Depression and Diabetes

Diabetes is enough to manage on its own. So is depression. What happens if you have both diabetes and depression? You are certainly in good company if you do. Depression is about twice as common in people with diabetes as it is in the general population.

Diabetes is a condition with high blood sugar levels due to lack of insulin production (type 1 diabetes) or insulin resistance (type 2 diabetes). Depression is a mood disorder. Why are these two chronic conditions related?

Researchers are still unraveling the tangled relationship between diabetes and depression. It appears that diabetes can cause depression and depression can cause diabetes, and that the two are related in additional ways. With all the attention to these two conditions comes good news: there are many ways to manage depression and diabetes.

Facts and Figures on Diabetes and Depression

Both diabetes and depression are common. The Centers for Disease Control and Prevention (CDC) report that 1 in 8 adults have diabetes[1], while 1 in 15 adults have major depressive disorder, according to the National Institutes of Mental Health (NIMH). [2]  

That is just the surface, though. The two conditions are clearly related, as your risk for depression is twice as high if you have diabetes than if you do not.

What Is Depression, and Whom Does It Affect?

Depression is more than feeling down every so often. Depression is also called depressive disorder or clinical depression. It is a mood disorder that includes having negative feelings, such as sadness or hopelessness, for most of the day for at least two weeks. [3] According to the NIMH, major depression is among the most common types of depression.

Many factors can contribute to depression. Genetic, environmental, lifestyle, and psychological factors all affect your risk for depression. You are more likely to be diagnosed with major depressive disorder if: [4]

• You are female.
• You identify with two or more races/ethnicities.
• You have a chronic illness, such as cancer, heart disease, or diabetes.
• You experience a major negative or even positive life event, such as losing or starting a job, having a baby, getting married or divorced, retiring, or moving.
• You are on certain blood pressure medications, sleeping pills, painkillers, or other medications.

Depression Signs and Symptoms

How do you know if you have depression? The NIMH lists the following signs and symptoms.

• Feelings of hopelessness, emptiness, sadness, or worthlessness.
• Loss of interest in and excitement for usually fun activities.
• Anxiety, trouble concentrating, or irritability without apparent causes.
• Feeling tired or having no energy.
• Trouble sleeping, or sleeping more than usual.
• Changes in weight or appetite.
• Muscle pain, headaches, or upset stomach for no real reason.
• Thoughts of death or suicide.

Contact your healthcare provider or seek help immediately if you have signs or symptoms of depression, or think you may have depression. Depression is not always easy to identify. Help is available, and there are ways to treat it so that you feel more like yourself again.

Link between Depression and Diabetes: Chicken and Egg?

Does diabetes cause depression? Probably. Does depression cause diabetes? Probably. Do underlying factors cause both conditions? Probably.

Research published in JAMA Internal Medicine found that there is a bidirectional relationship between depression and diabetes. Over 10 years,

• Participants with depression had a 17% higher risk of developing diabetes.
• Participants on antidepressant medications had a 25% higher risk of developing diabetes.
• Participants with diabetes had a 44% higher risk of developing depression.

In addition, a higher body mass index (overweight or obese) and lower physical activity levels were linked both to depression and diabetes.

Depression can increase your risk for diabetes for a number of reasons. [6]

• Certain antidepressants increase insulin resistance, which leads to prediabetes and type 2 diabetes.
• People with depression are more likely to be overweight and physically inactive. Both of these are risk factors for prediabetes and diabetes.
• Depression is linked to higher levels of stress hormones such as cortisol, which raises blood sugar.
• Some antidepressant medications increase cravings for high-carbohydrate foods, which can spike blood sugar and lead to weight gain.
• Depression can interfere with your blood sugar management and raise your risk for complications of diabetes.

Diabetes and Depression: Closely Linked

Type 2 Diabetes and Depression

On the other hand, why might type 2 diabetes lead to depression? The American Diabetes Association (ADA) offers several possible reasons.

• A diagnosis of type 2 diabetes can be a trigger for depression.
• Managing diabetes is stressful and time-consuming.
• You might feel as though you do not have control over your condition, especially if you do not hit your goal A1C or blood glucose levels.
• Complications, such as neuropathy, can be painful on a daily basis.
• You can feel pressure from your doctor or family to control your diabetes, or even guilt about your blood sugar levels

Type 1 Diabetes and Depression

Many of the factors that lead to depression in type 2 diabetes are also present in type 1 diabetes and the risk for depression is similar[8]. Another factor in type 1 diabetes is the use of insulin. In the 10-year study on the relationship between diabetes and depression, participants on insulin medications were 53% more likely to get depression.

Help for Diabetes and Depression

The first thing to know about diabetes and depression is that effective help is available. There are strategies to improve diabetes control and to treat depression. Controlling these conditions often goes hand in hand, so when you get a handle on one of them, you can often manage the other one better, too.

Physical Activity: Exercise is so simple and so effective. You may know that exercising can help with weight loss and heart health, but physical activity also directly helps with diabetes and depression by: [9]

• Improving mood.
• Increasing insulin sensitivity.
• Lowering blood sugar.
• Reducing anxiety.
• Helping manage stress.
• Giving you more confidence in your ability to manage diabetes.

Any activity is good, and more is usually better, as long as it is safe. The general recommendation is to work up to at least 30 minutes, at least 5 days per week. You can walk, jog, bike, hike, swim, do zumba, play a sport, or do anything you love that gets your heart pumping.

Diabetes Self-Management Programs: Self-management is a cornerstone of diabetes management. Better diabetes management can reduce symptoms of depression, and many of the actions that go into diabetes self-management directly help with depression. Diabetes self-management includes:

• Taking your medications as prescribed.
• Checking blood glucose in the mornings or as your doctor recommends.
• Losing weight if you have extra pounds.
• Increasing physical activity.
• Eating healthy.

A diabetes self-management coaching app can help with all of these on a daily basis.

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The Healthcare System:

Take advantage of the medical care you can get. The healthcare system can help with diabetes control and diagnosis and treatment for depression. Work with your doctor to get the right types and amounts of medications if you need them, and be sure to take them as prescribed. Psychotherapy and counseling are options that can also help. When possible, a collaborative care model, with a nurse in charge of all of your care, can be more effective than having two separate teams managing both conditions. [10]

Diabetes and depression are common comorbidities, but you do not have to succumb to them. Help is available in the form of lifestyle changes, medical care, and self-management programs. A digital health coaching app may be worth considering to support you as you work to maintain your physical and mental health.

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