Ellen O’Donnell, a pediatric psychologist with the MassGeneral Hospital for Children Diabetes Clinic, talks about how children and teens with diabetes are at a higher risk of depression.   

What is depression?
Depression is a mood disorder that causes feelings of persistent sadness, depressed mood and irritable mood. It can also cause other symptoms, such as changes in sleep, appetite, energy, concentration and interest or motivation. At its worst, depression may cause thoughts of suicide or wanting to hurt yourself.

While depression can be overwhelming, it is important to know that it is also quite common. There does not need to be a trigger or reason for depression. And the good news is that we know a lot about treatments that work for depression including therapy and medications.

 

How common is depression in people with diabetes?
People with diabetes are at higher risk for depression. People with Type 1 diabetes are up to three times as likely to experience depression compared to the general population and people with Type 2 diabetes are about twice as likely to experience depression. Young adults, in particular, are at high risk for both depression and for poor management of diabetes.

How does depression affect diabetes?
Diabetes can lead to increased risk for depression and depression leads to increased risk for poor management of diabetes. It is especially important to recognize that the stress and challenge of managing diabetes can lead to depression. One of the primary symptoms of depression is an ongoing sense of hopelessness and helplessness. People need to feel in control of their environment and of their own body. When we experience a lack of control it can lead to helplessness, hopelessness and depression.

I often say that living with diabetes, particularly Type 1 where the body makes NO insulin, is like caring for a toddler. One day they are potty trained, sweet and cooperative and you are feeling like the best caregiver in the world. You are in control. The next day, even though you do everything EXACTLY the same way, they throw tantrum after tantrum and go through three outfits with accidents.

You feel completely out of control. You have no idea what you did wrong - because you didn’t do anything wrong. You did everything the same way today as you did yesterday but your toddler, or your blood sugar numbers, behave completely differently. You feel helpless and hopeless.

What are signs of depression and diabetes burnout?
If you have diabetes it’s important to know the signs and symptoms of diabetes burnout, depression and how they interact. Diabetes burnout is a state in which someone with diabetes grows tired of managing their condition, and thus ignores it for a period.

Everyone who has diabetes will experience diabetes burnout at some point. Your ability to recognize it and get extra help when you need it can protect you against depression and help you stay in control of your diabetes. It’s also important to know if you might be depressed and if you need to get help.

If you are feeling frustrated and overwhelmed by managing diabetes and are losing motivation to take care of yourself but are otherwise feeling generally ok, you may be in burnout. If you are feeling more down, irritable or depressed, hopeless and helpless in general, you may be suffering from depression. Other signs of depression include having trouble sleeping or sleeping more than usual, changes in appetite including being either more or less hungry, and a general lack of energy and motivation or a lack of pleasure from things you used to enjoy. It’s especially important to seek help if you are experiencing suicidal thoughts or ideas.

How is depression different from “diabetes burnout”?
While people with diabetes are at increased risk for depression. It is also important to recognize that there is a difference between depression and diabetes burnout.

A person in diabetes burnout will likely also feel strong negative feelings about diabetes such as frustration, anger, sadness, and hopelessness. They may feel controlled by diabetes and feel that diabetes limits them or prevents them from doing things or achieving their goals. They may worry often about the potential long-term complications of diabetes but have little motivation to do anything about it. A person in diabetes burnout often feels alone with diabetes and as though no matter how hard they try, they cannot control their blood sugars.

You can see how many of the symptoms of diabetes burnout overlap with symptoms of depression. The difference is the extent to which the feelings of sadness, frustration, hopelessness and helplessness are specific to diabetes. If you are feeling this way mostly about diabetes and its impact on your life while otherwise doing well in school, at work, with friends and family, you are most likely not depressed but may be in diabetes burnout.

 

 

What to do and where to go if you need more support
Because of the increased for depression in people with diabetes, the American Diabetes Association recommends that diabetes health providers screen patients yearly for depression. For this reason, you will probably be asked periodically when you see your diabetes doctor or nurse educator to answer questions about your mood, sleep, appetite and energy. They may even recommend you meet with a diabetes psychologist or social worker for extra support. But, if they don’t ask, be sure to speak up when you are struggling – with either burnout or depression. There are things that can help. For example:

- Don’t let perfect be the enemy of good – sometimes we get so stuck on managing our diabetes the best we possibly can that we forget to be kind to ourselves. Do you expect too much of yourself? Can you find ways to give yourself healthy breaks from diabetes?

- Get your diabetes team involved – It is your responsibility to take care of your diabetes, but your diabetes team is always there waiting to help any time. They may be able to help you figure out ways to make managing your diabetes easier. They may also be able to connect you with extra supports.

- Connect with people who understand – there are many online blogs and forums for people with diabetes as well as organizations like American Diabetes AssociationJDRF and College Diabetes Network where you can connect with people who understand the challenges of living with diabetes. Organizations like National Alliance of Mental Illness and Families for Depression Awareness provide supports for people with depression.

- Set small goals – pick something simple and concrete that you can do or change to improve your mood such as getting together with a friend once a week or walking the dog a little further each day.

- Get moving – some studies suggest that exercise is as effective in treating depression as medication alone. And exercise helps with diabetes management. A win win.

- Consider therapy and or medication – If you are suffering from depression it is important to get help. Talk with your PCP or diabetes team. Get a referral to a therapist and consider therapy and or medication. The good news if you are depressed is that we know a lot about depression and what works to treat it.