Fighting Depression and Diabetes
By Dr Stan Steindl, Clinical Psychologist
Feeling sad or down is a normal part of every person’s life. But for people with chronic illness, particularly diabetes, depression is more common and can significantly affect a person’s ability to manage their illness.
Some studies suggest that up to 40% of people with diabetes have elevated symptoms of depression. Statistics vary but many indicate that people with diabetes can be two to three times more likely to suffer depression than the general population and are more likely to suffer from relapses over the years.
People who have diabetes and other chronic illnesses are challenged to face the reality of the disease and the anxiety that comes with it. They are also faced with problems that it places on everyday living such as monitoring and self-treatment and the effect it can have on relationships.
For people with diabetes, depression can interfere with their ability to manage their illness. Poor sleep, lack of self-confidence, low self-esteem, and loss of interest in life can lead to someone taking a less active approach to self-care and illness management. This may in turn increase blood glucose levels, increase risk of acute and long-term diabetes complications, and generally decrease the person’s quality of life.
Diagnosing Depression in people with diabetes.
Despite the high prevalence of depression, studies suggest that depression is still underdiagnosed in people with diabetes. This underdiagnosis could be because symptoms of depression mimic many of the symptoms that people with diabetes experience such as fatigue, and changes in sleep patterns, weight and appetite.
These symptoms are often soley attributed to the illness, and the possible presence of depression is not considered.
For this reason diagnosing depression needs careful valid criteria-based assessment tools. Psychologists and other caregivers generally diagnose depression in people with diabetes by carefully assessing various symptoms through interviews, psychometric testing, behavioural observation, and ongoing monitoring.
Some mood related symptoms of depression include: sadness, hoplessness, anxiety, preoccupation with death.
Somatic symptoms include: loss or gain of appetite or weight. Diminished or excessive sleep, fatigue, loss of libido.
Cognitive Symptoms of depression include: guilt, feelings of helplessness or worthlessness, memory loss, indecision.
A psychologist will also assess other factors that may induce depression including alcohol and drug use, personal loss or setback, and personal or family history of depression.
Depending on the severity of symptoms, diagnosed depression can be major depression which can develop quickly either as a result of a stressful even or sometimes ‘out of the blue’. More long-lasting depression- dysthymia- starts slowly and often results from a number of compounding stressful events.
What causes depression?
Evidence suggests depression among people with diabetes is caused by both pre-existing personal traits, which are found in the general population, and specific diabetes-related factors.
Studies have shown that some pre-existing personal factors can cause depression among diabetes sufferers and these are also consistent in the general population of people with depression. Women are more likely to experience depression than men.
Moreover, depression in people with diabetes is not restricted to adults. Children who are newly diagnosed with diabetes often develop depression when trying to cope with the disease. The coping pattern of ‘learned helplessness’ among children with diabetes is often related to depression.
Treatment for depression
Despite the high rate of depression among people with diabetes and the problems it can cause, depression can be effectively treated to improve the quality of life and improve glycaemic control.
Diagnosed depression responds well to psychological treatment, particularly cognitive behavioural therapy (CBT). CBT teaches skills that help people to cope with stressful life circumstances. CBT produces a durable improvement in many people’s conditions, which is a significant advantage considering the recurrent nature of depression in people with diabetes. This therapy is used effectively to treat depression by changing self-defeating thought patterns and negative behaviours which contribute to depression.
Some cognitive components include:
1.Recognising that there is a connection between thought, mood and behaviour. People who think about an enjoyable activity often feel happier.
2. Learning to monitor negative self-talk. For example, “I can’t do that” is negative. More positive self-talk is “I don’t know if I can do that, but I will try.”
3. Challenging thinking. This teaches people to interpret situations so that reactions are more realistic. For example, not panicking if you are late for work.
Behavioural component of therapy may include:
- Planning a weekly schedule
- Planning w pleasure schedule to help people identify what they enjoy and when they can schedule those things in.
- Setting and achieving goals to help people look positively on themselves and their achievements.
In helping people cope with diabetes, CBT may encourage people to focus on identifying very specific key problems they experience in living with diabetes. By identifying and resolving these key problems, people can significantly reduce their distress. In addition, helping people to manage the myriad of daily demands of life with diabetes can also help reduce distress.
Some people suffering more severe depression may also need antidepressant medication. Evidence suggests that people with diabetes can take antidepressant medication quite effectively depending on the type of drug and the person’s symptoms. Naturally, a medical practitioner should always be consulted when considering medication options.
It is also important for people to look at the positive experiences of having diabetes. Although the challenges of living with diabetes can be extremely stressful and can increase the risk of depression and emotional distress, many people report positive emotional outcomes. Many people describe feelings of accomplishment, satisfaction, and inner strength that flow directly from their lives with diabetes. Feelings such as deepened capacity for self-awareness, self confidence, faith and humour is often reported.
In one study, an 11 year old boy said that he hated the disease, but having diabetes had forced him to learn how to take care of himself. He said he wouldn’t give that up for the world.
A 54 year old man recently diagnosed with diabetes said he was having difficulties adjusting to some of the aspects of his new regime, but added, ‘it was not all that bad. I’ve started walking in the evenings with my wife and that has been great. We walk and talk’.
Helping people to identify and reflect on such positive experiences can have immediate benefits as well as more enduring ones. Reflecting positively helps people more effectively manage the unremitting demands of the disease.
If you would like to talk to a psychologist about the psychological impacts of chronic health, we have a number of clinical psychologists experienced in this area including, visit our Brisbane Psychologists page for more information on who is trained in managing chronic health.