In general, depression can impact anyone at anytime and does not need to be a life long illness. Depression comes in a wide range of intensities from a low lying depression called dysthymia to more debilitating, which may be diagnosed as a Major Depressive Disorder. A Major Depressive Disorder can be an acute or a recurrent problem impacting all areas of life.


Depression is a complex issue that is difficult to define as it comes with many symptoms and no one person presents the same. Most people are not the stereotypical individual that society has presented in movies, who lives on their couch all day, unable to function at any level. Most people living with depression work a job and function well enough to maintain relationships.


Depression is a mood disorder that typically includes feelings of: detachment, loneliness, isolation, depression, hopelessness and sadness. It may cause a decreased enjoyment of activities that were previously enjoyed and a lack of interest in the world around them.


According to the American Association of Diabetes Educators as well as the American Diabetes Association, depression is 2-3 times more prevalent in people with both Type I and Type II diabetes.


Depression Etiology

There are several different ideas as to the cause of depression that have been identified. These include genetics, social and environmental factors, and neurobiological factors. One or all of these may play a role. Regardless of exact cause, depression is a chemical imbalance predominantly seen in those with childhood trauma.


Other causes may relate to traumatic events in life that have a devastating impact on an individual. Like people who experience a traumatic loss may develop symptoms similar to depression. When the loss is the death of a love one the symptoms although the same as depression it would be diagnosed as mourning, unless it last longer then 2 months at which time it would be considered depression.


Reasons it is more prevalent in individuals with Type 1 diabetes:

  • Unstable Blood Glucose: Having unstable blood sugar during childhood can lead to brain issues such as developing a chemical imbalance, reduced gray matter and frontal lobe damage. Reasons it is more prevalent in individuals with Type I and Type II diabetes:
  • Life Style: For many it’s a loss of freedom, to live life free of constrictions and without having to worry about management of an illness. No longer being able to eat what you want or leave your home without thinking about your blood sugar needs.
  • Anger: When a person lives with a chronic illness many things get internalized usually in the form of self-blame. Depression is anger turned upon oneself. Everything from internal statements of “I did this to myself. I caused this!” to “This shouldn’t be that hard so, why am I always messing this up! I am stupid because I should have remembered to test my blood, take my pill or count the carbs!”
  • Family Stressors: When someone gets diabetes, family members start acting differently, which can cause relationships to fall apart while causing extreme levels of anxiety and arguments within the family. The person with diabetes may take on the family stress and blame themselves for everyone’s behaviors and see it as their fault.
  • High Blood Glucose: It mirrors the symptoms of depression (see symptoms below.)


Depression Symptoms

The symptoms of depression are vast but the issue is not the complexity of the symptoms but that many of the symptoms of high blood glucose levels are similar to depression. This is important when diagnosing depression in an individual living with diabetes, as high blood sugar needs to be ruled out.


Major Depressive Disorder and High Blood Glucose Levels Symptoms:

  • Depressed mood
  • Loss of interest or pleasure
  • Weight loss
  • Increase or decrease of appetite
  • Hypersomnia (excessive sleep) or Insomnia (trouble falling asleep)
  • Fatigue or loss of energy
  • Diminished ability to think or concentrate, or indecisiveness
  • Self-Blame/Guilt


Other Major Depressive Disorder Symptoms:

  • Weight Gain
  • Psychomotor agitation or retardation
  • Recurrent thoughts of death, suicidal ideation or suicide attempts


Other High Blood Glucose Symptoms:

  • Dehydration
  • Blurred vision
  • Increased thirst and frequent urination

Depression Diagnosis:

Depression Diagnosis:

Diagnosis of any mental illness needs to be done with a Mental Health

Professional (MHP) trained in diagnosis, which maybe a Licensed Clinical Social

Worker, Licensed Psychologist or a Psychiatrist.


In diagnosing depression in an individual with diabetes it is important that the

client/patient advocate for him or herself by tell the MHP evaluating them that

they have diabetes. Don’t wait to be asked, be honest with them and upfront, tell

them if your blood sugars are out of control and what symptoms that may cause.


If your psychotherapist or psychiatrist is unfamiliar with the symptoms of high

blood sugar, inform them what happens to you when your blood sugar is high. If

your mental heath professional is still unsure about the impact of blood sugars

refer them to speak with your certified diabetes educator or endocrinologist.

Make sure to sign a release allowing them to talk to your endocrinologist to

coordinate care.


All this will help the MHP rule out that your blood sugar control isn’t the cause of the depression.


Depression Assessment

The initial assessment is performed by a MHP, creating a Bio-Psycho-Social

Assessment that evaluates all aspects of an individual’s life, which assists in the

diagnostic process. As part of the process the MHP will conduct a Differential



The Differential Diagnosis takes into account that the depression might be a

result of some specific extrinsic factor such as drug abuse, various medications,

or general medical conditions like hypothyroidism. Depending on various factors

the MHP may have you get screened for a specific extrinsic factor to rule it out as

the cause of the depression.


The Diagnostic Static Manual (DSM-IV-TR) is the primary source in diagnosing

mental health disorders. It is used to rule out symptoms and other criteria like

length of symptoms need to be meet before a diagnosis can be made.


Criteria for Major Depressive Episode and Major Depressive Disorder:

  1. A. At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure.
    1. Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)
    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation made by others
    3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
    4. Insomnia or hypersomnia nearly every day
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
    6. Fatigue or loss of energy nearly every day
    7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
    8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
    9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide
  2. The symptoms do not meet criteria for a mixed episode.
  3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
  5. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Depression Treatment:

Depression Treatments:

There is a wide range of treatments for depression from psychotherapy to medications. For individuals with diabetes, Self Management Education has therapeutic value, because better control reduces some symptoms of depression and builds self-esteem.


Since, there are various reasons a person may be depressed, not all forms of treatment will resolve any one persons depression. Every individual is different and that means treatments need to be tailored to your specific needs. Just because someone you know was put on Zoloft does not mean that it will work for you.


First step is to seek the help of a Mental Health Professional where you can get an initial assessment. Keep in mind that high or out of control blood sugars during your assessment or over the past few weeks to years will impact the diagnostic process.


The cause of your depression, once known, usually defines treatment. For more information on the various causes see the “Depression Etiology” section.


Treatment Types

Treatment is based off the initial assessment discussed in the “Depression Diagnosis” section. I would recommend meeting with a certified diabetes educator while seeking emotion help from a psychotherapist. It is important to rule out the diabetes with the help of a CDE and/or your psychotherapist.


Certified Diabetes Education helps people get their diabetes management under better control, which may alleviate some symptoms of depression depending on cause. Best when used in conjunction with Cognitive Behavioral Therapy or Psychodynamic Therapy.


Psychotherapy helps reduce various life stressors and symptoms of depression, while increasing self-esteem. It helps people resolve personal issues and manage painful feelings like anger, sadness, hopelessness and frustration, to name just a few.


  • Cognitive Behavioral Therapy is considered most effective and research has shown good result in alleviating depression.
  • Psychodynamic Therapy focus many aspects of an individual and tends to be more client centered.
  • Psychoanalytical Therapy has value for seasoned therapy goers, but I do not recommend till you have mastered diabetes management. Psychoanalytic techniques tends to focus less behavioral change and more on resolving past issue that are still negatively impacting an individual in the here and now.


Once you have been assessed and extrinsic factor like your diabetes has been ruled out, your psychotherapist may refer you to a psychiatrist for further evaluation. For some people medication will be needed to resolve some of the symptoms of depression that talk therapy wont resolve.

Medication Therapy helps reduce or resolve some of the symptoms of depression that may be interfering with your diabetes management. Some symptoms of depression make it difficult or even impossible to manage diabetes.


  • Selective serotonin reuptake inhibitors (SSRIs) are used to reduce symptoms of moderate to severe depression and cause minimal side effects.
  • Monoamine oxidase inhibitors (MAOIs) are also used to reduce symptoms are a second line of defense due to increased side effects and need for diet restrictions.MAOIs can cause sever high blood pressure due to interactions with certain foods and medications. Generally not recommended to people living with diabetes, but in some cases when all else fails, they maybe prescribed.

Before starting any medication, over the counter medication or herbal alternative to medication, please inform both your endocrinologist and psychiatrist of the medications you are already on. As some psychiatric medications may negatively impact both diabetes and non-diabetes medications you already take and vise versa. For example, some psychiatric medication may lower or raise blood sugar levels.


Electroconvulsive therapy (ECT) is a last resort, when all else fails. It is much safer then it used to be with minimal side effects. It is a process where electrical currents are used to induce a small Seizure. It causes rapid changes in brain chemistry, reversing the symptoms of depression.


If believe you might be depressed, Contact my practice, as soon as possible. We can help!


If you are concerned that you are going to hurt your self or someone else please call 911 right away.


© 2011-2017 Eliot LeBow L.C.S.W., C.D.E.,  The information on this server including all images is proprietary and comprises legally protected subject matter belonging to psychotherapist Eliot LeBow, and is displayed on the basis of viewing only. All use, reproduction, and disclosure is prohibited without the prior consent of Diabetes Focused Therapist Eliot LeBow, including all registration marks: ® Diabetes Focused Psychotherapy, ® Helping People With Diabetes Thrive!, ® DiabeticTalks, ® DiabeticMinds, ® The Diabetic Diary. All rights reserved.

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Psychotherapist & Diabetes Specialist : Servicing Manhattan, Brooklyn, Queens, Staten Island, Long Island,  Connecticut, New Jersey.