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Diabetes, Depression, and Stress

- By Carol E. Watkins, MD

Depression is not generally listed as a complication of diabetes. However, it can be one of the most common and dangerous complications. The rate of depression in diabetics is much higher than in the general population. The correlation between diabetes and depression has gained attention during the past several years. Recent studies have shown that people with diabetes are two to three times more likely to suffer from depression as those without the disease. But they also suggested that effective treatment of depression can improve diabetic control. A depressed person may not have the energy or motivation to maintain good diabetic management.

Often, individuals with depression do not realize that they are depressed. It is easy to attribute the symptoms of depression to the diabetes. This is particularly difficult since depressed diabetics may have poorer glucose control. Medical professionals or mental health clinicians may be the best ones to determine what is due to diabetes and what is due to depression.

Common Symptoms of Depression: (Source: Diagnostic and Statistical Manual of the American Psychiatric Association, 4th Edition.)

  • Depressed mood for most of the day
  • Decreased pleasure in normal activities
  • Difficulty sleeping or significantly increased need to sleep
  • Weight loss or weight gain
  • Feelings of guilt or worthlessness
  • Low energy level
  • Difficulty making decisions of concentrating
  • Suicidal thoughts

Treatment of Depression:

The most important starting point is an accurate diagnosis. There have been major advances in the treatment of depression. There are specific medications and specific psychotherapy techniques that have been shown to help depression. Be sure to work with your physician to look for the right treatment for you.

Anxiety and stress can also cause large jumps in blood glucose levels. Panic attacks may resemble hypoglycemic episodes and vice-versa. People respond differently to stressful situations. Given the same subjective level of stress, one diabetic may have a different glucose response from another. Because of this, one should monitor blood glucose more frequently during periods of stress.

On the positive side, a conscientious diabetic may have a unique barometer of stress unavailable to the general population. There are a number of specific anxiety disorders that are treated differently. As with depression, there are specific medications and therapies that have been shown to work. If anxiety is severe, it is important to identify the specific type, so that one can embark on the right treatment.

The following are some general suggestions for dealing with stress and mild to moderate anxiety.

  • Examine your lifestyle for sources of stress. Are there "stressers" that can be eliminated?
  • Learn relaxation techniques. Yoga, meditation, prayer, and hypnosis may help.
  • Make sure that you are getting enough sleep
  • Exercise. The body's primitive stress response was designed to prepare the individual to fight or to run away. In our society, we do not usually respond to stress with physical activity. Exercise helps our bodies deal with the physiological results of stress.
  • Make a list of the things that are worrying you. When you have a concrete list, the problems often look more manageable.

Many people do not like the idea that they may have emotional difficulties. Some find it easier to attribute everything to physical problems or life circumstances. However, good diabetic management is dependent on the development of self-knowledge.

Adapted by Editorial Staff, February 2006
Last update, July 2008

1. Lustman, PJ, Griffith, LS, Freedland, KE, Clouse, RE; The course of Major Depression in Diabetics Gen Hosp Psychiatry 1997; 19(2) 138-143.

2. Stabler B, Surwit, RS, Lane JD, et al. Type A Behavior pattern and blood glucose control in diabetic children Psychosomatic Medicine 1987; 49: 313-316.

3. Cohen, ST, Welch, G, Jacobson, AM, et al The Association of Lifetime Psychiatric Illness and Increased Retinopathy in Patients with Type I Diabetes Mellitus Psychosomatics 1997; 38: 98-108.

4. Koenigsberg, HW, Klausner, E, Pelino, D et al. Expressed Emotion and Glucose Control in Insulin-Dependent Diabetes Mellitus American Journal of Psychiatry 1993.

5. Goldston, DB, Kelley, AE, Reboussin, DM Suicidal Ideation and Behavior and Noncompliance with the Medical Regimen among Diabetic Adolescents American Journal of Child and Adolescent Psychiatry 1997.

6. Lustman, PJ, Griffith, LS, Clouse, RE et al. Effects of Nortryptiline on depression and glycemic controlin diabetes: Results of a double-blind, placebo-controlled trial. Psychosomatic Medicine 1997;59(3) 241-250.



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