Introduction
According to the CDC, adults with diabetes are twice as likely to suffer from depression than adults without diabetes (CDC, 2022). But what is the link between the two? This article explores the possible effects of their relationship, and how evidence-based Cognitive Behavioural Therapy (CBT) can support the management of these conditions.
What is Diabetes?
Diabetes is a metabolic disorder that is characterized by high blood sugar levels. The condition can be caused by several factors, including genetics, lifestyle choices, and underlying medical conditions. People with diabetes are at an increased risk for developing serious health problems, including heart disease, stroke, kidney disease, and blindness (Clark, Fox & Grandy, 2007).
What is Depression?
Depression is more than just feeling down or going through a tough time. It’s a serious mental health condition that can have a profound impact on every aspect of your life. Depression is one of the most common mental disorders, affecting more than 16 million adults in the United States each year (ADAA, 2017). Symptoms of depression can include persistent sadness, irritability, fatigue, difficulty concentrating, changes in appetite, and thoughts of death or suicide (Kanter, Busch, Weeks & Landes, 2008). Our therapists offer a complete depression screening.
What is the link between Diabetes and Depression?
People with diabetes are twice as likely to experience depression than those without the condition (Sartorius, 2018).
Blood sugar fluctuations can cause fluctuations in mood and energy. Low blood sugar can cause mental confusion, irritability, and shakiness. This emotional and physical roller coaster can lead to depression. Some people with diabetes develop diabetic neuropathy, which is nerve damage that can cause pain, numbness, and tingling in the extremities. This can make it difficult to do everyday activities and can lead to feelings of isolation and loneliness.
Only 25% of people with Depression and Diabetes get mental health treatment despite the effectiveness of therapy for Depression.
Diabetes distress was traditionally thought to be the primary cause of depression among people with diabetes, but the relationship is more complicated than that.
Diabetes distress is a specific emotional state experienced by people with diabetes. It differs from major depressive disorder, as it’s directly linked to the stress of living with the condition.
For one, managing diabetes can be a difficult and stressful task. Having to constantly monitor blood sugar levels, take medication, and make radical dietary changes can be overwhelming. It’s a big transition in lifestyle. Further, those are at risk for diabetes are often people who experience stress, lack of sleep, low exercise, and poor diets over a long period of time. The external situational factors (i.e. job, family life) may not have changed.
People may be in denial and avoid accepting the diagnosis. Some people struggle with guilt or shame, especially how diet impacts social life or when they struggle to make lifestyle changes. It takes time to emotionally adapt to a major diagnosis.
Diabetes distress does not meet the qualifications for depression, but it can negatively affect your health. Being depressed, stressed, or guilty can make it harder for you to manage your condition. Therapy is great at helping patients adapt to new life changes. Therapists can offer tools for adjustment, dealing with all the emotional reactions, and supporting a new plan.
How can CBT help depression and diabetes management?
Recent studies have shown that individuals with long-term health conditions and mental health difficulties should be supported with an ‘integrated behavioral healthcare model’ (Ali et al., 2020). Integrated healthcare aims to treat the whole person, not just their physical health but also their mental and emotional wellbeing. This type of care considers all aspects of a person’s life, including their family, social, and work environment. The goal of integrated behavioral healthcare is to help people live their best lives possible. This means providing care that addresses all a person’s needs, not just their symptoms.
One of the most popular therapy approaches that use an integrated behavioral healthcare approach is Cognitive Behavioural Therapy. Cognitive behavioral therapy (CBT) is a psychotherapy that helps people change patterns of negative thinking and behavior. CBT has been shown to be effective in treating depression, and research suggests that it is also an effective therapy in managing Diabetes (Kanapathy & Bogle, 2017).
Depression and Diabetes share some risk factors, such as chronic stress, poor sleep, and certain medical conditions. These factors can make it difficult to manage both conditions. CBT can help by teaching people skills to cope with stress, manage their emotions, and make healthy lifestyle choices. CBT may also help improve blood sugar control in people with diabetes. One study found that people who received CBT had better blood sugar control, increased medication adherence, and improved contact with healthcare professionals than those who didn’t receive CBT (Hunter et al., 2018).
Conclusion
Collaboration between your physician and mental health therapist is important. Increasingly, medical doctors are referring patients with depression to licensed mental health clinicians If you are struggling with diabetes, it’s important to be aware of the signs of depression and to seek help if you start to experience any of them. Similarly, if you are struggling with depression, managing your diabetes may help to ease some of your symptoms. Either way, it’s important to seek professional help if you are struggling with either condition.
References
ADAA. (2017). Facts & Statistics | Anxiety and Depression Association of America, ADAA. Retrieved 3 October 2022, from https://adaa.org/understanding-anxiety/facts-statistics
Ali, M., Chwastiak, L., Poongothai, S., Emmert-Fees, K., Patel, S., & Anjana, R. et al. (2020). Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India. JAMA, 324(7), 651. doi: 10.1001/jama.2020.11747
CDC. (2022). Retrieved 3 October 2022, from https://www.cdc.gov/diabetes/library/features/prevent-complications.html
Clark, N., Fox, K., & Grandy, S. (2007). Symptoms of Diabetes and Their Association With the Risk and Presence of Diabetes. Diabetes Care, 30(11), 2868-2873. doi: 10.2337/dc07-0816
Hunter, J., DeVellis, B., Jordan, J., Sue Kirkman, M., Linnan, L., Rini, C., & Fisher, E. (2018). The association of depression and diabetes across methods, measures, and study contexts. Clinical Diabetes And Endocrinology, 4(1). doi: 10.1186/s40842-017-0052-1
Kanapathy, J., & Bogle, V. (2017). The effectiveness of cognitive behavioral therapy for depressed patients with diabetes: A systematic review. Journal Of Health Psychology, 24(1), 137-149. doi: 10.1177/1359105317713360
Kanter, J., Busch, A., Weeks, C., & Landes, S. (2008). The nature of clinical depression: Symptoms, syndromes, and behavior analysis. The Behavior Analyst, 31(1), 1-21. doi: 10.1007/bf03392158
Sartorius, N. (2018). Depression and diabetes. Dialogues In Clinical Neuroscience, 20(1), 47-52. doi: 10.31887/dcns.2018.20.1/nsartorius
