diabetes depression
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When I recently met my elderly aunt at a family function, she seemed a little more tired and less cheerful than her usual self. Her daughter told me that she has stopped her daily walk and is not following her diabetic diet. This behaviour probably started when her blood sugar readings came back high during her last doctor’s visit. Even though she’d been following most of the instructions from the doctor, she wasn’t able to figure out how to keep her diabetes in check. It looked like she’d given up on it.

How diabetes leads to depression

So much effort goes into managing diabetes – cooking low-calorie meals, constantly watching what you eat and having to exercise regularly. Besides, there’s often the accompanying fatigue and the fretting over whether your blood glucose levels are alright – all this can easily disturb the diabetic’s state of mind. Sometimes, despite the best of efforts, diabetics may have difficulty in achieving the desired results, and that can feel like fighting a losing battle, leading to depression. (1)

It’s not just psychological. A few studies have also suggested that prolonged hyperglycemia (high blood sugar levels) could cause alterations in brain structure that may increase the likelihood of depression in type 2 diabetes. (2)

The depression-diabetes vicious cycle

 Dr. Vijaylakshmi, a psychiatrist, points out, “Someone who’s depressed has no drive or energy to continue with self-care which is so crucial to managing diabetes. Depression can also cause fluctuation in the diabetic’s sleep and hunger patterns, and in turn, this affects the blood sugar.”

Are there proven links?

All persons who have diabetes will not have depression. However, the National Institute for Health and Care Excellence, UK, says that persons with chronic health issues such as diabetes are thrice more likely to suffer from depression than those without the condition. (3)

Research shows that factors such as younger age, female sex, lack of social support, insufficient glycemic control and diabetic complications tend to increase the risk of depression in diabetes. (4)

Several studies like the one by Harvard School of Public Health conclude that there exists a bidirectional association between diabetes and depression. That is, depression may cause diabetes, and diabetes may cause depression. (5-7)

Hypertension or high blood pressure is another condition commonly found in type 2 diabetes. Now, this introduces another angle to the diabetes-depression story because there is ample evidence that certain antihypertensive agents have the potential to cause or worsen depression. So it is quite possible that a diabetic who is also hypertensive may develop depression from the medication he or she is taking to deal with high blood pressure. (8, 9)

However, the counterpoint as Dr. Vijaylakshmi explains, “In many people, mild depression goes unrecognised. Their irritability or pessimistic outlook or lack of interest in anything or sense of hopelessness is accepted as part of their personality. So, when they develop diabetes, we may not be able to accurately identify how much of an effect diabetes has had on their mental state.”

In my aunt’s case, we eventually consulted a psychologist, and a few counselling sessions helped her get over the mild depression. She is now back on track with her diabetes management plan. In diabetics with moderate to severe depression, other modes such as cognitive behaviour therapy or anti-depressant medication may be necessary.

Depression is a largely underdiagnosed aspect in diabetics. So the next time you come across a loved one with diabetes who seems to be low in spirits without reasonable cause, do not dismiss it as just one of those things. Make sure you consult a counsellor or psychologist to rule out the possibility of depression.

Footnote

Dr Vijaylakshmi is a consultant psychiatrist at Cadabam’s Hospitals, Bengaluru.

References:

  1. Depression. American Diabetes Association.May 2014. Available at http://www.diabetes.org/living-with-diabetes/complications/mental-health/depression.html?referrer=https://www.google.co.in/
  2. L.I. Berge, T. Riise. Comorbidity between Type 2 Diabetes and Depression in the Adult Population: Directions of the Association and Its Possible Pathophysiological Mechanisms. International Journal of Endocrinology. 2015; Article ID 164760, 7 pages. http://dx.doi.org/10.1155/2015/164760 
  3. Diabetes and Depression. Diabetes.co.uk. Available at http://www.diabetes.co.uk/diabetes-and-depression.html 
  4. E. Andreoulakis, T. Hyphantis, D. Kandylis, A. Iacovides. Depression in diabetes mellitus: a comprehensive review. Hippokratia. 2012 Jul-Sep; 16(3); 205–214. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738724/
  5. A. Pan, M. Lucas, Q. Sun, R.M. van Dam, O.H. Franco, J.E. Manson et al. Bidirectional Association between Depression and Type 2 Diabetes in Women. Arch Intern Med. 2010 Nov 22; 170(21): 1884–1891. doi:  10.1001/archinternmed.2010.356
  6. P.C. Chen, Y.T. Chan, H.F. Chen, M.C. Ko, C.Y. Li. Population-Based Cohort Analyses of the Bidirectional Relationship Between Type 2 Diabetes and Depression. Diabetes Care 2013 Feb; 36(2);  376-382. https://doi.org/10.2337/dc12-0473 
  7. S.H. Golden, M. Lazo, M. Carnethon et al. Examining a Bidirectional Association Between Depressive Symptoms and Diabetes. JAMA. 2008; 299(23); 2751-2759. doi:10.1001/jama.299.23.2751
  8. American Diabetes Association.  Treatment of Hypertension in Adults With Diabetes. Diabetes Care 2003 Jan; 26 (suppl 1); 80-82. https://doi.org/10.2337/diacare.26.2007.S80
  9. M.H. Beers, L.J. Passman. Antihypertensive medications and depression.  Drugs. 1990 Dec; 40(6);792-799 available at https://www.ncbi.nlm.nih.gov/pubmed/2078996

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