The Other D-Word

I say it every year: February is not my favorite month. Does anyone like February? I’ve lived in a lot of places, but anywhere I go, February is dark, dreary, and somehow always feels like the longest month of the year (even though it’s the shortest). In my opinion, February is depressing – and there’s nothing more depressing than writing about depression. So instead of writing about it myself, I turned to one of the top experts on psychology and diabetes: Richard Rubin, PhD, CDE.

Richard has done it all – he’s a Professor in Medicine and in Pediatrics at Johns Hopkins University School of Medicine, he’s been involved in several long-term studies of psychosocial and life-style issues related to diabetes, his work has been published hundreds of times, and over the years he’s served as an officer, volunteer and committee chair for the American Diabetes Association as well as for other organizations like the American Association for Diabetes Educators.

As impressive as his career is, it is Richard’s emotional understanding and support that make me smile when his name is mentioned; you see, his sister Mary Sue has had diabetes for more than 50 years and his son Stefan has had diabetes for more than 30 years.


Diabetes and Depression – What’s the Connection?

It’s been a while since I talked about depression and diabetes, but it is such an important topic I wanted to discuss it again, especially because we continue to learn important things about the connections between these two conditions.

People who have diabetes are more likely to be depressed

In the US, about one adult in ten (10%) has major depressive disorder (MDD), the most serious form of depression; among people who have diabetes MDD is twice as common.

About one person in 5 (20%) who has diabetes also has MDD, and researchers estimate that almost half of all people with diabetes have MDD or milder forms of depression. That’s a lot of people!

Why are people with diabetes more likely to be depressed?

Are people with diabetes more likely to be depressed because of the daily challenges and frustrations of the disease? Or is it the long-term burden of complications? It turns out both of these contribute to the higher rates of depression among people with diabetes.

But recently researchers raised another possibility – could depression be causing diabetes, instead of the other way around?  There is some evidence for this notion, at least when it comes to type 2 diabetes.

Once you think about it, the idea is not that outlandish. Being depressed can lead to a less healthy lifestyle – eating more and exercising less, for example. In people at high risk for type 2 diabetes, that could push blood glucose levels up high enough for a person to have diabetes. Depression can also trigger stress hormone release, and that can also raise blood glucose levels.

Regardless of how the double whammy of diabetes and depression comes into your life, you need help to relieve your depression. Depression can ruin your emotional health, and it can wreck your physical health as well, by sapping your motivation to take good care of yourself.  The problems maintaining a healthy lifestyle that can lead to developing diabetes in the first place have the same bad effect on your health once you have diabetes. So it’s no surprise that research shows people with diabetes who are depressed have higher blood glucose levels and are more likely to have diabetes complications.

That’s the bad news. The good news is there are effective treatments for depression that help improve your emotional health and lower your blood glucose levels. I’ll tell you more about these treatments in a moment, but first, how can you tell if you are depressed?

Signs of depression

Depression is different from the occasional bout of the blues almost everyone experiences. Depression goes on for weeks, with almost no time when you feel right. When you are depressed you feel sad and hopeless, or you lose interest in things you generally enjoy, or both.  You also have other symptoms. You might eat or sleep much more or less than usual, your energy level might be very low (one patient of mine said she felt like she was walking through molasses), you might have trouble concentrating, and you might feel really bad about yourself, as well.

If you think you are depressed, help is available

If you think you are depressed, or even that you might be, please talk to your health care provider.

If you are depressed, medication can help. A colleague of mine, Dr. Patrick Lustman from the Washington University School of Medicine in St. Louis, is one of the leading researchers on diabetes and depression. He did studies showing that an antidepressant medication (Prozac), and a form of counseling called cognitive behavioral therapy (CBT) were each effective in relieving depression in people with diabetes. Not only that, people whose depression was relieved also had lower A1c levels.

What depression treatment is right for you?

If you are depressed, either medication or counseling could help. Each has its advantages. Medication may be easier to get, while counseling has none of the side effects some people experience with antidepressant drugs. Some people get the most benefit from a combination of medication and counseling. Your health care provider can help you choose the depression treatment that’s right for you.

CBT, the type of counseling used in Dr. Lustman’s study, is designed to help people identify thoughts that fuel depression, examine these thoughts, and consider other, more positive and often more realistic ones that could contribute to feeling better. For example, telling yourself diabetes is impossible to manage can create a self-fulfilling prophecy. Since thoughts have a powerful effect on behavior, sometimes minor adjustments in thinking produce big benefits.  So telling your diabetes is really hard (but not impossible) to manage could help fuel your motivation for doing all you can.

The benefits of effective depression treatment

Over the years I have had many opportunities to see the remarkable results of effective depression treatment. One woman told me that she had almost forgotten what it was like to feel good. Another patient talked about how much more energy he had – energy he could use to take better care of his diabetes. So if you need help, do something about it today.


A huge thanks to Richard for tackling this tricky topic – and for doing the important work he does to help us better understand these connections. On the bright side, I just looked at my calendar and realized that a week from today it will be March!

P.S. Richard has reminded me that February is “anything but dreary in the Southern Hemisphere.” Perhaps I should move? 🙂

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2 Responses to The Other D-Word

  1. Merwyn says:

    I need an easy to understand group of recipies to fix for my newly labeled diabetic husband. The info given to me is not understandable; milk is a no-no in some diet suggestions and suggested as OK in a few recipies beyond the no-no. I could list several foods which are OK versus no-no either on line or in free booklets given to me by local grocery store pharmacies. I’m afraid that I”ll fix dangerous meals due to mystery info that keeps showing up. And then my husband will double his lack of energy, his lack of hunger and his lack of joy and happiness from past years. I’ve spent hours on the computer and am still very confused about the do’s and don’ts I deal with during each meal I have to put together safely three times a day. It is a very frightening experience. Where do I get help?

    • Dayle says:

      Merwyn,

      There is a booklet the American Diabetes Association can send you (for free) that talks about basic nutrition for people with diabetes. Call 1-800-DIABETES (1-800-342-2383) and ask for the “What Can I Eat” booklet.

      Another resource can be found on the American Diabetes Association’s website: http://www.diabetes.org/food-and-fitness/food/ One of the resources here, called MyFoodAdvisor, will help you find recipes, add your own recipes and learn their nutrition information, and even suggest alternative ingredients to help make a dish more healthy! You can find that at http://www.diabetes.org/food-and-fitness/food/my-food-advisor/.

      Finally, I think one thing to keep in mind is that since every person is different, every person’s diet goals and meal plans should also be different. Next time you talk with your husband’s health care team, try asking them for specifics about what (and how much) they recommend your husband eat.

      It sounds to me that you are providing the best support you can – he must be lucky to have you. 🙂

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