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Depression

The Relationship Between Diabetes and Depression

Why you may be at risk of developing depression if you have diabetes.

Key points

  • Depression can lead to unhealthy lifestyle decisions, increasing the risk of diabetes.
  • Diabetes mellitus is a metabolic disease that results in high blood sugar, due to problems in insulin secretion and/or insulin regulation.
  • Diabetes can cause complications and worsening health problems that may lead to or worsen symptoms of depression.
  • Individuals with diabetes should always be screened for psychosocial complications such as depression.

The relationship between diabetes and depression is not new, but within the past couple of decades, researchers and primary care providers have been paying closer attention to this connection. In the late 1600s, the English physician Thomas Willis observed that diabetes sometimes occurred after significant life stress or sorrow.

If you have Diabetes Mellitus (DM), either type 1 or type 2, you have an increased risk of developing major depressive disorder (MDD). The reverse is also true, meaning that if you are depressed, you have a greater likelihood of developing type 2 diabetes, also known as adult-onset or insulin resistance.

Research suggests that the metabolic effects of diabetes can damage nerve endings and blood vessels, inhibiting brain function, potentially contributing to depression. Managing diabetes can be stressful with daily blood sugar monitoring, watching what you eat, and administering medication such as insulin. This daily monitoring can be stressful, and this continued stress can increase the likelihood of developing depression. Although diabetes and depression can co-occur together, both can also be treated together, and effective management of one can help have a positive outcome on the other.

Taking a look at the numbers

  • One in four individuals with diabetes reports having depressive symptoms

  • The lifetime prevalence of depression in women with diabetes is 10-25%

  • The lifetime prevalence of depression in men with diabetes is five to twelve percent

  • 52% of individuals with diabetes report experiencing social stigma related to their disorder
  • Type 2 diabetes is associated with a 20 percent increased risk for depression
  • Depression is associated with a 60 percent increased risk for type 2 diabetes

Commonalities between diabetes and depression

The underlying cause and effect relationship between diabetes and depression is not fully understood. However, there are many confounding factors between diabetes and depression, and they all have a greater likelihood of leading one to another:

  • The daily routines associated with managing diabetes can be stressful and lead to symptoms of depression.
  • Diabetes can cause complications and worsening health problems that may lead to or worsen symptoms of depression.
  • Depression can lead to unhealthy lifestyle decisions, such as poor eating, lack of exercise, smoking, and weight gain; all of these are known factors for diabetes.
  • Depression can affect your ability to complete daily tasks, think clearly, and communicate with others effectively, all of which can interfere with your ability to manage your diabetes.
  • Individuals with diabetes have a higher likelihood of exhibiting signs of depression that stem from their perception of how diabetes may negatively affect their life.
  • Obesity is common in individuals with depression and is a risk for metabolic syndrome, often leading to type 2 diabetes.
  • Depression is directly linked to non-adherence to diabetic management (blood sugar testing, medication, lifestyle modifications), potentially leading to long-term diabetes complications.
  • Depression is linked to poor self-care and metabolic control, which are risk factors for type 2 diabetes.
  • Depression causes an increased risk in cortisol, the body’s stress hormone. Excess cortisol leads to increased glucose and insulin resistance resulting in metabolic syndrome, increasing the likelihood of diabetes.
  • Daily stress from either type 2 diabetes or depression can increase cortisol and inflammatory markers, worsening depressive symptoms.

What is diabetes?

Diabetes mellitus is a metabolic disease that results in high blood sugar, known as hyperglycemia, due to problems in insulin secretion and/or insulin action. Insulin is secreted from islet cells in the pancreas in response to an increase in blood sugar. However, when an individual has diabetes, these pancreatic islet cells are non-functional. They do not release insulin (type I diabetes), or the insulin secreted cannot act on the organs and tissues in the body to lower blood sugar levels (insulin resistance aka type 2 diabetes). As a result, oral hypoglycemics or exogenous insulin is required on a daily basis in order to regulate blood sugar in the body. The chronic high blood glucose levels associated with diabetes lead to damage, dysfunction, and failure of many organs in the body, specifically the kidneys, eyes, blood vessels, nerve endings, and heart. Some common diabetes complications include the following:

  • Foot ulcers due to neuropathy
  • High blood pressure
  • Kidney complications
  • Sexual dysfunction and urinary incontinence (due to autonomic neuropathy)

In addition to a strict insulin and oral hypoglycemia regimen, individuals with diabetes must monitor their blood sugar, maintain a strict diet and exercise regimen, and schedule regular doctor visits to ensure their kidney function, vision, and blood pressure are all within normal limits. The treatment and maintenance demands can be financially straining, and the emotional and social impact of diabetes can add disruptions in multiple aspects of an individual’s life that may cause significant psychosocial dysfunction.

To learn more about depression and its related signs and symptoms.

Treating depression and diabetes

Individuals with diabetes should always be screened for psychosocial complications such as depression. If an individual is diagnosed with both diabetes and depression, a multi-faceted treatment regimen should be implemented to decrease complications of both chronic diseases. Research suggests that regulating blood sugar can help treat symptoms of depression, and treating depression can help normalize blood sugar. Treatment for depression includes antidepressant medication, cognitive behavioral therapy, and self-care routines. Cognitive-behavioral therapy for depression improves mood and helps regulate glycemic control when diabetic self-management education is included in cognitive behavioral therapy.

References

Berge LI, Riise T. Comorbidity between type 2 diabetes and depression in the adult population: directions of the association and its possible pathophysiological mechanisms. Int J Endocrinol. 2015;2015:164760.

Renn BN, Feliciano L, Segal DL. The bidirectional relationship of depression and diabetes: a systematic review. Clin Psychol Rev. 2011;31:1239–1246.

Hermanns N, Caputo S, Dzida G. Screening, evaluation and management of depression in people with diabetes in primary care. Prim Care Diabetes. 2013;7:1–10.

van der Feltz-Cornelis CM, Nuyen J, Stoop C, et al. Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2010;32:380–395.

Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24:1069–1078.

Lyketsos CG. Depression and diabetes: more on what the relationship might be. Am J Psychiatry. 2010;167:496–497.

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