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Article: Patients as Partners

Diabetes and Depression

A devastating duo

By Zane Wilson

Feeling down once in a while is normal, but sadness that won't go away, feeling life is hopeless, that there is no way out, and feeling this way for two weeks or more could be a sign of depression. Most people with diabetes do not have depression, but studies show that people with diabetes have a greater risk of depression than people without diabetes. Depression is not generally listed as a complication of diabetes. However, it can be one of the most common and dangerous complications.

Depression can affect anyone and 1 in 10 people will experience depression in their life, but people with diabetes may be at a greater risk. In fact, research shows that diabetes doubles the odds of co-morbid depression. A study from the University of Washington, links depression to a higher death rate in people with diabetes. The study found that patients who had diabetes and depression were 36 to 38 percent more likely to die from any cause, not just from diabetes-related complications. One reason for this, according to the researchers, may be because when people are depressed they don't take care of themselves as well, and may engage in unhealthy habits such as smoking or overeating.

Causes underlying the association between depression and diabetes are unclear, but experts see a definite link between diabetes and depression. One reason may be that depression hits people with diabetes more often than the general population because they get “burned out managing their disease. They get upset, gloomy and hopeless and many feel that they can't control what's going on”, says Dr Fisher. Also some diabetes patients, particularly women, don’t make their self-care a priority and instead continue to care for their families, their jobs, everything else in fact and that leaves little time for them to take care of themselves.

Being diagnosed with diabetes is a major life stress that requires physical and mental adjustments. The individual must learn about a complex system of dietary and medical interventions, and lifestyle, work, and social schedules may have to be altered. Just as important, but often ignored, are the psychological adjustments. People have to adjust to a new view of themselves, and for people who believed themselves to be invincible, this may be particularly difficult.

The stress of managing diabetes on a daily basis can build, and people may feel alone or isolated from friends and family. People who are suffering with diabetes complications like nerve damage, or are having trouble keeping their blood sugar levels stable, may feel like they’re losing control of their diabetes. According to psychiatrist Dr Frans Korb, depression can create a vicious cycle – and block good diabetes self-care. “If you are depressed and have no energy, chances are you will find such tasks as regular blood sugar testing too much. You may not feel like eating at all or struggle to keep up with a good diet. Of course, this will affect your blood sugar levels.”

Despite enormous advances in the past 20 years, depression often goes undiagnosed and untreated. Individuals with depression often do not realize that they are depressed. People with diabetes, their families and friends, and even their physicians may not distinguish the symptoms of depression, and it is easy to attribute the symptoms of depression to the diabetes. Yet people who suffer from both diabetes and depression tend to have higher health care costs in primary care. Depression is associated with elevated blood sugar levels, an increased risk for cardiovascular disease, poorer physical and mental functioning, and complications caused by diabetes. The chances of becoming depressed increase as diabetes complications worsen. It is very important to treat depression as well as diabetes.

According to Prof Lustman, professor of medical psychology in the department of psychiatry at Washington University School of Medicine, the combination of diabetes and depression can be deadly. "Because of physiologic and behavioral interactions between diabetes and depression, each becomes more difficult to control, increasing the risks of cardiovascular disease, diabetic retinopathy causing blindness, neuropathy and other complications." South African experts also mention obesity as a risk factor. “Depressed people often eat more and exercise less, which results in weight gain and sabotages efforts at controlling blood sugar levels”, says Dr Korb.

If you are feeling down and aren’t sure if you’re depressed, talk to your doctor. Diabetes that is poorly controlled can cause symptoms that look like depression. During the day, high or low blood sugar may make you feel tired or anxious. Low blood sugar levels can also lead to hunger and eating too much. If you have low blood sugar at night, it could disturb your sleep. If you have high blood sugar at night, you may get up often to urinate and then feel tired during the day.

There are many different treatments for depression, including anti-depressant medication, and psychotherapy. Doctors and psychiatrists show that psychotherapy and anti-depressant medications have positive effects on both mood and glycemic control. Treatment for depression in the context of diabetes should be managed by a mental health professional, together with the doctor providing the diabetes care. This is especially important when anti-depressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided.

Part of the treatment plan should include being educated about depression and how you can work to improve it. Often taking part in a self-help group is encouraged, where it is possible to talk to people who share the same types of problems. The South African Depression and Anxiety Group (SADAG) offers more information about depression, telephonic counselling by trained counsellors, and referrals to appropriate mental health professionals and various support groups throughout South Africa. They can be contacted, 7 days a week, between 8am and 8pm, on (011) 262 6396 or 0800 70 80 90, or visit the website www.sadag.co.za.

Many people do not like the idea that they may have a psychiatric disorder, and find it easier to attribute everything to physical problems. However, good diabetic management is dependent on the development of self-knowledge. Many of the things that other people's bodies do automatically, diabetics must do consciously, like closer monitoring of blood glucose, but also emotional state.

Spotting depression is the first step. Getting help is the second. If you have been feeling really sad, or down in the dumps, check for these symptoms:

  • Loss of pleasure You no longer take interest in doing things you used to enjoy.

  • Change in sleep patterns You have trouble falling asleep, you wake often during the night, or you want to sleep more than usual, including during the day.

  • Early to rise You wake up earlier than usual and cannot to get back to sleep.

  • Change in appetite You eat more or less than you used to, resulting in a quick weight gain or weight loss.

  • Trouble concentrating You can't watch a TV program or read an article because other thoughts or feelings get in the way.

  • Loss of energy You feel tired all the time.

  • Nervousness You always feel so anxious you can't sit still.

  • Guilt You feel you "never do anything right" and worry that you are a burden to others.

  • Morning sadness You feel worse in the morning than you do the rest of the day.

  • Suicidal thoughts You feel you want to die or are thinking about ways to hurt yourself.

If you have three or more of these symptoms, or if you have just one or two but have been feeling bad for two weeks or more, it's time to get help.

If you suffer from diabetes, ask your doctor for a depression screening. Depression can make diabetes a lot worse, so it is essential that it is recognized and treated along with the diabetes. It could mean the difference between a return to full functioning and permanent disability. Treatment for depression can improve a patient’s well-being and ability to manage diabetes, thus improving the quality of their lives. Depression is a treatable disorder. If you think you may be depressed or know someone who is, don’t lose hope. Seek help for depression.


The following are some general suggestions for dealing with stress and mild to moderate anxiety.

· Examine your lifestyle for sources of stress. Are there stressors that can be eliminated?

· Learn relaxation techniques. Yoga, meditation, prayer, and hypnosis may help.

· Make sure that you are getting enough sleep

· Exercise. The body's primitive stress response was designed to prepare the individual to fight or to run away. In our society, we do not usually respond to stress with physical activity. Exercise helps our bodies deal with the physiological results of stress.

· Make a list of the things that are worrying you. When you have a concrete list, the problems often look more manageable.


For more information, please contact

Cassey Amoore 011 262 6396


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