Certain activities, such as journaling, may help lift depression.(CORBIS)

People with diabetes are at high risk of depression, but there are ways to cope with it beyond antidepressants.

When Joan, 72, a retired nurse from San Diego, began to feel depressed, her primary doctor brushed off her complaints. "She said, 'Oh no, you're just doing too much,' and that sort of thing," she recalls. But Joan knew better. She was losing patience with her husband and getting upset with herself for failing to manage her diabetes well. (Click here to learn more about the symptoms of depression.)

Joan believes her depression is related to her type 2 diabetes. "It kind of gets you down because there's no end in sight. You just have to keep maintaining your will to continue regulating yourself and doing a good job with (managing the disease), and then when you don't exercise, you feel guilty about that," she says.

Antidepressants mayor may nothelp
Finally her doctor prescribed Prozac, but Joan found the drug brought on tremors in her hands. (Prozac is among a number of medications that may exacerbate "physiologic tremor," a normal type of involuntary movement that usually isn't visible to the eye.) So she stopped taking it. And because she is someone who has a lot of reactions to medications, she hasn't tried other antidepressants.
More about diabetes complications

Instead Joan is taking a class that teaches people with diabetes and depression new approaches to stressors in their lives and how to alter their behavior. Every week, students engage in some activity aimed at lifting depression, such as journaling.

Students are encouraged to do something fun, like calling a friend or going to the movies—anything to break the pattern of isolation that occurs when depressed people withdraw from activities they used to enjoy. (Click here for other nondrug options for coping with depression.)

"The other thing in my class is every week we have our diabetes-related goal because we know even modest improvements in their blood sugar can show up in their mood," says Susan Guzman, PhD, a senior psychologist with the Behavioral Diabetes Institute in San Diego, Calif., who leads Joan's class. A small pilot study by researchers at the University of Virginia, which was published in 2007, found that a rapid rise in blood glucose from before a meal to after a meal was associated with negative mood in type 2 diabetes patients.

Managing diabetes may help ward off depression
Setting goals for managing diabetes has helped Joan a lot. She's been checking her blood sugars more routinely. Her hemoglobin A1C has dropped a point. And she's begun an exercise routine that involves an hour of swimming aerobics five times a week. Plus, sharing experiences in class with other people who are in the same boat has been uplifting.

"It just really makes you feel good to know that you have some good friends who care about you," she says, "and you sometimes realize there are people worse off than you are."

Joan says her relationship with her husband has improved, and she feels better about herself when she visits her doctor. "The last two times I haven't gone in there and cried," she says.