Depression is two times as common in individuals with type 1 or type 2 diabetes compared with the general population, and is also linked with poor blood sugar control and outcomes. Other mental-emotional conditions had also been linked with diabetes.
Why is that? How is diabetes connected with mental health issues? Let’s explore this link in more detail.
Some reasons why diabetes is linked with depression
It makes sense to see an increased risk of depressed mood in people with diabetes. It is a chronic condition and it can be stressful to deal with the symptoms, monitor regularly the blood glucose levels, and keep up with doctor’s appointments. Diabetes can cause complications that can further increase stress, and additional visits to specialists like cardiologists, eye doctors, and foot specialists, which can be stressful as well. Diabetes is associated with poor lifestyle choices such as unhealthy eating, sedentary life, and excess weight, which further aggravate stress and depression. When feeling depressed, a person has a hard time performing day-to-day tasks, communicating, eating healthy, or exercising, all making diabetes harder to manage. Thus diabetes increases the risk of depression, and depression causes spikes in blood glucose levels, creating a vicious cycle.
The link between diabetes and depression. Latest research
Scientists wanted to better understand the connection between diabetes and depression and looked at some underlying problems that these two conditions may have in common. Interestingly, diabetes and depression seem to share biological origins, particularly an overactivation of the immune system which leads to excess inflammation and dysregulation of the hypothalamic-pituitary-adrenal axis (HPA).
The hypothalamic-pituitary-adrenal axis represents the interaction between the nervous system and hormones, specifically between the area of the brain called the hypothalamus, pituitary gland (also found in the brain), and adrenal glands. HPA responds to internal and external challenges and its proper function is needed to maintain mental and physical health. Dysfunctions of the HPA, excess inflammation, and abnormal immune response cause insulin resistance and thus increased risk of type 2 diabetes, heart diseases, depression, and increased mortality.
How to manage both diabetes and depression
Since diabetes and depression share similar pathways, managing one will help improve the other one as well.
- Healthy diet. Fresh vegetables, berries and other low glycemic fruits , whole grains, legumes, lean meat, fish, nuts, seeds, herbs and spices are all diabetes friendly foods. They also help manage depression, too. On the other hand, highly processed foods and soda correlate with high blood sugar levels, higher risk of diabetes complications and increased levels of depression and anxiety, as well. This is because fast food creates excess inflammation and lacks essential nutrients.
- Exercise. Regular exercise increases insulin resiistance and pormotes healthy weight. It also imporves mood, having well documented anti-anxiety and antidpressant effects. The levels of “happy” chemicals like dopamine, serotonin, endorphins and brain-derived neurotrophic factor “(BDNF) all increase after exercise. Furthemore, exercise helps prevent complications of diabetes such as heart diseases, nerve or eye complications. Aim for 30-45 minute workouts most days of the week, and include both aerobic and resisitance training in the fitness routine. Although high intensity interval training (HIIT) leads to increased release of feel good chemicals, low and moderate intensity exercise (i.e. swimming, waking, jogging, weights) are better choices for diabetes management and they boost the mood, too.
- Get both conditions managed with medication. Antidiabetes drugs for diabetes, anidepressant drugs and psychotherapy for depression. Recent studies reveal some interesting findings. Did you know that antiiabetes drug metformin has antidepressant qualities, too ? and the antidepressant drug fluoxetine helps regulate the metabolism of glucose? Supplements like ginseng or omega 3 help improve both the mood and blood glucose levels, in addition to fighting inflammation and improving the function of the hypothalamic-pituitary-adrenal axis (HPA).
- Psychotherapy and other stress management strategies. Stress is a major trigger of high blood sugar levels and poor long term management of diabetes. It is correlated with anxiety and depression, and a key driver of HPA dysfunction. Psychotherapy, deep breathing, yoga and mindfulness meditation can all help relieve stress and better manage diabetes, too.
- Sleep hygiene is important too. Lack of sleep contributes to poor glycemic control, as well as increased levels of stress, anxiety and depression. The quality of sleep is important as well. Some individuals may benefit from taking smal doses of melatonin before bedtime. In addition to improving sleep habits, supplementation with melatonin can help improve sleep, and supports healthy blood sugar levels, too.
- Consultations with healthcare professionals. Diabetes self-management programs can be accessed online or in person, and focus on behavor changes to improve metabolic control, boost fitness levels, manage weight and overall improve quality of life. New research suggests that programs supervised by nurse case managers can further improve the management of both diabetes and depression. There are also support groups where people with diabetes share their experiences and their strategies to cope with this condition.