Last week we talked about Celiac Awareness Month. Turns out May is also National Mental Health Awareness Month, so for our ongoing 411 series on diabetes complications, today we're tackling something that you might not even realize is a complication: depression.
Although not typically listed as a diabetes complication, it is well-documented that depression affects people with diabetes in large numbers. No surprise to us PWDs, considering all the crap we have to deal with: from guilt over blood sugars, to frustrating insurance battles, to the day-in and day-out weight of managing every tiny detail in our lives. We know full well that the hardest part of having diabetes may be the psychological side.
It's no wonder that the Centers for Disease Control reports that people with diabetes are twice as likely to suffer from depression.
Now, just to clarify: clinical depression is quite different than the "blues" or "diabetes burnout," in that it is a chemical imbalance in the brain. It does not simply fade away and it's not just the occasional "I hate diabetes!" outburst. But diabetes burn-out and other mental health issues are just as important to take care of, and burn-out can often be a trigger to more serious distress.
And the connection works both ways.
Some of the common signs of depression are:
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Restlessness, irritability
Whether you think have clinical depression or just going through a rough patch in dealing with the emotions of diabetes (which is as much a roller coaster as our blood sugars!), it is important to seek help as soon as possible. Depression, burn-out, and mental fatigue can have unwanted effects on your health and diabetes management. For example, a study in the Archives of General Psychiatry shows that women with diabetes and depression are at increased risk for cardiovascular disease, which is already one of the most common diabetes complications.
Clinical depression is quite treatable if you get the proper help. Although it may be difficult to find a psychiatrist or psychologist who understands diabetes the way you do, it's still important to get your depression symptoms treated.
Medications, such as tricyclic antidepressants, have been shown to be helpful in treating depression in people with diabetes. But they often have side effects, such as weight gain and nausea, which are clearly undesirable and may impact your diabetes management. Once you start taking an antidepressant, you'll want to work with both your psychiatrist and your endocrinologist, and not suddenly go off the drug without direction from your doctor, as quitting cold turkey can be very ugly!
Another route that can be effective even without the use of medication is psychotherapy or "talk therapy." This can often help work out issues regarding stress and guilt that build up over years of dealing with diabetes. It is well-recognized that psychotherapy is an important component of mental health treatment.
Korey Hood, a clinical psychiatrist and type 1 diabetic, tells us that even if you're unable to find someone who knows about diabetes specifically, you can play educator to your therapist about how diabetes effects your mental state.
"In the process, you're able to teach [the therapist] about diabetes, and have them increase their appreciation and understanding — and then in turn, they can counsel you on coping strategies for stress and anger or help build your communication skills with your family members," Korey explains.
Lee Ann Thill, a PWD with type 1, fellow D-blogger, and board certified art therapist in New Jersey, says that therapy has had a profound impact for her in coping with diabetes. "Personally, I value being able to share my feelings about diabetes with the people in my life, but since diabetes is already a burden on them, I try to be careful about how much and when I share. One of the things that I've most appreciated about being in therapy is the opportunity to unload the fear and anger I have about diabetes without feeling like I'm upsetting someone I love. Before getting therapy for myself, I underestimated how my feelings about diabetes were contributing to my depression, and I underestimated the value of having a safe, confidential place to share those feelings."
How to Find a Therapist
The main option for finding a therapist, just like with finding a physician, is to look up those covered under your insurance (assuming you have mental health benefits). Psychology Today and the American Psychological Association both have locator tools to find someone in your area, and you can specify your search to include people who deal with chronic illness, and then cross-check to be sure they're listed in your network.
Your local diabetes clinic may also have a list of nearby health professionals with whom they have a referral relationship. If you have an open relationship with your endocrinologist (which we hope you do!), talk to him or her about anything you're struggling with. Depression almost always impacts your diabetes management, and it's your physician's duty (and best interest) to help you get the help you need.
If you don't have insurance coverage for therapy, or if you don't like anyone in your network, don't be afraid to expand your search. Many professionals will work within your financial restraints to get you the help you need. Lee Ann recommends just picking up the phone and calling around. It can be difficult to determine areas of specialties from listings, so it's often easier to determine over the phone whether or not someone is experienced with diabetes. Ask questions about their experience, their credentials, and how they work.
"Having a therapist you like who understands your issues should be a priority when seeking treatment," Lee Ann says. "Anyone who can't take the time to help you understand what they do probably isn't someone you want to see."
Lee Ann also suggests looking "outside the box" when it comes to mental health professionals: "Family therapists are a great option, especially because diabetes is a family disease. I'm an art therapist, so I encourage people to investigate art, dance/movement or music therapy. In creative arts therapy, you'll be able to talk about your problems, but you'll also get to use the arts medium to express your feelings which can facilitate therapeutic progress."
We also hope you've heard of the Behavioral Diabetes Institute, a San Diego-based practice that's well-known for its team of specialists in diabetes. Although they're limited in geographic scope, director Dr. Bill Polonsky is a frequent speaker at diabetes events and has written a seminal book on the topic, Diabetes Burn-out: What To Do When You Can't Take It Anymore.
Other Reading Material
If you can't get to a therapist right away, there are some other good books that address the emotional issues of diabetes and chronic illness:
* Psyching Out Diabetes - Written by former President of the American Diabetes Association, Dr. Richard Rubin, who's an expert and principal investigator in several long-term studies of psychosocial and life-style issues with diabetes. Although the book is several years old and some of the technology talk is outdated, dealing with the emotional aspects of diabetes is "evergreen."
* 101 Tips for Coping with Diabetes - Keeping it in the family, Dr. Stefan Rubin is Dr. Richard Rubin's son, who has lived with diabetes since 1979. Both Stefan and Richard have spoken at the CWD Friends for Life conferences about living well with diabetes. This book covers tips for handling stress, anger, depression, meal temptation, and more.
* How to Be Sick - Recommended by Psychology Today and the Huffington Post, this Buddhist-infused book on "how to be sick" takes a spiritual approach to living with a chronic illness. While it might not be for everyone, spirituality has been shown to affect people with diabetes in positive ways.
Last word for today:
Depression, like diabetes, is manageable and treatable if you get help, so don't wait. Whatever you choose to do, just know that you are not alone!