Depression and Diabetes

Depression is about twice as common among people with diabetes than the general population, affecting at least 15% of people with diabetes.

While depression in and of itself is a problem if left untreated, depression can also have a negative impact on diabetes self-management, blood glucose control, and cause other complications. If you are feeling depressed, be sure to tell your health care provider. There are steps you can take to feel better.

Why Are People With Diabetes Vulnerable to Depression?

There is not just one cause of depression. It is a complex disease that can occur as a result of a multitude of different factors, including biology, emotional and environmental influences. For people with diabetes, depression can develop as a result of the lifestyle adjustments they have to make to control their diabetes. Managing diabetes can be stressful and time consuming and the dietary restrictions can make life less enjoyable.

What Are the Symptoms of Depression?

There are several warning signs of depression, including:

• Sadness.
• Anxiety.
• Irritability.
• Loss of interest in activities once enjoyed.
• Withdrawal from social activities.
• Inability to concentrate.
• Insomnia (difficulty falling and staying asleep).
• Excessive feelings of guilt or worthlessness.
• Loss of energy or fatigue.
• Changes in appetite.
• Observable mental and physical sluggishness.
• Thoughts of death or suicide.

If you (or someone you love) has diabetes and show signs of depression, tell your doctor immediately. There are treatments that can help you feel better.

How Is Depression Diagnosed?

There are no laboratory tests to specifically diagnose depression. The diagnosis is based on reported symptoms -- including any problems with functioning caused by the symptoms.

How Is Depression Treated in People With Diabetes?

Depression in people with diabetes has been successfully treated with tricyclic antidepressants. These drugs work by increasing the levels of norepinephrine and serotonin, neurotransmitters in the brain that help nerve cells communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of depression. Tricyclic antidepressants work by correcting the balance of these chemicals.

Common tricyclics include Elavil, Norpramin and Pamelor. Common SSRIs include Prozac, Paxil and Zoloft.

Common side effects of tricyclic antidepressants include:

• Blurred vision
• Dry mouth
• Dizziness
• Weight gain
• Constipation
• Nausea
• Diarrhea
• Agitation
• Insomnia (difficulty falling and staying asleep)
• Nervousness
• Headache
• Changes in sexual desire and/or ability
• Exhaustion
• Muscle twitching (tremors)
• Increased heart rate

Common side effects of SSRI antidepressants include:

• Nausea
• Diarrhea
• Headache
• Agitation
• Nervousness
• Nightmares
• Dizziness or lightheadedness
• Changes in sexual desire and/or ability

These side effects often go away or become tolerable over time. To minimize the side effects, your doctor may prescribe a small dose of the medication and gradually build up to a higher dose. Side effects also vary with the specific antidepressant used; not every drug causes all of these side effects. Therefore, it may help to change to a different drug that is less likely to cause a particularly uncomfortable side effect if you are having problems.

Counseling, or psychotherapy, is also often beneficial for those suffering from depression. Meeting with a support group can also help.

What Is the Outlook for People With Depression?

The outlook for people with depression who seek treatment is very promising. By working with your doctor or a qualified and experienced mental healthcare professional, you can regain control of your life.

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.