Does Type 2 Diabetes Cause Depression

Depression: More Than Just A Bad Mood

Depression is a medical illness that causes feelings of sadness and often a loss of interest in activities you used to enjoy. It can get in the way of how well you function at work and home, including taking care of your diabetes. When you arent able to manage your diabetes well, your risk goes up for diabetes complications like heart disease and nerve damage.

People with diabetes are 2 to 3 times more likely to have depression than people without diabetes. Only 25% to 50% of people with diabetes who have depression get diagnosed and treated. But treatmenttherapy, medicine, or bothis usually very effective. And without treatment, depression often gets worse, not better.

Symptoms of depression can be mild to severe, and include:

• Feeling sad or empty
• Losing interest in favorite activities
• Overeating or not wanting to eat at all
• Not being able to sleep or sleeping too much
• Having trouble concentrating or making decisions
• Feeling very tired
• Feeling hopeless, irritable, anxious, or guilty
• Having aches or pains, headaches, cramps, or digestive problems
• Having thoughts of suicide or death

If you think you might have depression, get in touch with your doctor right away for help getting treatment. The earlier depression is treated, the better for you, your quality of life, and your diabetes.

Depression To Diabetes Risk

During the whole study period 2,844 females developed type 2 diabetes and 7,415 were identified with depression.

Those with depression had a 17% higher risk of developing diabetes even after the researchers ruled out certain risk factors, such as BMI and physical activity.

The women on antidepressant medications had a 25% higher risk of developing diabetes compared to those without depression.

The investigators also found that those with diabetes had a 29% higher risk of developing depression compared to women without diabetes. This figure prevailed even after taking into account certain risk factors.

Those taking insulin for their condition had a 53% higher risk compared to the non-diabetic women.

The authors wrote:

The findings from this well-characterized cohort of more than 55,000 U.S. women with 10 years follow-up add to the growing evidence that depression and diabetes are closely related to each other, and this reciprocal association also depends on the severity or treatment of each condition. All the associations were independent of sociodemographic, diet and lifestyle factors.

The researchers say their findings indicate that depression has an impact on diabetes risk beyond inactivity and body weight.

They also believe that their study showed a relationship between stress and diabetes.

The authors noted:

They concluded:

Poor Diabetes Management And Depression

When diabetes is not well managed, blood sugar can be outside of normal ranges, which comes with a range of symptoms.

Symptoms that arise because of blood sugar being too low or too high can mimic depression, such as fatigue, digestive upset, irritability, or difficulty concentrating. When blood sugar is too low, you might feel shaky and sweaty, which can also happen with anxiety.

If you notice any of these symptoms, be sure to check your blood sugar. If it is outside of normal ranges, follow your healthcare provider’s recommendations for correcting it.

If your blood sugar is within normal ranges and you are still experiencing these symptoms, talk with your healthcare provider about the possibility of being screened and treated for depression.

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How Can I Treat My Depression In Tandem With My Diabetes

The treatment of diabetes is an extremely individual course. People suffering from symptoms of depression for an extended period of time should seek medical advice.

There are a number of treatment options, some easier than others but are accompanied by more adverse side effects and potentially toxic health implications, for example anti-depressants. While others treatments are non-toxic and have a health promoting effect, for example Mindfulness, but, such treatments, require a desire to change and be rid of the symptoms of depression.

One clinical trial for example has found a link between depression in diabetic people and a later diagnosis with the degenerative Alzheimers disease.

Further research collected from a large sample of diabetics in New York has suggested that by treating depression in people with diabetes, they are less likely to die at a follow up period of 5 years.

Inclusion And Exclusion Criteria

In this meta-analysis we included all studies that longitudinally examined the relationship between depression and onset of type 2 diabetes, irrespective of their study design. Studies were excluded if the authors did not explicitly exclude subjects with prevalent diabetes at baseline and if there were insufficient data to estimate a relative risk, either an odds ratio, risk ratio or hazard ratio. When multiple publications from the same study population were available, we included the most recent publication, regarding this study as an improvement of the older publication, representing both studies.

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Diabetes And Depression: The Risk

Diabetes increases the risk of depression. A metaanalysis of 16 studies that examined the risk of depression in those with diabetes showed that both relative risk and hazard ratio were significant at 1.27 and 1.23 .13 In the Health, Ageing, and Body Composition Study, older people with diabetes showed an increased incidence of depression compared to those without diabetes .14

Conversely, depression increases the risk of diabetes by 65%. In a prospective study of 4,803 adults aged 55 years or older, the incidence rate of diabetes was higher among depressed subjects relative to nondepressed subjects . An increased risk of diabetes mellitus was also associated with characteristics such as non-severe and untreated depression.15 The relationship between diabetes and depression appears to be bidirectional. Diabetes and its complications lead to increased prevalence of depressive symptoms and depression leads to an increased risk of diabetes .

Diabetes And Depression: A Two

Having either illness increases the chances that the other will develop. The conditions aggravate each other, too. When depression worsens, so does diabetes likewise, when diabetes worsens, so does depression.

A reason for the connection is that they have shared risk factors . Researchers have found that both diabetes and depression have biological and behavioral components underlying their development. The illnesses are:

• Strongly influenced by lifestyle
• Associated with chronic inflammation in the body
• Exacerbated by sleep problems
• Influenced by the hypothalamic-pituitary-adrenal axis functioning in the brain
• Genetically influenced

Given their shared risk factors and causes, it makes sense that depression and diabetes occur together. Aside from this common ground, each illness contributes to the other.

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Does It Matter If Its Type 1 Or Type 2

Regardless of the type of diabetes you have, there is an increased risk of depression. Researchers have found that significant depressive symptoms affect approximately one in four adults with either type 1 or type 2 diabetes. However, only about 10% to 15% of people with diabetes receive a formal diagnosis of a depressive disorder.

There are not many studies regarding depression in children and adolescents with diabetes, but in those few studies, it has been found that rates of depression are also higher in children and adolescents with either type 1 or type 2 diabetes.

Diabetes And Depression: The Link

Diabetes and depression are inter-related. Changes in the brain: structural, functional and neurochemical may increase the risk of depression in people with diabetes.6 Hyperglycaemia can contribute towards low mood through reducing hippocampal integrity, neurogenesis and neuroplasticity leading to hippocampal atrophy.7 For patients, an awareness of their diagnosis, along with its associated complications, and the burden of treatment may lead to them feeling helpless, which may result in depression. Also, the increased rate of obesity associated with depression, and the resulting insulin resistance, may increase the risk of incident diabetes.8 Disturbed sleep patterns are often seen in people with depression,9 altered circadian rhythm along with poor sleep quality are associated with insulin resistance and therefore an increased risk of diabetes.10

Alternatively, diabetes and depression may be linked through changes in biological, behavioural, neurohormonal and immuno-inflammatory pathways.11 Foetal over-exposure to cortisol, secondary to maternal stress, and low birth weight have been associated with hypothalamic-pituitaryadrenal axis programming and elevated cortisol reactivity possibly predisposing that individual to future metabolic disorders.12

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How Does Depression Relate To Diabetes

Diabetes can cause complications and health problems that may worsen symptoms of depression. Depression can lead to poor lifestyle decisions, such as unhealthy eating, less exercise, smoking and weight gain all of which are risk factors for diabetes. Depression affects your ability to perform tasks, communicate and think clearly.

Depression Risk In Diabetic Patients

A recent epidemiological study of 90686 participants found that depression was more prevalent in people with diabetes, regardless of the fact that they had diagnosed or undiagnosed diabetes. The same study showed that anxiety was more prevalent only in participants who were aware of their diabetes . One possible explanation might be that the psychological burden of being ill may play an important role on triggering anxiety and depression. However, the fact that in patients with previously undiagnosed diabetes, depression had a higher prevalence and could be due to an unfavourable lifestyle, such as physical inactivity, unhealthy diet or a stressful lifestyle.

Severe hypoglycaemia in patients with DM2 and without anti-depressive treatment was positively associated with the severity of depressive symptoms, independent of glycemic control, insulin therapy, lifestyle factors and diabetic complications . A meta-analysis estimating the association between depression and neuropathy in patients with DM2 could not clarify if the relationship is bidirectional or not .

Hypothetically, depression could be increased by anti-diabetic treatment . A strong association between depression in patients in their forties with orally treated diabetes was found, compared to patients in their seventies . On the contrary, insulin therapy in elderly people with DM2 led to the improvement of depressive symptoms and did not affect the health-related quality of life of these patients .

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Can Depression Cause Diabetes

Researchers have found an increased risk of diabetes in people with depression, though the link remains unclear.

A review in the American Journal of Psychiatry discussed how inflammation is often seen in people with depression and can negatively impact both mental and physical health, leading to further inflammation. Additionally, chronic inflammation is characteristic of diabetes.

Researchers have also hypothesized that lifestyle factors often seen in people with depression, such as poor diet and physical inactivity, may play a role in increasing the risk for diabetes. Some medications taken for depression might also contribute to a higher risk of diabetes, though there has only been an association found and not causation.

Depression’s Role In Diabetes

Several other studies presented at the ADA meeting addressed the chicken and egg issue of whether depression causes diabetes or vice versa.

In one such study, researchers from Emory University School of Medicine in Atlanta examined blood sugar control, or glucose tolerance, of 443 healthy adults without known diabetes or glucose intolerance who were and were not being treated for depression. Glucose intolerance is the major indicator of diabetes.

The researchers thought they would find that depressed patients had higher levels of prediabetes and undiagnosed diabetes disease than people who were not depressed, but this is not what they found.

After adjusting for diabetes risk factors such as weight, age, and race, little association was seen between depression and glucose intolerance. Although diabetes was associated with depression, unrecognized glucose intolerance was not.

“Since these results suggested that awareness of the health risks conferred by diabetes may contribute to depression, patients with newly diagnosed glucose intolerance should be counseled appropriately and monitored for development of depression, researcher Lawrence S. Phillips, MD, and colleagues wrote.

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Clinical Burden Of Disease

Traditionally it was widely believed that depression was an understandable reaction to the difficulties resulting from living with a demanding and life-shortening chronic physical illness that is associated with debilitating complications. This model is supported by a systematic review of 11 studies that found no difference in the rates of depression between those with undiagnosed diabetes, those with impaired glucose metabolism, and people with normal glucose metabolism . An increased rate of depression was only found in those with diagnosed diabetes suggesting that the knowledge of the diagnosis and the burden of managing the condition and its complications are associated with depressive symptoms rather than biological mechanisms such as hyperglycemia. The implication of this finding is that healthcare professionals may have an important role in moderating the psychological burden associated with diabetes by considering the way in which the diagnosis of diabetes is conveyed and the psychosocial support that is given at and after diagnosis.

Can Diabetes Make You Cry

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It’s common to encounter mood swings, stress, or even depression if you have diabetes. To reduce the chances of experiencing these mental health conditions, maintain your management plan and keep your blood sugar in a healthy range.Read more

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How Are Diabetes And Mental Health Connected

A diabetes diagnosis can feel like not just a threat to health, it can also seem like a threat to a persons way of life, because managing diabetes means making changes to your day-to-day routine. Your doctor might instruct you to change your diet by eating certain kinds of foods, avoiding sugary beverages, or restricting alcohol intake which can be difficult for anyone regardless of a diabetes diagnosis. Added responsibilities like tracking blood glucose and insulin can be hard to remember at first, doctors appointments can cause time away from work, and the costs of appropriate care may be burdensome. These changes can be emotionally draining, and you might start to notice that you are feeling a bit off or have very little energy left to carry out important tasks to managing your condition.

• People living with type 1 or type 2 diabetes are at increased risk for depression, anxiety and eating disorders.
• Rates of depression across the lifespan are 2 times greater for people with diabetes than in the general population.
• People with type 1 diabetes are twice as likely to live with disordered eating.
• In women with type 1 diabetes, bulimia is most common eating disorder while women with type 2 diabetes are more likely to deal with binge eating.

The fear of blood sugar fluctuations can be very stressful. Changes in blood sugar can cause rapid changes in mood and other mental symptoms such as fatigue, trouble thinking clearly, and anxiety.

Selection Of Case And Control Subjects

Individuals eligible for inclusion in this study were residents of Saskatchewan, eligible for prescription drug benefits during the study period, and aged > 20 years. Two study groups were identified: people with diabetes and people without diabetes .

Case subjects were identified based on the established case definition of the National Diabetes Surveillance System within the diabetes index period. Subjects were identified as having diabetes if they had two or more physician service claims for diabetes within a 2-year period or one or more hospitalizations with a diabetes code as the primary, secondary, or other diagnosis. Dispensation of oral antidiabetic agents was used to restrict the diabetes cohort to type 2 diabetic patients. Diabetes index date was identified as the date of first dispensation for an oral antidiabetic agent or the date the National Diabetes Surveillance System criteria were met, whichever came first. Women with services claims for gestational diabetes were excluded.

Control subjects were identified by randomly selecting two subjects from the nondiabetic population for each diabetic subject within the same index year. Control subjects were assigned the same index date as their respective case subject and were not matched on any demographic characteristics.

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Can Antidepressants Improve Diabetes

Some medications for depression have been shown to improve, not worsen, glycemic control. Still others lead to improved insulin sensitivity by helping the body use insulin to carry glucose into cells more efficiently, which reduces the risk for hyperglycemia.

Part of the reason for improvement may be that receiving depression treatment in general leads to improved depression symptoms and positive lifestyle and behavior changes. When depression improves, people are more likely to eat nutritiously, exercise, take necessary medications , and monitor their blood glucose levels. This, in turn, improves diabetes.

The mixed effects of antidepressants lead to more questions. Could it be possible that the type of antidepressant taken for depression makes a difference?

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Some people experienced clinical depression which was hard to overcome. People who were clinically depressed said it felt like ‘a black fog’ or a ‘blackness’ came over them. Sometimes stress from work or family life tipped them over the edge, and people found it difficult to cope with diabetes. One man said that when he is not feeling depressed, he finds it much easier to eat healthily, but when he is depressed he comfort eats.Antidepressants or talking therapies, such as cognitive behaviour therapy or counselling helped people cope with depression. Different people react differently to antidepressants, and sometimes it takes time to work out which drug works best. Several people we talked to were taking fluoxetine for depression and found that it worked quite well for them. One man who suffered from clinical depression before being diagnosed with diabetes, said, Medication seems to make it a lot easier than it was. It stops the tears but it doesn’t stop the blackness.

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A Psychologist Or Psychiatrist

You might like to talk with a psychologist or psychiatrist. These professionals are best placed to make a diagnosis and provide treatment for depression. Treatment may involve the following:

• One-on-one counselling
• Medication
• A combination of psychological therapy and medication.

Ask your diabetes health professional if they know a psychologist or psychiatrist in your area who is familiar with diabetes, or try the following:

• Find a psychologist near you by going to the Australian Psychological Society website at psychology.org.au
• Find a psychiatrist near you by going to the Royal Australian and New Zealand College of Psychiatrists at yourhealthinmind.org/mental-illnesses-disorders/anxiety-disorders.

You will need a referral from your GP to see a psychiatrist, but not to see a psychologist.

Your GP can tell you if you are eligible for a Mental Health Treatment Plan to reduce the costs of seeing a psychologist or psychiatrist.

Dont be afraid to ask for help. Seeing a psychologist is one of the best things I ever did.

Rodney, 36, person with diabetes