, at last, solid again.  In short, you have adapted.
• It’s possible that none of this will happen to you until six months or longer after diagnosis rather than in the first weeks. People who don’t experience at least some of these emotions – and who appear overly calm or deny that they need to make any adjustment at all – may simply be storing up problems for later.

Coping strategies

In order to adapt, you have to be able to cope, and how well you cope will be influenced by a number of factors. Diagnosis of diabetes is unlikely to come at a point in your life when, conveniently, you just so happen to have plenty of time to spare. More likely, life will be making its usual demands – children, work, relationships, money issues, house moves, health problems and more. It’s also possible that major life events in the past – bereavement, health scares, divorce, complicated pregnancies or any number of things – may be continuing to affect you.

Diabetes itself will make its own demands on your energies.  In other words, life doesn’t freeze-frame to allow you time to regroup in the face of diabetes. And as women with diabetes – according to the research – are more likely to feel under strain and lacking in resources, they are in even greater need of finding ways to cope.

Here are some suggestions:

• If possible, take a break from stressful life events to recharge. If necessary, ask for a bit of support from family, friends or employers. If you can’t do these things – depending on the circumstances – and continue to feel low and pressured for more than two weeks, you may be developing depression.
• When it comes to your diabetes management, have realistic expectations about what you can achieve. For example, if you want to be more active but hate gyms, don’t join a gym. Find other ways of increasing your activity levels, for example walking, rather than driving or taking public transport.
• Are you a coper-carer? Take a good look at how you’ve managed change in the past. Are you good at caring for other people’s needs but have great difficulty acknowledging your own? In an average week, how much time is devoted to just you and your needs. If you don’t have at least a few hours, not including sleep, for yourself, perhaps you are a coper-carer.
• Just as a poor diet and very little physical activity are bad for your diabetes management, they can also contribute to feelings of depression. Eating healthily (but not restrictively or rigidly) and using more energy can help lift mild depression. 
• Relaxation techniques, such as yoga or T’ai Chi, or even attending evening classes, can also be of benefit.  Remember, also, that even if you were diagnosed some time ago, you may still need coping strategies when the time comes to review your diabetes management.

Further information

To speak to a trained counsellor with an understanding of depression, call the Diabetes UK Careline on 0845 120 2960.

Depression Alliance (for information, support and advice about treatment) – call 0845 123 2320, email Information@depressionalliance.org or go to their website.

The British Association for Counselling and Psychotherapy provides information about counselling and therapy as well as details registered counsellors across the UK working in private practices – call 0870 443 5252.

Samaritans – call 08457 909090 (lines open 24 hours a day).