Living with diabetes - witehr Type 1 or Type 2 - has its fair share of challenges. Although the focus may be on the physical impact of the condition, it can be easy to overlook the emotional effects diabetes can have. Clinical psychologist, Dr Jen Nash, looks at depression - the signs to watch out for and how to get help
Life with diabetes can be hard work, as Jenny, 38, from Leicester, who was diagnosed with Type 1 in childhood, will testify. “Having diabetes is like having a full-time job, but not just any job, one that takes up your time 24/7 – 7 days a week, 365 days a year, with no holiday, no praise and no pay!” Jenny explains. “If I was in a job like that, I wouldn’t stick around for very long, but I have no choice as having diabetes means I have to keep working at my health day in and day out.” It’s no wonder, then, that after years of coping with her condition, Jenny became depressed.
But, Jenny isn’t alone – depression and low mood are common experiences for people with diabetes. In fact, research shows that a third of people who have diabetes may develop depression at some point, as a result of the demands that the condition can make on their lives – from the necessary lifestyle changes to relentless self-management, which – inevitably – can impact on their quality of life.
What’s more, diabetes and depression often interact with each other, making the downward spiral of mood worse. So, if you are already feeling low in mood, as Jenny discovered, it can become more difficult to care for your diabetes as your blood glucose levels become higher, and fatigue and lethargy set in. “The lower I was in mood, the less motivated I was to manage my blood glucose levels properly, but as guilty as I felt about it, I just didn’t have the energy to pull myself out of this vicious cycle,” she admits.
Depression or burnout?
In addition, people with diabetes can struggle with ‘burnout’, a linked – yet distinct form – of low mood specific to those with diabetes, when a person feels overwhelmed by their condition and the frustrating burden of diabetes self-care, as James, 53, from London knows all too well. “Although I had an inkling that things weren’t quite right, the impact of my Type 2 diagnosis and the reality that this was it – the rest of my life was going to be all about managing my blood glucose levels, and thinking about what I ate, drank and how much exercise I did – were overwhelming,” James says.
While depression may affect a person in broader psychological ways – having negative thoughts about themselves and the world, and a sense of hopelessness about the future, for example – burnout centres on feelings focused specifically on diabetes. This is something that James would attest to, as other aspects of his life were going well. So for him, the cause of his low mood was clear, “I had just secured a high-level promotion at work, and I felt like I was taking life in my stride, so I can definitely pinpoint that trying to get to grips with my condition was when things began to slide emotionally for me.”
The good news is that depression and diabetes-related burnout are treatable, and many people go on to make a full recovery. Fortunately for James, and with the help of his wife, Jane, he found support with a local diabetes group and hasn’t looked back. “Meeting up with people in the same position as me, the same concerns when coping with their diabetes has been a godsend to me, and Jane, who’s able to talk to people, who, like her, are living with the condition, too.”
The other good news (although it might be of little comfort if you’re in the midst of dealing with depression right now) is that many people who recover from depression report that the experience deepened their self-knowledge and understanding of life. This has aided them in other respects, helping them to become more self-aware, more sensitive to others and more thoughtful as parents, for example.
Why me?
There is rarely one specific cause of depression, and biological, psychological and social factors all play a part in its development.
Biological
– some people are more susceptible to developing depression than others, with those who have a close relative who has been diagnosed with depression being more at risk. Two brain chemicals, noradrenalin and serotonin, play an important role in brain function, and have been found to be deficient in people with depression.
Psychological
– there are psychological factors that also contribute.
Our thoughts have a big influence on our moods, and some ways of thinking can be less helpful than others. What’s more, depression can be a natural reaction to loss – and the diagnosis of diabetes can often lead to a sense of loss of valued health, similar to that experienced in the grieving process. Social factors – social factors are also important in the development of depression. When challenging things happen in life (diagnosis of diabetes, along with other stressful events, such as: family and work stresses, feeling lonely and isolated, or a major life event such as an accident, loss of job or loved one), we can feel less in control of our lives.
Getting help
Just as there are different causes of depression (see ‘Why me?’ above), treatment can also be addressed at these levels. Antidepressants, getting support from family and friends, talking therapies (counselling, cognitive behavioural therapy (CBT) or psychotherapy) and challenging negative thinking can all help to alleviate depression and low mood. Antidepressants can sometimes be helpful in treating depression. But, they can cause side effects for some people, and the type and dose need careful management.
Taking antidepressants in combination with therapy may be the ideal way to treat your depression. A number of studies have shown that having the benefit of support through a close, confiding relationship is an incredibly powerful protection against developing depression. So, try to talk to someone you trust about what you are feeling. You may not have anyone in your life who you feel able to talk to about your depression. Sometimes your loved one can be too close to your problems, or too much a part of them, to be the ideal person to help you. A psychologist, counsellor or therapist can help, so talk to your GP or healthcare team about access to NHS support.
For Jenny, looking back, getting help from her GP, who prescribed antidepressants and referred her to a psychotherapist, was the first step in helping her overcome her depression. It’s been a life-changing experience, but one that she feels has helped her better understand her emotional response to her condition. “If I’m honest about it, I think I had a delayed reaction to dealing with being Type 1 for so many years – feeling different from the other kids at school, and then not being able to take for granted the things that people who don’t have the condition can, particularly in my teenage years and early twenties,” she says. “Although life is difficult enough, with all of the chores and the worries of diabetes to deal with, I’ve learnt to be more positive about having diabetes.”