Diabetes-related Depression: How to work your way around the two Ds

A study published in Diabetesjournals.org in June 2023, titled Bidirectional Mendelian Randomization and Multiphenotype GWAS Show Causality and Shared Pathophysiology Between Depression and Type 2 Diabetes, found that was a greater chance of people with diabetes developing symptoms of depression. As per the data, it was found that people with type 2 diabetes have a 40% chance of developing symptoms of depression. On the other hand, people with symptoms of depression have a 25% chance of suffering from type 2 diabetes. 

“Many patients with diabetes can suffer from depression as managing diabetes can be complicated and stressful. And people with depression could overeat, put on weight, and end up having depression. The two, in a way, are interconnected," says Dr Sneha Kothari, consultant endocrinologist, Gleneagles Hospital, Mumbai. According to Kothari, diabetes caused due to excess of cortisol hormone could lead to depression too. 

Understanding ‘Diabetes Distress’ 

The link between diabetes and depression has been around for a long time, but the awareness around it has increased in recent years, says Dr Rajiv Kovil, head of diabetology, Zandra Healthcare, Mumbai. "When a person suffers from diabetes, two things can happen: Diabetes distress and diabetes depression," Kovil notes adding that ‘diabetes distress’ is a relatively new terminology that has been in use since the last decade or so. This probably has to do with the fact that people are becoming diabetic at a younger age. 

As per a 2020 report by the National Library of Medicine, the risk of pre-diabetes among the under-35 age group was at 56.7% and at 33.1% among the under-30. “Older people, who are diagnosed with diabetes often are more accepting of the condition. They are more ready to deal with it. Denial is more prevalent among youngsters and this leads to depression," Kovil says.

“It is understandable that those diagnosed with diabetes might feel overwhelmed. There would also be a feeling of feeling left out— others can eat certain foods, but I cannot. I need to excuse myself to take insulin injections," notes Mumbai-based psychologist Jenisha Shah. This feeling, she says, tends to be more prominent if one gets diagnosed with diabetes at a younger age, say during teenage. The ‘why me’ feeling tends to build up. “The emotional impact of feeling disappointed, angry, not being able to lead a normal life is bound to happen," she explains.

If you were to look closely at diabetes-related depression among the genders, you'd find different factors at play. “Insulin resistance among men can cause hypogonadism, which means low levels of testosterone. This can have an impact on one’s libido, which can eventually lead to diabetes depression among young men," Kovil explains. Among women, onset of perimenopause or menopause compounded with a diabetes diagnosis could cause depression. “Menopause is a time when women’s hormones go haywire. That, compounded with having to manage diabetes, can increase irritability and a sense of being lonely, " Kovil observes. 

How to overcome diabetes-related depression

Irrespective of genders, Kovil says that once a diabetic individual is diagnosed with depression they should seek professional help and take medication to manage the condition. Here, Kovil pauses to reiterate an important distinction: “There’s a fine line between diabetes-induced distress and depression caused by diabetes. And only proper diagnoses can help deal with either." 

“It's normal to feel frustrated or anxious, so acknowledge your feelings. Share your concerns and feelings with family, friends, or a mental health professional," advises Dr Prerna Sharma of Institute of Human Behaviour and Allied Sciences, Delhi. “Join a support group of people who share the same experiences and  understand your experiences. Engage in activities that bring joy and relaxation," she adds. 

Be gentle with yourself, advices Shah. “Take small steps, but be consistent with them. And if you face a setback, don’t be hard on yourself," she says. While talking with a friend or seeking a support group is beneficial, Shah believes that “understanding your limitations and working out a routine accordingly will go a long way." Sharma suggests keeping a log book or an app to monitor your progress. “Don’t seek perfection but set realistic targets and divide lifestyle changes into manageable steps," she says adding, “When taking care of your health becomes a long-term goal, then it’s important to celebrate small victories."  

Sumitra Nair is an independent journalist based in Kochi.