Diabetes and Mental Health: Depression and Anxiety When You Have Diabetes

by Jessica Pyhtila, PharmD, BCPS, BCGP

Having a diabetes diagnosis can be stressful. The everyday burden of managing your blood sugar and overall health can sometimes be overwhelming. This is especially true for those who suffer from mental health conditions like depression and anxiety. Although anyone can be diagnosed with depression or anxiety, people with diabetes are more likely to suffer from these conditions. In turn, these mental health conditions can significantly worsen their quality of life. For this reason, it is important to know how to manage your mental health if you have diabetes.

Diabetes and Depression

Depression is common in those who have both Type 1 and Type 2 diabetes. People with diabetes are around twice as likely to have depression as those without the disease. Although up to 15% of people with diabetes carry an official diagnosis of depression, nearly 25% of people with diabetes have symptoms of depression. This leads to a variety of complications, including:

  • Worsened quality of life
  • Impaired diabetes self-management
  • Increased risk of complications
  • Reduced life expectancy

Experts are still debating the reasons for the relationship between diabetes and depression. One school of thought is that the burden of managing a chronic disease may lead to a person developing depression. However, other factors may also contribute to the higher rate of depression in people with diabetes.

For example, some scientists believe that biological factors may be to blame for both depression and diabetes. These may occur due to the diabetes itself. Further, these factors may cause changes to the brain and metabolism that set the stage for low mood and depression. Some of these factors include:

  • Blood sugar changes: Those with diabetes often undergo dramatic swings in blood sugar, which has been linked to changes in mood.
  • Brain structure changes: Diabetes can lead to changes in certain parts of the brain itself. This includes the hippocampus which is linked to memory, and the hypothalamus which is involved in hormonal regulation and stress. These changes may manifest in your mood.
  • Sleep changes: Poor sleep patterns are linked to diabetes. Specifically, poor sleep can cause insulin resistance, which causes your body to use insulin less effectively. Poor sleep is also linked to depression and a greater risk of mood changes.
  • Inflammation: As a metabolic disease, diabetes is linked to an increase in many inflammatory chemicals throughout the body. These include C-reactive protein, TNF-alpha and cytokines. These chemicals have also been linked to depression.

Diabetes and Anxiety

Anxiety is common in those with diabetes and can occur at the same time as depression. Studies have shown that people with diabetes are 20% more likely to have anxiety than those without diabetes. Many different subtypes of anxiety exist, like generalized anxiety disorder, social anxiety disorder, panic disorder, and posttraumatic stress disorder (PTSD).

Although anyone with diabetes can suffer from anxiety, it is common for a person to struggle with anxiety when they undergo a change in their health status. Typically, this includes an increase in anxiety after getting a diabetes diagnosis, and if health complications from diabetes like kidney problems start to occur.

In addition, feeling anxious or nervous is a common effect of low blood sugar. For this reason, those with anxiety may feel worse if their blood sugar levels drop. It may also be hard for the person to tell the difference between their normal anxiety levels and when their anxiety is being exacerbated by low blood sugar. In some cases, people may develop increased anxiety about having low blood sugar or giving insulin injections.

When to Seek Help With Your Mental Health When You Have Diabetes

It can be hard to know when you need help, especially if you have never sought mental health assistance before. Some signs that it might be time to seek assistance with your mental health include:

  • You have trouble finding the motivation to check your blood sugar, take your diabetes medications, or make recommended lifestyle modifications
  • You delay or forget to make recommended follow-up visits with your diabetes healthcare team members
  • You feel overwhelmed by your diabetes diagnosis and your overall health
  • Your diabetes management leads to interpersonal conflict with friends or family members, and you may avoid friends or loved ones

Improving Your Mental Health While Controlling Your Diabetes

Fortunately, multiple treatment strategies are available to benefit your mental health. Generally, this consists of a combination of medications and therapy. These treatments may have the additional effect of helping to control your diabetes, by improving your mood and overall mindset. In turn, you can be in a better place mentally to focus on your diabetes and blood sugar management.

Mental Health Therapy in Diabetes

Talk therapy can be helpful for those with diabetes. The stress of having a chronic disease like diabetes can take a toll on your mental well-being, which in turn may also impact your physical health. A trained therapist, typically a psychologist (PsyD or PhD) or a licensed clinical social worker (LCSW), can help you navigate your stress and identify healthy coping mechanisms. Multiple types of talk therapy are available, depending on your needs. Your therapist can help you decide which is the best fit. Some common types of therapy include:

  • Cognitive-Behavioral Therapy (CBT): CBT focuses on helping you develop beliefs about your life as well as healthy actions. The goal of CBT is to replace negative thought patterns and actions with healthier ones.
  • Family Therapy: Family therapy focuses on improving interpersonal communication, conflict resolution problem-solving.
  • Dialectical-behavioral Therapy (DBT): DBT focuses on helping you develop better mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Diabetes organizations can help you find a mental health provider who is familiar with both diabetes and mental health issues. For example, the American Diabetes Association maintains a directory of therapists that specialize in meeting the needs of people with diabetes. To be included in the directory, therapists need to maintain special diabetes qualifications.

Mental Health Medications in Diabetes

Generally, the same medications for depression and anxiety can be used whether or not you have diabetes. Although your doctor will select a medication for you based on your specific medical history and needs, in general, selective serotonin reuptake inhibitors (SSRIs) are considered first-line therapy for both anxiety and depression. These medications include fluoxetine (Prozac), escitalopram (Lexapro), and sertraline (Zoloft). If you have other diabetes-related complications like diabetic nerve pain, your doctor might instead choose a serotonin norepinephrine reuptake inhibitor (SNRI) like duloxetine (Cymbalta). This medication is commonly used to treat depression, anxiety and nerve pain. Thus, if you suffer from nerve pain in addition to low mood or anxiety, duloxetine may help you achieve control over these multiple issues.

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