Over 30 million people in the United States live with diabetes and studies have shown that individuals who have diabetes are 2-3 times more likely to have depression than the general public. While the reason for this common comorbidity is unknown, many scientists believe that it may be connected to both biology and behavior. In both people with depression and diabetes, it is common for the HPA (hypothalamic-pituitary-adrenal) axis to be activated which is known to control responses to stress and also helps to regulate body functions such as digestion and mood. Additionally, lifestyle factors such as getting inadequate sleep, poor nutrition and lack of exercise are common to both a diagnosis of depression and diabetes.

Depression and diabetes seem to have a bidirectional connection, meaning that having depression seems to lead to an increased chance in developing diabetes and having diabetes seems to lead to an increased chance of developing depression. Additionally, it seems that when symptoms of diabetes are more severe, it is common for depression symptoms to increase—which often leads to less self-care—creating a vicious cycle.

Unlike some other comorbid conditions, diabetes and depression have an added complication in that the medications often used to treat depression, while still very effective, can have effects on glycemic control making it very important that your health care physicians can work in collaboration to provide the best treatment.

People with diabetes and even their physicians may misinterpret depression’s warning signs, mistaking them for normal responses to a new diagnosis of diabetes or thinking common symptoms like lethargy and weight change are only due to diabetes. Feelings related to a new diagnosis will usually begin to go away within a few weeks. If these feelings last longer and are interfering with your ability to live your life, it may be time to seek help for depression.

Notes and Sources

Comorbid diabetes and depression, experiencing diagnoses of both diabetes and depression, are a major clinical challenge as the outcomes of both conditions are worsened by the other. Although the psychological burden of diabetes may contribute to depression, this explanation does not fully explain the relationship between these two conditions. Both conditions may be driven by shared underlying biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors. Depression is frequently missed in people with diabetes despite effective screening tools being available. Both psychological interventions and antidepressants are effective in treating depressive symptoms in people with diabetes but have mixed effects on glycemic control. Clear care pathways involving a multidisciplinary team are needed to obtain optimal medical and psychiatric outcomes for people with comorbid diabetes and depression.

Some symptoms of depression may reduce overall physical and mental health, not only increasing the risk for diabetes but making diabetes symptoms worse. For example, overeating may cause weight gain, a major risk factor for diabetes. Fatigue or feelings of worthlessness may cause people to ignore a special diet or medication plan needed to control their diabetes. Studies have shown that people who have both diabetes and depression have more severe diabetes symptoms than people who have diabetes alone.

To learn more about diabetes and mental health, visit the American Diabetes Association.

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