By Lisa Foster-McNulty MSN/RN/CDE
If you have both diabetes and depression, you already know that it doesn’t feel good and you’d be better off if you could do something about it, right?
I’ve heard a lot about diabetes and depression over the years, especially that diabetes causes depression and depression causes diabetes. No matter, if you have both, it makes it a whole lot harder to do the things you need to do to take care of yourself and your diabetes. Let’s dive right in and take a look at what some newer research says, and come up with a strategy. Are you with me?
A 20 year observational study of patients with Type 1 diabetes linked depression with worse survival. The results of this study were presented by Catherine E. Fickley. Ms. Fickley’s group followed individuals with Type 1 who had been diagnosed with diabetes as children. They were in their 25th year of follow up. During the study, there were 94 deaths, representing 20.5% of the group. Most often the deaths were in those with the most depressive symptoms. The depressed subjects had a 2.87-fold increased risk for death. The link between depression and earlier death was the same in both men and women. Describing the few prior studies that have investigated depression in Type 1 diabetes, Ms Fickley noted that antidepressant use was linked with an increased risk of death in women. Another linked depressive symptoms to cardiovascular disease.
Lawrence Fisher, PhD, authored a similar study involving people with Type 2 diabetes. It looked at whether depression in patients with diabetes should be considered a “co morbid psychiatric condition” or part of the broader experience of diabetes distress. Diabetes distress refers to worries, concerns, and fears about having diabetes. His research investigated whether treatments that target diabetes distress would also reduce depression symptoms. Study participants with Type2 and moderate diabetes distress were randomized to an education and support program, a web-based diabetes self-management program, or the web-based program plus problem-solving therapy. All study treatments showed significant reductions in distress and depression. Dr. Fisher said this suggests that depression in adults with Type 2 can be reduced by diabetes-distress-focused interventions alone. Much of what is labeled depression in these patients might best be viewed as the distress associated with struggling with a demanding chronic condition rather than a co morbid psychiatric condition.
What does all this research tell us?
The bottom line is that we can have a powerful impact by simply “focusing on the diabetes element of the emotional experience.”
So all this reading about depression had made me feel a bit depressed– or distressed—I’m not sure which! What I am sure of is that this is important stuff with serious ramifications. Depression and distress don’t just make us feel bad in the present, they actually shorten our lives. That should get your attention.
Do you think you are depressed? How would you know if you are depressed? What can you do about it?
First, do a little soul-searching and see if there’s anything you can do on your own. Remember the Type 2 people in the behavioral therapies? Maybe you can connect with a support group, (many groups exist in major cities around the world) work with a Certified Diabetes Educator for some education and a tune-up, or brush up on some problem solving skills. Knowledge is power, and being in the driver’s seat feels good. Maybe that will get you back on track. It seems from the research that being engaged in some type of program is a help. I even have to wonder if these benefits can be obtained by starting an exercise program, doing guided imagery, journaling, developing a new repertoire of recipes that you can easily carb count, and the like.
But what if that’s not enough? Or you can’t get the motivation to become engaged with a program? There are many depression screening tools—basically a quiz that you can take– out there, such as the PHQ-9 and the Beck Depression Inventory, in case you’d like to find one of these by using a search engine. You could take a screening test and see how you score. If your score warrants it, print out your test and take it to your doctor or primary care provider to discuss the results. They can get you pointed in the right direction. Perhaps you’d benefit from an antidepressant. Maybe a referral to work with a counselor is in order. You may also want to try to get a handle on this by reading some self help books. A great resource is Dealing With Diabetes Burnout by Ginger Vieira. It could be that you need some extra tools to improve the diabetes balance in your life. You CAN take steps to address your depression or diabetes distress so that YOU are back to being in a better place!