All people have periods when they feel a little blue every now and then. That’s part of the ebb and flow of life. But if you have feelings of hopelessness or despair that lasts for weeks, you may be clinically depressed.
If you have diabetes, you may be even more susceptible to depression than someone without diabetes. Depression appears to be more common, last longer, and recur more frequently in people with diabetes than in the general population. Depression can occur when you are first diagnosed with diabetes, after you have gone through feelings of denial and anger, or later on, after you have been dealing with diabetes for years.
No one is really sure why people with diabetes are more prone to depression. It may be that the burden of diabetes management can wear on you and bring you down. It may arise out of feelings of isolation, feeling set apart from family and friends, and a sense that you are different from everyone else. Or it could be a physiological condition resulting from damage to the nerves that control your moods.
Whatever the reason, it is important to understand that if you are depressed, there is nothing wrong with you as a person. Depression can put you in a vicious cycle. You may feel depressed, have little energy for living, and neglect your diabetes care. This can make you feel worse physically, and even more depressed. Having high blood glucose levels for a period of time can make you feel sleepy and fatigued, for example. It can be difficult to break this cycle. The first step in dealing with depression is recognizing that you have it. Then you can take measures to break the cycle.
One of the first signs of depression is a loss of pleasure. You no longer enjoy doing things that once made you happy. You may also notice a change in sleep patterns. You may have trouble falling asleep at night, you wake up often during the night, or are restless during the night-time. You may wake up earlier than usual and find it difficult to get back to sleep. Alternatively, you may find that you want to sleep more than usual, even during the day.
You may also notice a change in appetite. Foods that once appealed to you no longer pique your interest. Or you may eat out of habit, without enjoyment. You may eat more or less than usual and may lose or gain weight quickly. You may have a hard time concentrating. Even watching a TV show or reading a blog article may be difficult, because you are feeling restless. You may feel tired all the time and have no energy.
Some people with depression also feel nervous or anxious and have a difficult time just sitting still. You may have a hard time making decisions, even trivial or inconsequential decisions. You may also find yourself troubled by thoughts of guilt or self-deprecation. You feel like you can never do anything right. If you are depressed, you may feel worse in the morning than you do the rest of the day. When you are at your lowest point, you may even entertain suicidal thoughts. You may feel that you want to die or think about ways to hurt yourself.
What You Should Do
If you see yourself in three or more of these symptoms, you may have depression. Even if you only have one or two symptoms, but have been feeling bad for 2 weeks or more, it may be time to seek help.
The first thing to do is talk to your doctor. Tell her how you have been feeling. There may be an obvious physical reason for your depression and your doctor will want to examine you to see if anything else could be a factor. For example, some medications, alcohol or drug abuse, or poor blood glucose control can cause some of the same symptoms. Low blood glucose levels can make you feel hungry and cause you to overeat. They can also disturb your sleep at night. High blood glucose levels can make you get up during the night to urinate often. You may then feel tired all day. Thyroid problems can also cause symptoms of depression.
Once your doctor has ruled out any physical causes, you may be referred to a specialist. You may already be working with a mental health professional as part of your diabetes care team. If this is the case, it may be time to pay her a visit. If not, your doctor may recommend a psychiatrist, psychologist, psychiatrist nurse, or licensed social worker. These professionals can help you get to the bottom of your feelings and suggest a course of treatment.
There are two general types of treatment for depression: psychotherapy or counselling and antidepressant medication. Often, the best results come from a combination of the two.
Your psychotherapist can help you look at the problems that trigger your depression. Once you identify these triggers, you can then work on ways to resolve, or at least relieve, these problems. Sometimes all you need is a short-term course of therapy to help you get back on track. Other times, you may need to keep seeing your therapist for a longer period of time. It is critical that you feel comfortable with your therapist. You should feel at ease and be able to talk freely. If you are not comfortable with your counselor, shop around until you find someone you are able to connect with.
If your therapist feels that you would benefit from medication, you will need to see a psychiatrist. Psychiatrist are medical doctors and are the only mental health professionals who are allowed to prescribe medication. If you are referred to a psychiatrist, don’t feel that something is wrong with you. Many people feel that if they need to see a psychiatrist, they must be crazy. Nothing could be further from the truth.
Psychiatrists are trained professionals who are qualified to evaluate both the psychological and medical basis of any kind of emotional or mental problem. Many emotional disturbances are caused by physical problems, such as chemical imbalances in the nervous system or damage to the nerves. Your psychiatrist may be the best person to evaluate and treat such a situation.
Your psychiatrist may suggest an antidepressant medication. Most antidepressants work by increasing the amount of a chemical called serotonin in the synapses, or gaps, between the nerves. Too little serotonin can cause depression. Ask your psychiatrist and regular doctor how your antidepressant medication will affect blood glucose levels.
Make sure your doctors are talking to each other about your depression and your diabetes. If you do take an antidepressant, make sure to give it time to work. Usually a month or more is required before these medications work. If you don’t see an improvement, tell your doctor. Often switching to another type of antidepressant will do the trick. You will probably benefit most by antidepressant medication if you also receive counselling at the same time.
If you have serious depression, the most important thing is to recognize the symptoms and seek help right away. It is usually a condition that can make you feel worse if left untreated and may be more than you alone can handle. If your doctor can’t refer you to an appropriate mental health professional or you would like to switch mental health counselors, contact your local psychiatrist society or psychiatry department of the closest medical school.
Also contact the local branch of any organization for psychiatric social workers, psychologists, or mental health counselors. Your local hospital may also have a referral service that can help you.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Diabetes and Depression by A Campayo, C Biel and A Lobo
Symptoms of Depression and Anxiety in Youth with Type 1 Diabetes: A Systematic Review and Meta-Analysis by L Krabbe, B Lux et al
Depression in Type 2 Diabetes Mellitus: Prevalence, Impact, and Treatment by P Lustman, M Brown et al