Dealing with Diabetes and Depression

Contributor: Dr. Staci-Marie Norman, PharmD, DCES

According to a pamphlet given to my father at the Cleveland Clinic after his lung transplant, approximately a third of people with a chronic illness will develop depression due to the stress of managing their condition. More specifically, it said that 25% of those who live with diabetes will have some period of depression during their life with diabetes.

Did you know many of the symptoms of depression can be mistakenly attributed to diabetes? Symptoms that overlap include:

• weight gain or loss
• fatigue
• loss of energy

Symptoms more specific to depression include:

• too much or too little sleep
• problems with concentration
• apathy or lack of feelings and emotions
• feelings of worthlessness or guilt
• thoughts of death or suicide

Why is depression common among those with diabetes? When we are diagnosed with a chronic disease, there are a lot of adjustments. We must come to terms with our illness and the treatment. We may mourn a loss of health, which can change how we see ourselves and how we relate to others. A period of sadness is normal, but for some, clinical depression can be triggered at any time in our chronic illness journey. We may be handling everything well, but another external stressor occurs (like the Covid pandemic, for example), and symptoms of depression are triggered.

How can depression impact our diabetes management? Let’s consider these examples:

• Physical activity – if you are not feeling very energetic, will you strap on those tennis shoes and go for a walk?
• Nutrition –  how will you fix a healthy meal for yourself if you do not care?
• Medications – can you remember to take your meds if you have low concentration levels?
• Glucose management – will you find the motivation to check your blood sugar regularly?

Depression can take a toll very quickly, but there is good news!  Depression, like diabetes, is manageable.  Be open with your physician about how you feel.  Your team may recommend “talk therapy,” medication, or a combination of both, which can often provide a more rapid and complete recovery than just one or the other.

As a pharmacist, I’d like to reassure you that many medication options exist to treat depression. They all work by affecting different chemicals in the brain that seem to be at lower levels during depression. All antidepressant medications take 4-6 weeks to build up in your system before you start seeing an effect. You may not recognize a change, but people around you may begin to see improvement in your mood and energy. So, be patient! Give the medications a chance to work. If you aren’t getting the results you seek or have troublesome side effects, such as weight gain or lack of sex drive, talk to your healthcare provider. There are many options; each works differently and has different side effect profiles.

Take time to focus on yourself and your health. Be sure to do little things that can make you feel better, like walking or fixing a nice balanced meal (of course, using the plate method). If you are feeling down in the dumps, have a candid conversation with your physician about depression. And if you are having thoughts of suicide, please reach out to someone who can help or call the National Suicide Prevention Hotline at 1-800-273-8255 or the new 988. Because life is wonderful and we all should be able to enjoy it!

Dr. Staci-Marie Norman, PharmD, DCES, received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Care and Education Specialist. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submissions. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.