Diabetes and depression

We all know that diabetes is a serious condition characterised by abnormally high blood sugar levels. Once diabetes develops, there is no cure, although it can be managed. This chronic condition, if not managed properly, can take its toll on the body, with potential damage to the kidneys, blood vessels, nerves, and eyes. What you may not know is that it is also associated with mental illness in the form of depression and mood disorders. Top endocrinologist and diabetes expert Dr Mark Vanderpump explains:

What is the link between diabetes and depression?

The most common psychiatric disorders affecting patients with diabetes are depression and mood disorders, but exactly why this is the case is harder to pinpoint. Possible connections between diabetes and depression are as follows:

• Theory 1: depression leads to diabetes – depression leads to poor diet, which in turn can affect the metabolism and contribute towards the development of diabetes.
• Theory 2: having diabetes leads to depression – diagnosis of a chronic condition and having to manage it for the rest of your life can be overwhelming and affect mental health.

• People with diabetic neuropathy (where diabetes causes nerve damage, causing pain, most commonly in the legs and feet) seem to have a higher incidence of mood disorders.

It is possible that the truth is a bit of both – in some cases it may be that depression leads to diabetes and in others that diabetes leads to depression. It is also likely that the two act in a vicious chicken-and-egg cycle, each condition exacerbating the other.

The danger of depression

Being depressed and having diabetes can make both conditions worse. Particularly worryingly, depression can mean that people with diabetes are less likely to take the medication necessary to manage their blood glucose. Depression also leads people to function more poorly in general, both mentally and physically and can lead to them taking more time off work.

There is some evidence that the combination of both diabetes and depression may lead to a higher risk of stroke, heart attack, or dementia.

What makes things worse is that if diabetes is managed poorly, high or low blood sugar levels can cause anxiety, restlessness or fatigue – all symptoms of depression. The similarity of symptoms can mean that depression in people with diabetes can go undiagnosed, as they think these feelings are simply symptoms of diabetes.

It is important to see a doctor if you believe you are depressed.

Symptoms to watch out for

Symptoms of depression to look out for include:

• No longer enjoying activities that you used to enjoy
• Difficulty sleeping or sleeping too much
• Lack of appetite or binge eating
• Being unable to concentrate or make decisions
• Fatigue
• Anxiety
• Feeling isolated
• Waking up feeling sad
• Thinking about suicide
• Self-harming

See your GP if you have experienced these symptoms for two weeks or more. The Department of Health recommends that they ask you two questions:

• During the last month have you been bothered by feeling down, depressed or hopeless?
• During the last month, have you been bothered by having little interest or pleasure in doing things?

If your answers are yes, they will give you a questionnaire to gauge the nature and extent of your symptoms.

What can you do to combat depression?

In this situation, it can be incredibly hard to motivate yourself. However, you can take certain steps that will help:

• Increase your physical activity - this releases endorphins in the brain. Endorphins make you feel good, which helps to combat the symptoms of depression.
• Adopting a “can do” attitude to diabetes management can also help with the feeling of helplessness. Obviously, this is easier said than done – support groups can often help in this respect.
• Avoid or significantly cut back on caffeine, recreational drugs and alcohol.
• Getting a good night’s sleep will also help.