Diabetes & Depression: Build Off the Small Wins

A Conversation With Alan Silver, PsyD, Samaritan Family Medicine – Geary Street

As a clinical psychologist in a primary care clinic, Dr. Silver sees patients who suffer with both diabetes and depression. He estimates that about half his patients experience both conditions.

The following is a discussion with him about how the conditions affect each other, and the advice he gives his patients.

Q – Can diabetes lead to depression, or is it vice versa? And do the two conditions make each other worse?
From what we see, it’s a chicken-or-the-egg situation. There are a lot of moving parts with depression and diabetes, and it’s easy to get lost in one or the other.

One thought is that depression can lead to diabetes, because the depression leads the patient to unhealthy choices like poor eating habits or not exercising. Depression can also cause an increase of cortisol and other hormones, which can have an impact on metabolism.

On the flip side, we think of diabetes leading to depression, because high blood sugar levels can cause mood swings, ranging from anxiety to feeling tired. In addition, it can be depressing to do everything right with your diabetes, and still have problems controlling your blood sugar.

And by the same token, I’ve seen depression and diabetes exacerbate each other. If you have diabetes and you’re struggling to get it under control, that can lead to severe depression which can cause you to make more unhealthy choices which lead to your diabetes getting worse. 

Q  – What’s the best advice for people struggling with both conditions?
With diabetes, I tell my patients not to get down on themselves. Diabetes is a disease where, even if you do everything right, you can still have a bad day in regard to your blood sugar level.

With depression, I encourage my patients to do an activity they enjoy, because behavioral activation from doing something they enjoy will help decrease their symptoms.

It’s not a matter of treating one condition before the other, or both at the same time. 

I help my patients to set manageable, attainable goals for themselves because your motivation can take off once you’ve reached the first few milestones. For example, if you’re checking your blood sugar once a day, start checking it twice a day and see if it changes. Take the time do fun and meaningful activities to help manage the stressors of diabetes.

It’s really important to be gentle with yourself, because there will be bumps in the road when you make changes to your life. Don’t try to be perfect, and stay positive.

If you’re struggling to manage your diabetes, or if you’re concerned that you might be suffering from depression, make an appointment with your primary care provider today.

Dr. Silver is a clinical psychologist with Samaritan Family Medicine – Geary Street.

Learn more about Samaritan’s mental health services.