Diabetes and Depression: The Chicken and the Egg

Why many with diabetes develop depression and how to treat depression associated with diabetes.

"At some point, over 50% of people with diabetes will have clinical depression. Currently, one-third of my patients are on antidepressants."

- Dr. Andrew Ahmann, Endocrinologist and Director of the Harold Schnitzer Diabetes Health Center at Oregon Health and Science University

It's well researched that those with diabetes are two times more likely to be depressed than the general population. It's not completely clear why people with diabetes develop depression. It's the common chicken and the egg situation that is often present when mental health is involved. This leads to the questions:

1. Does diabetes cause physiological depression due to hormonal changes involving insulin and neurotransmitters?
2. Or does the diagnosis of a serious and chronic illness lead to feelings of helplessness, sadness and a lack of interest in life that then turns into depression?

According to numerous studies, it's both. A person with diabetes may be more physiologically susceptible to depression though the connection is not clear, but there is a definite connection for many people regarding what's called reactive depression. In this case, the depression is a reaction to the diabetes diagnosis.

Reactive Depression

Those diagnosed with diabetes may have a higher risk of depression due to the pressure and worry of having a complicated, difficult to treat and possibly chronic illness. This can lead to fear, sadness and frustration. It also drastically changes life plans, dreams and goals. This is especially true for those who have to monitor their glucose levels throughout the day and adjust their insulin accordingly.

When this type of reactive depression happens, the desire to monitor glucose carefully goes down and the 'what's the point' feeling can seriously hamper a person's ability to monitor the illness carefully.

When the illness is not monitored diligently, the result can be serious physical and psychological complications from diabetes. Diabetes, especially insulin-dependent type I diabetes, completely changes a person's life. What was once commonplace, such as deciding what to eat or sitting at a three-hour baseball game with friends, becomes a complicated and stressful change in life that requires a commitment to diabetes management.

The first few months following a diagnosis can be very difficult, as it takes time for acceptance. Dr. Ahmann tells HealthyPlace.com, "I think that, for now, we can't say for sure what causes the depression. It's partly related to having to live with a chronic disease every day. If you look at people without diabetes, they probably feel they are handling as much as they can. They may already feel overwhelmed. When you add diabetes it gets much worse. Every time you exercise, eat, or get upset, you have to monitor your blood sugar. There is no question that we expect there to be some physiological issue with depression separate from just feeling overwhelmed, but we are just not sure what it is." The reactive depression theory is supported by similar research regarding cancer diagnoses and depression.

Here is how Joe, a 45-year-old man with childhood-onset diabetes type 1 describes the difficulty of diabetes management:

"I have to think of diabetes 24 hours a day. Sometimes I think about the people at work who can just have lunch and talk with colleagues. I feel I miss critical conversations and networking because I have to go to the bathroom and test and shoot up and I have trouble getting forward at work.

Most people go to the meetings where you meet new people and you build relationships and I get so little opportunity to do that. There is not a solution to this. It makes me depressed. I then have to make extra time to build relationships.

When you're working for other people, it's the expectation that you are there for networking. If I were at a conference and one of my folks was constantly absent during a critical time, I would be upset. That's the depressing fact that there is very little I can do. If there's a mid-morning break, that's my chance to check my blood levels and by the time I get back, people are sitting down and I've missed a conversation." (Joe talks more about his diabetes and how he found a solution to many of his diabetes complications in section three.)

No matter what the reason, a person with diabetes has a higher risk of depression. The goal is to manage the depression so that a person with diabetes can take care of themselves physically.