Gary McClain, PhD, is a therapist, patient advocate, and writer who specializes in helping clients—as well as their family members and professional caregivers—deal with the emotional impact of chronic and life-threatening illnesses.
If you’re living with diabetes, you probably know what it’s like to have those days when managing your diabetes seems like too much work. Like when your numbers are still not where they should be, or you’re asking yourself if you can take those diet restrictions one more day. Maybe you’re having to switch to another regimen.
Living with diabetes is not an easy road. And it’s not uncommon to hit a stretch where you feel like diabetes is kicking you around and not about to let up anytime soon. When that happens, a lot of emotions come up. Feeling sad, disappointed, maybe even kind of hopeless. No wonder it’s not uncommon for people living with diabetes to also be diagnosed with depression.
But is it depression? Recent research has led healthcare professionals to take a second look at what it means when people with diabetes experience depression symptoms. Dr. Lawrence Fisher, of the University of California, San Francisco, lead author of an important study, uses the term “diabetes distress” to describe symptoms of depression that might be the result of the challenges of living with diabetes and not what professionals have been diagnosing as depression.
Essentially, the research on diabetes distress is concluding that it is normal to experience feelings like sadness and frustration when you are living with a chronic condition like diabetes. And if it’s normal, then the diagnosis of depression may not always apply.
What is diabetes distress?
Diabetes distress is what can happen when you hit one of those rough patches. It refers to feelings like sadness and hopelessness that are directly related to the way diabetes is affecting your life, including the ups and downs of managing your blood sugar levels, your self-care, your job, and your personal relationships. Getting support and taking a look at your self-care regimen are good ways to cope with diabetes distress. It’s temporary, but while you are experiencing it, diabetes distress can interfere with your ability to cope with stress.
What is depression?
Depression is a psychiatric disorder. Symptoms include feelings of sadness and hopelessness, excessive crying, fatigue, difficulty getting out of bed, and difficulty concentrating, among many others. Depression may be caused by biochemical imbalances, faulty thinking, or a reaction to current life circumstances. Generally, the symptoms of depression are ongoing and require treatment by a mental health professional.
So do I have diabetes distress or depression?
The symptoms that are considered possible signs of depression can be the result of diabetes distress or actual depression. That’s the point that has been made by the authors of this recent research. The key difference between the two is that distress is temporary and is a normal reaction to the challenges of living with diabetes. Depression is more likely to be long-lasting and the symptoms can be more debilitating. Depression is also a psychiatric diagnosis.
Why does it matter if you call it distress or depression?
A physician may diagnose depression based solely on the symptoms you are experiencing but not consider the impact of living with diabetes and any current diabetes-related challenges you may be facing. A psychotherapist may also not factor diabetes into their evaluation. As a result, you can receive a diagnosis of depression, which may be an over-diagnosis. And with this diagnosis, practitioners are required to have a depression treatment plan in place.
A diagnosis of depression may result in treatment that you don’t necessarily need. This might include antidepressants which may come with their own side effects. A depression diagnosis may also result in referral for psychotherapy, which you might benefit from but also don’t necessarily need.
Also, keep in mind that any diagnosis you receive, including psychiatric diagnoses, will become part of your medical history.
What can I do?
Here are some ideas about what you can do if you think you may be experiencing diabetes distress:
1. Ask yourself some questions. Starting with: What’s bringing me down? How does my diabetes fit into the picture? In other words, see if you can identify what it is that is causing you to feel distressed. Define the problem and you’ll be in a better position to explore solutions.
2. Review your self-care routine. Consider what’s working and not working in your current approach to managing your diabetes, including your regimen, your diet, your lifestyle, and the other aspects of your routine. Sometimes emotions can be a wake-up call that something has to change. Maybe it’s time to sit down with your physician or a diabetes educator and see if your routine needs to be tweaked.
3. Get support. Talk to other people who are living with diabetes. Share how you’re feeling. Vent if you need to. Chances are you’ll learn that others have also experienced diabetes distress. Find out how they coped. Ask for some encouragement.
4. Watch your self-talk. Be on the alert for that critical voice that says, “You shouldn’t be feeling like this” or, “This is not going to get any better.” Diabetic distress is normal. So stay optimistic by reminding yourself that you are not without options. And that you’ve got what it takes to get through it.
5. Stick around! Getting active in an online community is an excellent way to cope with the emotions that living with diabetes can bring up. In fact, the authors of the study on diabetes distress recommend online communities for people experiencing diabetes distress.
6. Whatever you call it, don’t go through this alone. Getting support from others who have diabetes, updating your diabetes self-care, and taking better care of yourself emotionally may be just what you need to cope with diabetic distress.
But what if those feelings just won’t go away?
If you do seek the services of a mental health professional, make sure you are getting the right help. Work with someone who understands how chronic conditions like diabetes can affect you emotionally. Coping with emotions around diabetes should be a key aspect of any mental health counseling related to diabetes distress.
Keep in mind that if you are indeed depressed, it’s important to get a diagnosis and appropriate treatment. In fact, another study of those with type 1 diabetes showed that untreated depression can be life-threatening.
If you talk to a physician or a therapist about symptoms of depression, educate them on diabetes distress and ask them to take this into consideration as they evaluate you for depression. Be your own best advocate!