The Link Between Depression and Diabetes

"It's believed that as many as 25 percent of people with diabetes struggle with depression," says Peter Sheehan, MD, president of the New York City leadership board of the American Diabetes Association and a consultant whose company is called Sheehan Health Management Consulting. "A chronic disease is very stressful."

Managing a chronic disease--and one that requires constant vigilance with a myriad assortment of medications--can be exhausting. Feelings of powerlessness and hopelessness are common, too.

Our depression Q and A will help you tell if you may be suffering from depression. 

Q: Are diabetics typically screened for depression by their doctor at the time of their regular visit?
A: Depression in diabetics is underdiagnosed and undertreated, says Michelle Bravo, CDE, of Mercy Medical Center in Baltimore. Very often, a discussion of being depressed might get pushed back since the person already has so much on their plate.

"I've had people come in for a visit completely tearful," she says. "They may be in denial of a diagnosis or unaware that the diabetes is manageable."

Q: Are there particular times when depression is more common?
A: When a person with type 2 diabetes has to go on insulin, this can cause depression, says Denise Rizzolo, Ph.D., PAOC, an assistant professor in the physician assistant program at Seton Hall University in South Orange, NJ. "Insulin seems like the last stop for many people," she says. "The thought that they were not successful at oral medications can lead to depression. And once they have that sense of failure, they become more depressed."

Q: Are depression and poor blood sugar control linked?
A: When blood sugar levels are out of control, it's not uncommon for a person to experience the symptoms of depression. "It's been known for years that if you treat depression in someone with diabetes, the depression will improve," says Sheehan.

Q: What help is out there for those who suffer from depression?
A: Diabetics who are diagnosed with depression can be prescribed an antidepressant, which is often effective. But the prescribing doctor should always talk to the diabetes doctor to see whether the medication will affect blood sugar levels. Talking with a psychotherapist can also be helpful, and often, combining the two (medication and counseling) is the best treatment of all.

Q: Can symptoms of low or high blood sugar mimic symptoms of depression?
A: Yes. Both a high and a low blood sugar reading can leave you feeling exhausted or anxious. If your blood sugar's high at night and you need to get up for the bathroom, of course you'll feel even more tired the following day. And this can make you feel more depressed.

Q: Who gets depressed more--men or women?
A: Women have a higher rate of depression, and this could partly be due to hormonal factors. Changes in the menstrual cycle, pregnancy, and the post-partum period all can make a woman feel depressed. Women frequently face more stresses than men when in addition to managing their diabetes, they're taking care of children or aging parents, and generally carrying more responsibilities at home and in the office.

Living with Diabetes: Depression. American Diabetes Association.