Is There a Link Between Diabetes and Depression?

Diabetes is a group of conditions that can affect how the body produces insulin and processes blood sugar. Depression is a mental disorder that causes low mood, loss of interest, and impairments in daily life. People with type 1 or type 2 diabetes are at a higher risk of developing depression, and people with depression are at a higher risk of developing type 2 diabetes. 

Around 17.2% of people with diabetes will also develop depression, although research suggests that depression frequently goes undiagnosed and untreated.

In this article, we explore the connection between diabetes and depression and how one condition may affect the diagnosis and treatment of the other. 

The Connection Between Diabetes and Depression

Researchers suggest that the two conditions likely share underlying biological and behavioral causes. While the exact nature of the connection between depression and diabetes is not fully understood, the stress of managing chronic health conditions such as diabetes is known to contribute to symptoms of depression.

Poorly controlled diabetes may also lead to other health problems—including nerve damage, vision problems, and hearing loss―that can also contribute to depression.

The connection between the two goes in both directions. Depression can also contribute to the development of diabetes. Depression can lead to unhealthy behaviors, including poor diet and lack of exercise, making it more likely that a person will develop type 2 diabetes. However, research suggests that this risk cannot be entirely explained by factors such as antidepressant use or body weight.

Risk factors that increase the likelihood that a person may develop depression and diabetes include:

• Being alcohol dependent
• Having a family history of either condition
• Being overweight
• Having coronary artery disease
• Having hypertension
• Inflammation
• Sleep disturbances
• Inactive lifestyle
• Poor dietary habits

A 2018 review found that the number of people with comorbid diabetes and depression has increased in recent years and is expected to continue to grow in the future.

Complications of Diabetes and Depression

Unfortunately, people with diabetes and depression tend to experience worse outcomes for both conditions. This includes poorer quality of life, impaired diabetes self-management, increased health complications, and reduced life expectancy.

Diabetes can contribute to several health complications, including heart disease, nerve damage, and kidney problems. It can also lead to problems with foot health, oral health, hearing, vision, and mental health.

Depression can play a role in worsening the complications of diabetes. When people are depressed, they often struggle with feeling unmotivated and may have difficulty finding the energy to engage in self-care. This can lead to unhealthy lifestyle habits that complicate diabetes care and management. 

Complications of both conditions may include:

• Higher blood sugar levels: One study found that people with depression and type 2 diabetes have higher blood sugar levels than people who don't have comorbid depression.
• Greater risk for cardiovascular problems: Researchers have found that people with diabetes and depression are 82% more likely to have a heart attack than people who don't have these conditions.
• Increased risk for other complications: Studies have also found that the risk of experiencing diabetes complications is higher among people who also have symptoms of depression.

Having diabetes and depression together also increases an individual's risk of developing dementia.

Diagnosis of Diabetes and Depression

Diabetes is diagnosed by checking blood glucose levels. Your doctor may administer fasting plasma glucose tests, random plasma glucose tests, an A1c test, or an oral glucose tolerance test to aid in diagnosis.

Depression is diagnosed by assessing a person's symptoms and their impact on their ability to function. Your doctor will ask about your medical history, family history, and symptoms. You may also receive a physical exam and lab tests to help rule out other conditions that might contribute to symptoms of depression. 

To be diagnosed with clinical depression, you must experience symptoms that cause distress or impair functioning and last two weeks or longer. Doctors and mental health professionals utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a tool published by the American Psychiatric Association, to diagnose mental disorders such as depression.

Self Tests for Depression

Doctors and mental health professionals utilize a variety of assessments to help diagnose depression. Many of these are available online, including the Beck Depression Inventory and the Patient Health Questionnaire. 

Two questions that can help identify symptoms of depression are:

• During the past month, have you been bothered by having little interest or pleasure in doing things?”
• During the past month, have you been bothered by feeling down, depressed, or hopeless?”

If you answered "yes" to either question, you should talk to your doctor about a more formal evaluation and diagnosis.

Treatment of Diabetes and Depression

While treatment rates for diabetes are typically high, research also shows that mental disorders such as depression often go untreated. Depression is typically treated with medication, psychotherapy, or a combination of the two. Diabetes is generally managed with lifestyle modifications, blood sugar monitoring, and medications. 

Medications

Antidepressants are often prescribed to treat depression. Some of the different types of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Monoamine oxidase inhibitors (MAOIs)
• Tricyclic antidepressants (TCAs)
• Atypical antidepressants
  

Medications that may be prescribed to control blood sugar include insulin and metformin. Insulin is a hormone produced by the pancreas that plays a vital role in glucose uptake. metformin is a medication that decreases the liver's glucose production, lowers sugar absorption by the intestines, and increases insulin sensitivity.

Psychotherapy

Different types of psychotherapy can also be effective in the treatment of depression. Commonly used kinds of therapy include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and dialectical behavior therapy (DBT).

For people with both diabetes and depression, combining psychotherapeutic intervention with diabetic education can have a significant effect on both depression symptoms and glycemic control.

Coping With Diabetes and Depression

Both conditions can benefit from lifestyle modifications such as regular physical activity and smoking cessation. Social support can also have a significant impact on coping and treatment adherence.

Lifestyle Changes

Lifestyle changes are often key aspects of self-care and treatment for both diabetes and depression.

Strategies that can help improve both conditions include:

• Regular physical exercise: Staying active can help people with diabetes better manage their glucose levels, and research has found that exercise can be effective in reducing symptoms of depression.
• Dietary changes: If you have diabetes, your doctor will recommend dietary changes to help you manage your blood sugar levels. You may be advised to avoid certain foods and monitor carbohydrate intake to minimize spikes in blood glucose. Many of the changes you make in your diet, such as limiting sugar intake, may have a beneficial effect on symptoms of depression as well.
• Quit smoking: Smoking is linked to an increased risk of diabetes and depression, so quitting can positively impact your health.
• Social support: Having social support is essential for managing any chronic health condition. When you have diabetes and depression, it’s vital to have people you can rely on for emotional and practical support.

If you have diabetes and depression, it’s essential to seek treatment for both conditions. Combining treatment for both diabetes and depression can help you better manage both conditions and improve your quality of life.

Support Groups

There are many support groups available for people with diabetes and depression. These groups provide a space to share your experiences, get practical tips and advice, and connect with others who understand what you’re going through.

Some support groups focus specifically on one condition or the other, while others provide general support for people managing both conditions.

Some places where you can look for support groups include:

• The American Diabetes Association
• The National Alliance on Mental Illness
• The Depression and Bipolar Support Alliance
• Local hospitals or clinics
• Your doctor’s office

If you’re unsure where to start, ask your doctor or mental health provider for recommendations.

A Word From Verywell

Coping with diabetes and depression can be challenging, but treatment and support can make a big difference. With the right care, you can manage both conditions and live a full and enjoyable life. 

If you’re struggling to cope with diabetes and depression, don’t hesitate to seek help. Talk to your doctor or mental health provider about what you’re going through and ask for treatment and support options recommendations.