Diabetes and depression

Question:

My dad was diagnosed with diabetes about a year ago, and now he seems so depressed. Is there a link between the two?

Answer:

A number of recent studies report a link between diabetes and depression. Dr. Frank Hu of the Harvard School of Public Health has found that “there is growing evidence that they are linked behaviorally and biologically…we should not consider these as two isolated conditions any longer.”

Dr. Hu and his colleagues suspect that stress is the common thread. If you’re depressed you have elevated levels of stress hormone. This causes problems with blood sugar metabolism, increased insulin resistance and added pounds of belly fat – all of which are risk factors for diabetes.  

Besides the biological link, being diagnosed with a chronic condition such as diabetes can be distressing. Checking blood sugars, taking insulin, worrying about infections, managing medications, changing life-long eating habits and being on steady alert to the damaging effects of diabetes can, at the very least, be discouraging. It can also cause an individual to feel overwhelmed and sad over what they perceive as a decrease in the quality of their life. Anxiety, sadness, and long-term stress are all emotional pathways leading to depression.  

With both biology and a disheartened state of mind each playing a role, it makes sense that someone struggling with diabetes might feel depressed. But because living with diabetes requires a good dose of self-care, depression will sabotage the one person that can help: you. When you’re feeling down in the dumps, you really don’t care about much. No appetite, no energy, no sleep and no desire to socialize will all leave you in no mood to take care of yourself. The less you do so, the more your diabetes takes hold, and the more depressed you become. It’s a vicious cycle.

Now let’s talk about your dad “seeming depressed.” We know he’s at risk, so let’s take a look at the symptoms of depression the American Diabetes Association says you should look for.

• Loss of pleasure: little or no interest in the things you used to enjoy.
• Change in sleep patterns: trouble falling asleep, waking often during the night, wanting to sleep more – including during the day.
• Early to rise: waking up earlier and not able to get back to sleep.
• Change in appetite:  eating less or more than usual, resulting in a quick weight gain or weight loss.
• Trouble concentrating: not able to watch a TV program or read because other thoughts or feelings get in the way.
• Loss of energy: feeling tired all of the time.
• Nervousness: feeling so anxious you can't sit still.
• Guilt: feeling that you "never do anything right" and worry that you are a burden to others.
• Morning sadness: feeling worse in the morning than you do the rest of the day.
• Suicidal thoughts: wanting to die or are thinking about ways to hurt yourself.

If you have three or more of these symptoms of depression, or if you have just one or two but have been feeling badly for two weeks or more, go seek help from your doctor. You’ll need a thorough medical work-up to break down the cycle and figure out exactly what’s going on: high or low blood sugar could be making you tired or anxious, as could medications, or a thyroid condition. Add alcohol use into the mix and all of these symptoms could worsen. 

If it turns out that your father does have depression, there are two standard forms of treatment: behavioral therapy and/or medications. A team of researchers at the Veterans Administration Ann Arbor Healthcare System and the University of Michigan’s Health System released promising study findings that telephone counseling can reduce depression, lower blood pressure and increase exercise which, in turn, improves heart health and overall mood among diabetics. 

The researchers provided behavioral therapy to 145 type 2 diabetes patients over 12 weeks, followed by monthly sessions for nine months. After six weeks; they got the patients involved in a pedometer-based walking program. John Piette, MD, the lead author of the study, reported that at the end of the year, 58 percent of the participants reported no symptoms of depression compared to 39 percent who didn’t receive the counseling. Piette concludes that “Patients with depression and additional chronic medical conditions do better, if their depression is addressed first.”

Your hunch that your dad’s depression is linked to his diabetes is very likely correct. So, go break that link by getting him to a physician to assess what’s going on, and if it is depression, get him the therapy he needs.