Diabetes and depression/anxiety are common health problems. Many people around the world live with them. Some people only have one, but others live with both. Diabetes can make a person more likely to feel depressed, and depression can make it harder to manage diabetes. This article explains how these two problems are connected and why it is important to treat both.

What is depression?

Depression is an illness that makes you feel very sad or tired for a long time. You may not want to do things you used to enjoy. Other signs include trouble sleeping, eating too much or too little, and difficulty concentrating. Depression can affect both your daily life and your physical health.

What is anxiety?

Anxiety is when your brain feels worried or scared—even if nothing dangerous is happening. It’s like your body’s alarm system going off when you think something bad might happen. It’s normal to feel anxious sometimes, such as before an important life event. However, if you often feel anxious, even when things are going well, it can make life harder.

How common is it?

People with diabetes can be depressed or anxious more often than people without diabetes. Studies show that if someone has diabetes, they are almost twice as likely to be depressed, regardless of the type of diabetes. That’s why health professionals check for depression in people living with diabetes.

How diabetes can lead to depression/anxiety

• Daily stress: Taking care of diabetes is hard work. Monitoring glucose, medications, food choices, and appointments can feel overwhelming. People living with type 1 diabetes have the even greater burden of carbohydrate counting, insulin calculations, a greater risk of high and low glucose levels, and frequent glucose monitoring
• Worry about complications: Concerns about future health (like vision or nerve problems) can cause stress and depression
• Feeling alone or judged: Some people say they can feel judged or left out in social situations
• Physical changes: Diabetes can change the balance of hormones in your body and brain, which can add to feelings of depression

Depression can affect diabetes

Depression can make diabetes harder to manage. For example, it may lead to:

• Less physical activity
• Unhealthy eating
• Smoking
• Missing medications or appointments

Depression also affects how your body handles stress, which can raise glucose levels. It can also cause inflammation in the body, which can make diabetes more difficult to manage.

The cycle between diabetes and depression

Diabetes and depression can make each other worse. If you are depressed, you might not take care of your diabetes. If your diabetes gets worse, you may feel more depressed. This can make both problems harder to manage. It can even lead to more hospital visits.

Shared risk factors

Some factors increase the risk of both type 2 diabetes and depression:

• Being above a healthy weight
• Low physical activity
• Poor diet
• Financial stress
• Family history (genes)

How health professionals assess this

Doctors use special questionnaires to find depression/anxiety in people with diabetes, such as:

• PHQ-9 (depression)
• GAD-7 (anxiety)
• HFS-II W (fear of hypoglycaemia)

They help to identify when you need extra support.

Treatments

Talking therapies

• Cognitive Behavioural Therapy (CBT): This helps change negative thoughts and teaches new ways to cope
• Motivational interviewing: This supports healthy behaviour choices

Medicines

• Some people benefit from antidepressants or anti-anxiety medications
• Diabetes medications may also need adjusting

Your healthcare team will help balance both safely.

Healthy habits

• Exercise, eating healthy foods, and getting enough sleep can help both depression and diabetes
• Relaxation and joining support groups can also assist

Working together

The best outcomes happen when care is coordinated between doctors, nurses, mental health professionals, and diabetes educators.

Mental health medications and diabetes

Antipsychotic medications and diabetes

Some medicines used to treat mental health conditions can affect how your body handles glucose. They can increase the risk of weight gain and alter glucose levels. Because of these changes, people taking these medicines might have a higher chance of getting type 2 diabetes. Some antipsychotic medications are more likely to cause these changes than others. If you are taking the following medications it is essential to monitor your glucose levels regularly:

aripiprazole	clozapine	olanzapine
quetiapine	risperidone	asenapine
amisulpride	paliperidone	brexpiprazole

Antidepressant medications and diabetes

Some studies show a small increase in type 2 diabetes risk with antidepressants, but it is not clear why. This may relate to:

• The medication
• Underlying depression
• Lifestyle factors

However, treating your mental health is essential and should not be delayed.

How diabetes medicines affect mood

Recent research shows that the type of diabetes medicine taken may be linked to mood changes.

Medicines with a lower risk of depression:

• Metformin
• DPP-4 inhibitors
• GLP-1 analogues
• SGLT2 inhibitors

Medicines with a possible higher risk:

• Higher doses of insulin
• Higher doses of sulfonylureas

Why?

Studies and real-life experience indicate that increases in body weight can reduce mood, while decreases in body weight can improve it. Both insulin and sulfonylureas may contribute to weight gain if a person consumes a high-carbohydrate diet. Metformin, DPP-4 inhibitors, GLP-1 analogues, and SGLT2 inhibitors may all help reduce body weight.

Even so, starting insulin treatment shouldn’t be delayed because high glucose levels can cause problems over time. When you begin using insulin, it’s important to watch how much carbohydrate you eat. Talking to a dietitian can help you figure out the right amount.

Insulin is usually started if you find out you have type 1 diabetes or after having type 2 diabetes for a long time. Both situations can be stressful, which increases the risk of depression and anxiety.

Problems with getting help

Sometimes people don’t get the support they need for depression and anxiety because:

• They feel embarrassed or judged
• Mental health services are hard to access
• Care is not well coordinated
• People don’t always know the right questions to ask. Diabetes Australia can help with those questions

Since diabetes and depression are linked, they should be recognised and treated together early. Mental health is part of diabetes care and working as a team provides the best results. Medications for one condition can have both positive and negative effects on the other condition. Your health team will take this into consideration. Treating the whole person and offering support can prevent long-term effects and improve quality of life.

By Donna Itzstein, Credentialled Diabetes Educator and Pharmacist