Diabetes and Depression

Depression and Anxiety seem to be epidemic in this generation. Whether this is a cold hard fact or simply a result of over- diagnosis, it is a statement worth noting. Similarly, Diabetes is the fastest growing chronic condition in Australia. In light of this, it is interesting that whilst human beings are discovering new frontiers in science, technology and space, there is still an awful lot of mystery involved in the inner world of ‘soul health’. Nevertheless, as we grow in our knowledge of the human psyche, there are some things that are helpful to know. Some of this ‘newish’ knowledge is in the area of neuroscience and the effects of diet, exercise and medical conditions such as diabetes on mental health and a person’s emotional life.

How the two conditions are linked

Several studies suggest that people diagnosed with diabetes are twice as likely to experience depression. Amongst other possible links, depression will generally affect motivation, and thus affect a person’s efforts to eat well and exercise, the very things that help a person avoid or manage diabetes. The interconnectedness of mind and body is an established fact, and the interplay between diabetes and depression is a plausible example of this.

Researchers are still working out exactly how the two conditions feed each other, but a few biological links stand out:

• Stress hormones: ongoing stress and low mood raise hormones like cortisol, which can push blood glucose levels up and make diabetes harder to manage.
• Inflammation: both conditions are associated with higher levels of inflammation in the body, which is thought to affect mood and how the body uses insulin.
• Blood sugar swings: highs and lows in blood glucose can leave you tired, irritable, foggy or flat, which can look and feel a lot like depression.
• The daily load: checking levels, managing food and medication and worrying about complications is a lot to carry. When it becomes overwhelming it is often called diabetes distress, and it can open the door to depression.

The result can be a loop. Low mood makes self-care harder, blood glucose becomes harder to control, and that in turn affects mood. The good news is that support in one area often helps the other.

The Australian picture

This is not a small issue here at home:

• Around 1 in 15 Australian adults are living with diabetes, according to the Australian Institute of Health and Welfare.
• People living with diabetes are two to three times more likely to experience depression or anxiety than the general population, according to the National Diabetes Services Scheme (NDSS).
• The NDSS also reports that severe diabetes distress affects about 1 in 4 people with type 1 diabetes and 1 in 5 people with insulin-treated type 2 diabetes.

What the research says

Psychcentral.com posted an article on the association between diabetes and mental health. Below is a segment of it.

Causes underlying the association between depression and diabetes are unclear. Depression may develop because of stress but also may result from the metabolic effects of diabetes on the brain. Studies suggest that people with diabetes who have a history of depression are more likely to develop diabetic complications than those without depression. People who suffer from both diabetes and depression tend to have higher health care costs in primary care.

Despite the enormous advances in brain research in the past 20 years, depression often goes undiagnosed and untreated. People with diabetes, their families and friends, and even their physicians may not distinguish the symptoms of depression. However, skilled health professionals will recognize these symptoms and inquire about their duration and severity, diagnose the disorder, and suggest appropriate treatment http://psychcentral.com/lib/diabetes-and-depression/2/

I was talking to a friend recently who had struggled with anxiety and what he had thought was burn out. Interestingly, he had since been diagnosed by a health practitioner with high blood pressure, and once addressed, the anxiety reportedly decreased. Another possible example of mind- body interplay. In a society that seems to reward fast paced, stress induced living, together with quick fix food and limited exercise time, the risk of not only physical illness but mental illness can be a reality. The connection between physical and mental health is obvious.

Treatment options that address both

Because the two conditions are so connected, the most helpful approach usually looks after body and mind together:

• A team approach: your GP, diabetes educator, dietitian and counsellor or psychologist working together, so nobody is treating only half the picture.
• Talking therapy: approaches like Cognitive Behaviour Therapy can help with low mood, unhelpful thinking and the stress of managing a chronic condition.
• Movement: regular physical activity helps blood glucose control and is one of the best-supported natural lifts for mood. Even a daily walk counts. You might enjoy our article on mental health and recreation.
• Medication review: if medication for depression is suggested, your GP can choose options that suit your diabetes management.
• Stress management: sleep, rest and practical tools for managing stress can ease both mood and blood glucose levels.

When to talk to your GP and when to see a counsellor

See your GP first if:

• Your mood has changed and you haven’t had a health check recently
• Your blood glucose has become harder to control
• You have questions about medication, or new physical symptoms
• You would like a referral or a Mental Health Treatment Plan

See a counsellor if:

• You have felt low, flat or unmotivated for more than two weeks
• Managing diabetes feels exhausting or overwhelming
• Stress, worry or relationship strain is making self-care harder
• You want practical tools to change unhelpful thinking and habits

For many people the best answer is both. Your GP looks after the medical side while a counsellor helps with the emotional load. At Breathe you can see a counsellor or a psychologist, in person or online. If you are ever in crisis or having thoughts of harming yourself, please call Lifeline on 13 11 14 or 000 in an emergency.

Be intentional about your health, cover all bases. We are complex beings. For one person, a change of diet may be the key to better emotional health, for another less stress. For still another counselling may be required or for someone else a visit to your GP might be the order of the day. When you are ready, you can book a session.

Nick Gwynn

breathecounselling.com