One-on-one with Dr Cliff Allwood

Dr Cliff Allwood, specialist psychiatrist – Akeso Clinic Pietermaritzburg, explains how diabetes and depression are linked.

What comes first – depression or diabetes?

As far as we know, there is not a causative link between the two conditions and they may occur at different times. However both conditions may be linked to a significant physical, medical or emotional stressor. The onset may have occurred at a similar time.

Is there a link between the two? And how does this work?

There does not seem to be a direct link, however, we do know that clinically the two conditions do affect each other. Each makes the other worse. Both conditions need to be adequately treated.

How do you break this vicious cycle?

Both conditions have to be taken seriously. Diabetes and any other medical conditions must be treated. Ongoing monitoring and control is essential. Depression must be treated with whatever biological, psychological, social or spiritual interventions are appropriate and effective. Lifestyle changes may have to be made in both conditions, and exercise is essential for both conditions.

How does depression in a diabetic patient differ to any other form of depression?

In the diabetic patient, mood can be affected by blood sugar changes. The patient has to be aware of the effects of both ‘highs’ and ‘lows’. Sometimes the medications used for diabetic control may have an effect on mood. Diet and lifestyle changes may also affect mood. The patient is encouraged to be observant about the effects of changes. A partner or close friend can be helpful in observing changes. On the other hand, depression may affect the manner in which the patient is managing his/her diabetes. Depression may have a negative effect on motivation and compliance with treatment.

In advanced stages of diabetes sufferers may lose sight, limbs, or have other medical conditions. These profound disabilities will commonly result in depression. The depression requires full treatment. Untreated depression may have severely negative effects on later compliance and efforts towards treatment and rehabilitation.

Is there an increase in this?

There is a worldwide increase in the incidence of depression.

What are the signs of depression in the diabetic patient? Do these differ from other forms of depression?

Depression in a diabetic patient is no different from depression in people who don’t have diabetes, except as mentioned in question four. However, any signs of ‘confusion’ in the patient must be taken very seriously since this indicates that either the blood-sugar is out of control, or there is some reaction to the medication. This requires a full medical examination and appropriate treatment.

How is depression beaten?

Treatment for depression varies dependent on the specific history and symptoms of each sufferer. Research does however indicate that treatment with medication and psychotherapy is generally most effective. Substantial lifestyle changes may be required and the recruitment of social support is also necessary, as self-isolation makes depression worse. If the depression is severe the sufferer can be treated with the assistance of an inpatient treatment programme, such as the programmes offered by Akeso.

When should partners or family members worry?

When the depression is preventing the sufferer from functioning as they wish to.

Are there tips and tools to reducing your levels of depression if you have diabetes?

Self-care is an important practice as is increasing self-awareness. The establishment of good habits like journaling (a food and mood diary); moderate and consistent cardiovascular exercise (brisk walking etc.); dealing proactively with negative thoughts; sustaining healthy friendships; ensuring compliance with medication; supplementation with Omega 3s; getting 20 minutes of sunshine every day; developing resilience; practicing self-acceptance and being kind to oneself – are just a few ways to limit the destructive impact of depression.