Depression and diabetes

Daniel Sher explores how diabetes and depression are linked, and gives some pointers for managing diabetes and depression together.


If you have diabetes, your chance of developing depression is two to three times higher than that of other people. As if we didn’t have enough to worry about already.

Why is this a problem?

Depression can make it harder for you to manage your glucose levels, often leading to diabetes burnout. Before you know it, you’re stuck in a vicious cycle of sadness, mood swings and poor blood glucose control.

What is depression?

Depression usually involves feelings of sadness, but depression and sadness are not the same thing. Rather, depression is a psychological disorder that affects a person not just emotionally, but also in terms of their thoughts and bodily functions.

Some of the symptoms of clinical depression include:

  • Ongoing sadness that doesn’t seem to ease up.
  • An inability to enjoy activities that previously brought you happiness.
  • Sleep disturbances.
  • Mood swings at home or at work are interfering with your relationships.
  • Concentration difficulties.
  • Suicidal thoughts and behaviours.
  • Inappropriate guilt and poor self-esteem.
  • Social withdrawal.
  • Changes in weight and appetite.
  • Low energy.
  • Less motivation to test your blood glucose, exercise and take insulin (diabetes burnout).

How common is depression in people with diabetes?

Time and time again, research studies have shown that having diabetes puts one at risk of developing depression. For example, a 2012 study showed that people with Type 1 diabetes are three times more likely to have depression; while people with Type 2 diabetes are twice as likely to be depressed.

Another 2019 study confirmed these numbers, leading the authors to say that reducing diabetes by 25% could stop 2,34 million cases of depression from happening. But, believe it or not, research shows that the relationship goes both ways. Having depression can also make a person more likely to develop (Type 2) diabetes.

Clearly, then, a close link between the two conditions exists. But why does this link exist? Why do depression and diabetes occur together so often?

Explaining the link between diabetes and depression

Injections. Finger pricks. Doctor’s visits. Lows. Highs. Dietary restrictions. Worry and fear. Yes, as people living with diabetes, we deal with a whole lot of stress. Is it really that surprising that we’re more likely to end up with depression?

Of course, living with diabetes comes with a psychological burden which in and of itself can trigger depression. But, the stress of diabetes alone doesn’t completely account for this link. This is where things get interesting.

Diabetes, depression and the brain

Recent research suggests that high blood glucose levels have a direct impact on the parts of the brain that affect mood and thinking. The researchers used a (fMRI) brain scanner to compare the brains of people living with diabetes versus people without the illness. The people living with diabetes were given some glucose to raise their sugars.

The scanners showed that when blood glucose levels went up, a certain brain chemical (glutamate) was released in parts of the brain that control thinking and emotions. Glutamate is closely linked to depression. The researchers also showed that people with worse glucose control over time had patterns of electrical activity in the brain that are linked to depression.

So, in other words, this study tells us that the link between diabetes and depression is not just a matter of increased life-stress: the two disorders are linked on a biological level. People living with diabetes experience changes in the brain that make depression more likely; and this is especially the case when blood glucose levels are high.

A vicious cycle

Many clients who approach me for help are stuck in a vicious cycle. They struggle to control their diabetes as well as they would like; and they soon start to develop signs of depression. The depression makes it harder for them to stay motivated and hopeful. They start to slack-off in terms of self-monitoring, diet and exercise. Their glucose control suffers as a result. This leads them to become even more depressed.

Why is this important?

For starters, if you are one of millions of people living with diabetes who is struggling with depression, know this: it’s not all in your head. The stress and strains of living with diabetes are very real. But, the illness also predisposes you to depression because of altered brain chemistry.

Now that we know this, it’s absolutely vital for doctors, patients and family members of people living with diabetes to know how to recognise the signs of diabetes and get help where needed. Treating both diabetes and depression together is vital.

How to get help

The good news is that this cycle can be broken. In most people, depression responds well to treatment. Let’s look at the two most common treatment options:

  1. Psychotherapy

Also known as talk therapy, counselling or just therapy. Speaking with a licensed mental health professional can help you to change the thoughts and behaviours that make depression more likely.

Cognitive behavioural therapy (CBT) is one of the most popular forms of therapy for treating depression. If possible, try to find a therapist who is experienced in working with people living with diabetes. It can really help to speak with someone who understands the struggles and nuances of living with a chronic illness.

  1. Medication

One of the most common forms of antidepressant medications is called a selective serotonin reuptake inhibitor (SSRI). Examples include Celexa, Lexapro, Zoloft and Zytomil. A 2006 research paper suggests that medication and therapy are equally effective in managing depression; and that the best outcomes usually occur when the two are combined.

  1. Lifestyle interventions

Therapists often include ‘behavioural modification’ to their treatment. This means empowering the client to make healthier choices when it comes to their diet, diabetes management and exercise patterns. Making positive choices in this regard can help you manage your depression and diabetes at the same time.

How to get help

If you are concerned that you may be developing depression on top of your diabetes, speak to your endocrinologist or general practitioner. Alternatively, you may want to make direct contact with a clinical psychologist or psychiatrist in your area. If possible, try to consult with a mental health professional who has experience in working with diabetes.

If you or a family member are suicidal, contact the South African Depression and Anxiety Group on their 24-hour suicide hotline: 0800 567 567.

Final thought

So, we now know that people living with diabetes are more likely to experience depression. Not just because their lives are a whole lot more stressful, but because diabetes, depression and the brain are all linked on a biological level. For those of us with diabetes, this means that we need to remain vigilant for signs of depression.

By getting the mental health treatment that you deserve, it’s possible to improve your overall quality of life and your blood-sugar control at the same time.


References

Bădescu, S. V., Tătaru, C., Kobylinska, L., Georgescu, E. L., Zahiu, D. M., Zăgrean, A. M., & Zăgrean, L. (2016). The association between Diabetes mellitus and Depression. Journal of medicine and life, 9(2), 120-125.

Chireh, B., Li, M., & D’Arcy, C. (2019). Diabetes increases the risk of depression: A systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies. Preventive medicine reports, 100822.

Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., … & Atkins, D. C. (2006). Randomized trial of behavioural activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of consulting and clinical psychology, 74(4), 658-670.

Endocrine Society. (2014, June 23). High blood sugar causes brain changes that raise depression risk. ScienceDaily. Retrieved June 19, 2019 from www.sciencedaily.com/releases/2014/06/140623092011.htm

Roy, T., & Lloyd, C. E. (2012). Epidemiology of depression and diabetes: a systematic review. Journal of affective disorders, 142, S8-S21.

MEET OUR EXPERT


Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes patients to help them thrive. Visit www.danielshertherapy.com


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Let’s talk depression

World Health Day is celebrated on the 7th of April to mark the anniversary of the founding of the World Health Organisation. This year’s theme is “Let’s Talk: Depression.”

One in three South Africans will or do suffer from a mental illness in their lifetime – and depression is the most common mental illness. About one in six South Africans suffer from depression – although only about a quarter of people living with a mental illness ever seek or receive treatment.

Depression is the leading cause of suicide and, in South Africa, there are 23 completed suicides every day – and a further 460 attempted suicides every 24 hours. “Men are more likely to commit suicide than women as they don’t seek help until it’s too late,” said the South African Depression and Anxiety Group’s (SADAG) Director, Cassey Chambers.

It may not always be easy to tell the difference between a run-of-the-mill bad mood and depression. If you have five or more of these symptoms for most of the day, nearly every day, for at least two weeks, and the symptoms are severe enough to interfere with your daily activities, you may have depression:

  • Depressed mood, sadness or an ‘empty’ feeling or appearing sad or tearful to others.
  • Loss of interest or pleasure in activities you once enjoyed.
  • Significant weight loss when not dieting, or significant weight gain.
  • Inability to sleep or excessive sleeping, always feeling exhausted.
  • Restlessness or irritation (irritable mood may be a symptom in children or adolescents   too), or feelings of ‘dragging’.
  • Fatigue or loss of energy.
  • Feelings of worthlessness, or excessive or inappropriate guilt.
  • Difficulty thinking or concentrating, or indecisiveness.
  • Recurrent thoughts of death or suicide.

Depression affects people of all ages, from all walks of life and negatively impacts a sufferer’s ability to carry out everyday tasks. Depression has consequences for families, friends, workplaces, communities, and healthcare systems. Untreated depression can lead to self-injury and suicide. SADAG, like the WHO, believes that educating people about depression can reduce the stigma that surrounds mental illnesses and encourage more people to seek help.

We all have days when we want to hide under the covers and wish the world would leave us alone; days when we feel precariously on the verge of tears or an angry outburst. Minor things can trigger a bad day: having a squabble with a friend or colleague, getting stuck in traffic, or just waking up on the wrong side of the bed. Off-days happen to everyone, but when a bad day turns into a bad month, it’s time to take a closer look at your mood. It’s time to talk depression.

This year, for World Health Day, SADAG aided the whole of South Africa to talk about depression, using the following tools:

  • New online videos from actress and celebrity Lillian Dube sharing her experience with depression; Dr Frans Korb discussing depression in men; Dr Chabalala sharing information on depression in the elderly; psychologist Zamo Mbele giving tips on coping with depression as well as support group leaders Sheila and Thuli talking about how you can benefit by joining a local support group. Visit www.sadag.org to watch these videos, which were launched on Friday 07 April.
  • SADAG hosted a FREE Online #FacebookFriday Q&A Chat on “Let’s Talk: Depression” with psychologist, Liane Lurie at 1-2pm and again at 7-8pm with psychologist, Linda Blokland. Participates asked questions regarding depression diagnosis, symptoms, treatment plans as well as how to get help and support. Visit our Facebook Page “The South African Depression and Anxiety Group”.

This year’s World Health Day theme gives us a unique opportunity as the global community to talk about a health topic that concerns us all. Depression can be treated and suicide can be prevented. The more we understand about depression and suicide, the better we can help our communities.

In a country where access and services for people suffering with mental health issues is scarce, SADAG provides an invaluable service through their counselling call centre offering free telephonic counselling, referrals, information and support, as well as through various projects including school talks, rural outreach programmes, corporate talks and training.

To speak to a SADAG counsellor, call 0800 21 22 23 or SMS 31393 if you or a loved one are going through depression and need help.

SADAG is a mental health advocacy group, running a call centre with 15 helplines offering free telephonic counselling seven days a week, 365 days a year, and runs the only Suicide Crisis Helpline (0800 567 567) in the country. SADAG gives referrals nationwide, as well as information and support for all mental health issues encouraging people to speak out and get help.


Important SADAG Numbers:

SADAG Helpline – 0800 21 22 23

Suicide Crisis Helpline – 0800 70 80 90

24 Hours Substance Abuse Helpline – 0800 567 567

SMS – 31393

facebook Website – www.sadag.org


Article written by SADAG