Depression and diabetes

Diabetes and diabetes =============== Diabetes and depression are one of the most common diseases of this century and millions of people around the world struggle with them. Diabetes is a metabolic disorder that makes blood sugar control difficult and requires constant and careful care; While depression is a deep mental illness that weakens a person's motivation, energy and hope. When these two diseases occur at the same time, their effects on each other multiply and make the patient's condition more complicated. Why are diabetic patients more susceptible to depression? The relationship between diabetes and depression is bidirectional: having diabetes increases the risk of developing depression, and conversely, a history of depression increases the probability of developing type 2 diabetes. Several systematic reviews and large studies have shown that this overlap is not just a coincidence; Rather, causal patterns can be seen in both directions. On the one hand, living with a chronic disease, frequent visits, continuous monitoring of sugar, dietary restrictions and worrying about side effects can lead to mental exhaustion and depression. On the other hand, depression with physiological and behavioral changes (decreased mobility, overeating, smoking and sleep disorders) provides the basis for insulin resistance and increased sugar. This two-sided picture is clearly described in scientific reviews and reference articles. Biologically, the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic system are involved in both disorders. Chronic stress and depression increase cortisol and catecholamines; These hormones increase hepatic glucose production, decrease insulin sensitivity, and activate inflammatory pathways. Mild-to-moderate systemic inflammation (cytokines such as IL-6 and TNF-α) is also common in both depression and diabetes, fueling the vicious cycle of inflammation-insulin resistance-mood disorder. The result is that a diabetic person is exposed to biological and psychological pressures at the same time, which increase the risk of depression. The role of stress and anxiety in the management of diabetes Stress and anxiety from both physiological and behavioral pathways make it difficult to control blood sugar. Activating the stress response increases the secretion of adrenaline and cortisol; This situation is associated with increased hepatic gluconeogenesis, inhibition of insulin secretion and increased glucagon secretion; Therefore, blood sugar tends to rise. If this cycle is repeated chronically, insulin resistance is stabilized and blood sugar fluctuations increase. At the behavioral level, anxiety can undermine adherence to care: glucose monitoring is less frequent, injections or medications are delayed, food choices shift toward “reward foods” (high-calorie and sweet), sleep is disrupted, and physical activity is reduced. In addition, there is a concept called "Diabetes Distress"—the emotional stress of living with diabetes—which, if left untreated, is associated with blood sugar crashes and increased HbA1c. New clinical guidelines also emphasize that stress reduction, psychological support, and facilitation of healthy behaviors (regular exercise, adequate sleep, stable nutrition) are integral parts of standard diabetes care. Effect of depression on blood sugar control Depression is commonly associated with lack of motivation, fatigue, psychomotor slowness, and hopelessness—factors that directly impact diabetes self-care. Evidence shows that depressed diabetics miss more medication doses, reduce the frequency of sugar monitoring, follow up on medical appointments less often, and have irregular sleeping and eating patterns; The usual consequence of these behaviors is an increase in average glucose (HbA1c), greater fluctuations in glucose and, in the long term, a higher risk of micro/macrovascular complications. For this reason, the updated standards of care in diabetes recommend that screening for depression (with valid tools) be done from the initial visits and, if needed, psychological/pharmacological treatment should be started along with metabolic treatment. Another thing to consider is drug interactions: some antidepressants can change appetite or weight and indirectly affect blood sugar; Therefore, close coordination between the diabetes doctor and the psychologist/psychiatrist is important to choose treatments with the least adverse metabolic effects. In addition to medication, structured psychotherapies (such as CBT) and lifestyle interventions—when delivered as part of an integrated diabetes program—can improve both mood and adherence to diabetes treatment, ultimately stabilizing blood sugar control. The 2025 guidelines have also emphasized regular assessment of medical-psychiatric areas and multidisciplinary support. Warning signs in people with diabetes and depression In this section, the symptoms that are common in people who have diabetes and depression at the same time are examined. Note that many of these symptoms overlap with the symptoms of diabetes or sugar fluctuations, so careful observation and quick treatment can prevent the problem from worsening. ### Behavioral and emotional signs People who suffer from depression at the same time as diabetes usually show noticeable changes in their behavior and emotions. One of the most obvious symptoms is a persistent feeling of sadness and hopelessness that persists without direct connection to everyday life events. These people may no longer have any interest or motivation in the activities that were enjoyable for them before; A condition called "loss of pleasure or anhedonia". In addition, many patients gradually withdraw from family and social gatherings and live alone. Irritability, outbursts of anger, and loss of concentration are also common in these people, making it difficult for them to make even simple daily decisions, such as choosing meals or taking medication. In more severe cases, the patient may feel worthless or even talk about death and suicide. These symptoms are a serious alarm and should not be ignored, because they directly affect the quality of diabetes care and the treatment process. ### Changes in appetite and weight Change in eating pattern and weight is another important symptom in people with diabetes and depression. Some depressed patients experience a severe loss of appetite, and this issue can lead to sudden weight loss and, as a result, changes in medication or insulin needs. On the other hand, another group tends to overeat and consume high-calorie and sweet foods, especially when experiencing negative emotions. This type of nutrition, in addition to being overweight, increases insulin resistance and makes blood sugar control more difficult. Weight fluctuations—both decrease and increase—directly affect the metabolic status of patients and, if neglected, can lead to dangerous complications of diabetes. Sometimes these changes are caused by the use of antidepressants that affect appetite and metabolism. Therefore, observing any unusual changes in weight or appetite should be considered as a warning sign and should be discussed with a specialist doctor. ### Changes in sleep Sleep disturbance is another common symptom of depression in diabetic patients. Some people experience insomnia at night; This means that they either have a hard time falling asleep, or wake up many times in the middle of the night, or wake up very early in the morning and are unable to fall asleep again. On the other hand, some patients suffer from excessive sleepiness and continuous sleepiness and spend a large part of the day in sleep. Even when there are enough hours of sleep, patients feel tired and lethargic because their sleep is not of the required quality. These sleep changes are not only limited to the psychological state; Rather, it directly affects the body's metabolism. Insomnia or irregular sleep increases the level of stress hormones such as cortisol, and this leads to increased blood sugar and insulin resistance. For this reason, identifying and treating sleep disorders plays an important role in better controlling diabetes and improving the mental condition of patients. ### Reduced motivation for health care One of the most serious consequences of depression in diabetic patients is decreased motivation to take care of themselves. These people often ignore the regular use of medication or insulin injections, and sometimes even completely abandon their treatment. In addition, the amount of blood sugar monitoring decreases and the patient does not want to use a glucometer or check test results. Many depressed patients ignore their medical appointments and periodic tests, and this causes diabetes complications to be diagnosed late. On the other hand, important activities such as foot care, personal hygiene, regular exercise and choosing a healthy diet are significantly reduced. This neglect not only worsens the patient's physical condition, but also makes him feel more guilty and helpless and aggravates the cycle of depression. Effects of depression in diabetic patients The combination of diabetes and depression is a complex and worrisome condition that has many consequences on a person's physical and mental health. Depression not only has a negative effect on how to manage the disease, but also directly changes the physiological process of the body. In this section, we discuss the three main consequences of depression in diabetic patients: increased blood sugar and difficulty in controlling the disease, higher risk of cardiovascular complications, and reduced quality and life expectancy. ### Increased blood sugar and difficulty in controlling the disease Depression directly and indirectly affects blood sugar in diabetic patients. Physiologically, depression is associated with an increase in stress hormones such as cortisol and adrenaline. These hormones increase insulin resistance and as a result, the patient's blood sugar level remains high continuously. On the other hand, depression reduces a person's motivation to take care of themselves. A patient with depression may ignore taking medications or insulin injections, not follow a healthy diet, and avoid regular exercise. These behaviors all cause severe fluctuations in blood sugar and difficulty in controlling the disease. In addition, irregular sleep and overeating caused by depression are important factors in high blood sugar. As a result, compared to non-depressed diabetic patients, depressed patients are more exposed to chronic hyperglycemia and their HbA1c levels are usually reported to be higher. ### One of the most serious consequences of depression in diabetic patients is the higher risk of cardiovascular complications It increases the risk of cardiovascular diseases. Depression causes inflammatory changes in the body and increases inflammatory markers such as CRP and interleukins. These changes, along with high blood sugar and blood pressure caused by stress, make the walls of the vessels more vulnerable and accelerate the process of atherosclerosis or hardening of the arteries. The result of this process is an increased risk of heart attack, stroke and other serious heart complications. In addition to physiological mechanisms, the lifestyle of depressed people also contributes to this risk. Inactivity, smoking or alcohol consumption, poor nutrition and not seeing a doctor regularly are all factors that increase the likelihood of heart problems. Studies have shown that diabetic patients with untreated depression are twice as likely to develop heart disease and have a higher mortality rate. Therefore, paying attention to mental health in this group of patients is not only a psychological issue, but it is considered a vital part of preventing heart diseases and saving the patient's life. ### Decreasing the quality of life and life expectancy Depression in diabetic patients has a profound effect on the quality of life. Depressed people often feel tired, hopeless, and unmotivated, so they lose their ability to perform daily tasks, social interactions, and even work duties. This situation not only endangers the patient's mental health, but also leads to social isolation and feelings of loneliness. The decrease in the quality of life is directly related to the decrease in life expectancy. Patients who see themselves unable to control the disease gradually develop negative attitudes and the probability of following the treatment and visiting the doctor decreases. This issue increases the risk of chronic complications of diabetes such as neuropathy, nephropathy and retinopathy, which directly lower the quality of life. Finally, untreated depression can reduce the life expectancy of diabetic patients and increase the risk of premature death. Solutions to treat and simultaneously manage depression and diabetes Simultaneous management of depression and diabetes is one of the serious challenges in the health field, because these two diseases mutually affect each other. Depression reduces motivation to care for diabetes and, conversely, uncontrolled diabetes exacerbates depressive symptoms. Therefore, the treatment should be comprehensive, multimodal and combined. In the following, the three main axes of treatment, i.e. drug treatments, non-drug treatments and lifestyle modification, are examined in detail. ### 1. Drug treatments (antidepressants and diabetes control). Drug therapy is very important for depressed diabetic patients. Antidepressants such as SSRIs (such as sertraline) are often a good choice because they are both effective in improving mood and have little negative impact on blood sugar. In some cases, drugs such as duloxetine can reduce neuropathic pain caused by diabetes in addition to depression. Of course, some drugs may cause weight gain, so the choice of drug should be made with the doctor's opinion. Simultaneous control of diabetes is also necessary. Regulating blood sugar medications, insulin and regular glucose monitoring not only controls the disease but also helps to improve the mental state and reduce the symptoms of depression. ### 2. Non-drug treatments (psychotherapy, counseling, support groups) Psychotherapy, especially CBT, is effective in depressed diabetic patients because it helps them change negative thoughts and continue their treatment with more motivation. Individual and family counseling also plays an important role; When the family better understands the patient's condition, more emotional support is provided. Also, support groups can show patients that they are not alone and gain more motivation and hope by hearing the experiences of others. ### 3. Healthy lifestyle (nutrition, exercise, enough sleep) Lifestyle modification is one of the main foundations of treatment. A balanced diet including vegetables, whole grains and low-fat proteins helps control blood sugar and has a positive effect on mood. Regular exercise, such as walking or cycling, in addition to lowering blood sugar, causes the release of happy hormones. Even gentle exercises like yoga can reduce stress. Adequate sleep is also very important; Lack of sleep can aggravate both depression and diabetes. Having a regular sleep schedule improves the quality of life. The combination of appropriate drugs, psychotherapy and healthy lifestyle is the best solution for simultaneous management of depression and diabetes. Team cooperation between the endocrinologist, psychologist and the patient's family can break the vicious cycle of these two diseases and lead to a significant improvement in the quality of life. ### a bridge between body and soul; The key to overcoming depression and diabetes Diabetes and depression are not two separate diseases, but act as two intertwined circles that can aggravate each other. If a person suffering from diabetes also suffers from depression, he will lose the motivation and ability to control his disease, and as a result, his blood sugar and physical complications will become worse. On the other hand, the difficult management of diabetes and the stress it causes deepens depression. Therefore, only a comprehensive and coordinated approach, i.e. simultaneous attention to drug treatment, psychotherapy and lifestyle modification, can break the vicious cycle of these two diseases. The role of family, treatment team and social support are vital in this; Because hope, motivation and companionship are the bridge that leads the patient's body and soul to health and a better quality of life. **To receive a visit (online or in person) with Dr. Yazdan Panah, fill out the form below**