"What we know is that depression is certainly a lot more likely if you have diabetes," says Susan Guzman, senior psychologist at the Behavioral Diabetes Institute in San Diego. "Is it the blood sugars that cause it? Is there a genetic component? We don't know."
In a review of 42 different studies, researchers in St. Louis, Mo., found that people with diabetes were twice as likely to be depressed as people without the disease, and women were at greater risk than men.
Guzman believes it is probably some combination of psychological and physical factors. Cultural, spiritual, and situational stressors may play a role as well.
"Diabetes gives people a lot of opportunities to feel like a failure," she says. "That really triggers depressive thinking."
More complications, more depression
Yet depression, while common in diabetes, is not normal, and there are things people can do to treat it. "We call it a biopsychosocial disease or condition, and usually treatment involves work in each of those areas," says Guzman.
People with diabetes and depression have a greater mortality risk than people the same age who have either one of those conditions alone, underscoring the need for treatment.
In fact, researchers in Pennsylvania recently reported that depressed, older adults with diabetes who received more resources for depression treatment were half as likely to die over a five-year period versus diabetics who didn't receive that level of care.
Don't mistake depression symptoms for diabetes
It's easy to confuse physical symptoms of diabetes, such as lack of energy, with symptoms of depression, Guzman observes. But there many other symptoms that provide clues to a diagnosis of depression. These may include:
- Loss of pleasure in activities you used to enjoy
- Change in sleep patterns
- Waking up earlier than usual
- Change in appetite
- Trouble concentrating
- Feeling guilty that you never do anything right and worrying that you are a burden to others
- Morning sadness
- Suicidal thoughts
"Basically, if it's starting to affect their functioning," Guzman says, "it's time to get help." Yet a diagnosis of depression is missed 50% of the time in primary care settings, according to Mental Health America, the nation's leading nonprofit advocacy group for the mentally ill. And among people with diabetes, two out of every three depressed patients seen in the primary care setting receive no specific antidepressant treatment, one study finds.
Unfortunately, Guzman says, some doctors mistakenly see depression as an expected reaction to patients' medical conditions. For many, depression falls outside their area of expertise, so they are uncomfortable with it. And the time constraints of managed care may discourage doctors from asking their diabetic patients how they're coping with the disease.
"Their hand is on the doorknob and their eyes are on the clock and they know that's not going to be a short conversation," says Guzman.