June 18th, 2008
11:36 AM ET

Which comes first? Depression or diabetes?

By Ann J. Curley
CNN Medical Assignment Manager

Which came first, the chicken or the egg? The familiar question entered my mind as I was reading a study in this week's Journal of the American Medical Association regarding diabetes and depression. Why? Because the study found that patients with type 2 diabetes have a higher risk of developing depression and patients with depression have a higher risk of diabetes.

Lead study author Sherita Hill Golden, M.D. of Johns Hopkins University says her research involved two analyses of data generated by a study looking at heart disease and type 2 diabetes. The study involved over 5,000 men and women, ages 45 to 84.

First the researchers looked at people who began the study with symptoms of depression, but did not have diabetes. Those people had a 42 percent higher risk for developing diabetes during a three-year follow-up. Golden speculates that behaviors associated with depression, such as overeating, smoking, and not exercising, help to trigger the diabetes.

A second facet of the study looked at patients in whom type 2 diabetes was diagnosed, who had no symptoms of depression. Those patients showed a 54 percent higher risk for depression during the three-year follow-up period. Golden believes that the stress of managing diabetes can lead to depression for some patients. Although this study focused on type 2 diabetes, Golden says that depression is also common among type 1 diabetics.

Health care providers and patients must be aware of the double-edged sword of diabetes and depression. Identifying and treating both is critical. It’s important to understand that depression, when untreated, can lead to behaviors that can lead to, or worsen diabetes, because people eat poorly and don’t exercise. But there are many treatment options for both conditions that can keep patients healthy and happy.

Do you have diabetes or depression? Are you concerned that one might lead to the other? What are you doing to take care of yourself?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

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soundoff (45 Responses)
  1. Morgan

    This blog is so perfect. Over the weekend, I received a call from a police officer stating my that mother was outside of her home with a nightgown on trying to go and get something to eat. First, she lives by herself, and since she's been diagnosed with diabetes, she assumes that being fat/overweight will kill her. So losing weight and not eating has become an obsession. Unfortunately, denying herself and her diabetes of food and nutrition must have taken its toll b/c her blood sugar levels dropped to 40, which caused her to sort of lose control of her actions. She was very aware that food was her problem (in her nightgown trying to get some food), but her thought process was off track. The paramedics had to give her astronaut food to immediately bring her levels back to a normal. Well, when I got to my mom's house I was very startled b/c having a nightgown on outside of her home and the details of the telephone call sounded familiar to episodes that my mom had over 20 years ago when she was diagnosed with a mental illness. So I informed the paramedics of this and they assured me that my mother was fine, just disoriented and confused. She knew her address, my telephone number, and answered every question correctly. She is doing fine now and has been taking it easy since then. But I wanted to tell my story so that people can see that I have a true story that shows a link between diabetes and mental health. It was so scary, but that episode forced us to educate ourselves and understand the importance of a healthy diet as well as healthy lifestyle.

    June 18, 2008 at 12:37 | Report abuse | Reply
  2. Anonymous

    Yup-got both. I can't say if diabetes led to depression or the other way around, but I experienced significant trauma and depression as an adolescent and early adult, only to develop Type 1 at 24 years old. Since then, I've gained over 100 pounds, and both conditions progressively get worse, even with 2 to 3 doctor's visits per month.
    The stress of living with diabetes is overwhelming. Every second of the day needs to be monitored to keep blood sugar levels normal. It's a level of perfection no one can obtain, yet I get tired of being admonished by doctors or well-meaning people who think they have all the answers for me. I've learned over time to listen to the doctors, ignore the idiots, and realize it's my life and my responsibility. But, like water on a stone, it's really wearing me down over time. I try to keep the focus on the here and now, living the best I can. As long as the quality is good, I'm planning on not getting hung up on the quantity. I've dropped over 40 pounds to date, and I'm getting more exercise, plus eating right. Contrary to what some studies have shown connecting better mood with increased exercise, I do not feel any better emotionally with exercise. It doesn't do a thing for my depression, but I feel less self-conscious and self-hating with the good changes in my body. I guess it's a start.

    June 18, 2008 at 15:54 | Report abuse | Reply
  3. Louise

    I was diagnosed with type 2 diabetes over 15 years ago. I weighed over 200 pounds at the time of diagnosis. My form of exercise is walking since I don't drive. I lost about 75 pounds through diet and exercise and have kept it off. The highest my HbA1C has been was an 8 and was 5.7 at my last test in May. I was not depressed prior to my diagnosis but was depressed for 2 years following my mothers death in 1999. Managing my food intake was a bit challenging but I did it. I started by going to a full service butcher. I had all of my meat cut and packed into 4 ounce packages. I ate a lot of salads and raw vegetables. It took a lot of work as I experimented with how much pasta, rice, and baked potatoes I could eat. It was hard but I did it. The biggest pain is testing your blood sugar. Test strips are expensive and to gain control you have to test multiple times a day to measure the effect of your diet and exercise. The problem is most insurance companies only give you enough test strips to test a couple of times a week. I just wish a non-stick glucose monitor was available it would make testing much easier.

    June 18, 2008 at 16:21 | Report abuse | Reply
  4. t

    Yesterday I had a medical test that required no food or drink for a 12 hour period. I felt light headed after a morning shower, so I laid down and may have fainted. I informed the technician of the morning events because I thought going 12 hours without fluids was too long. The technician asked if I was a diabetic. As of yet I have not been diagnosed with diabetes. I do have major depressive disorder and the current episode is now 4 1/2 years long. A combination of depression, medicine that was tried yet failed to treat the depression, inactivity, loss of job/income, other chronic health conditions, poor eating and sleeping habits all lead to morbid obesity. The biggest change was from Remeron, after taking that medicine and gaining 24 pounds in the first 2 weeks, and a total of 30 pounds before the doctors took me off the medicine after less than a month of use. It also put my TSH out of whack. Since that point in time, I no longer get hungry or full. It is like my satiety trigger no longer works, I eat until I regurgitate or I get a headache and realize I hadn’t eaten anything. The test I had yesterday was for gastroparesis, which could be caused from diabetes. At this point I've been able to avoid getting diabetes, however I also feel it is just a matter of time. Other than tracking my daily caloric intake through a website, I’m too depressed to do anything else. Though the gastroenterologist would like me to get back in treatment for the depression. The last counselor dropped me because they were not a Medicare provider. I also am having trouble finding a doctor for my physical problems. In the last five years there have been too many doctors, psychiatrists, and counselor changes that happened with insurance changes. I’m sure having diabetes would just compound all of this. I do agree with the gastroenterologist that it is all intertwined and you cannot take care of one without the other.

    June 18, 2008 at 18:04 | Report abuse | Reply
  5. Merri Ellen

    Two words sum up the connection: diet and exercise!

    When doctors see patients with either depression or diabetes, I find it so sad that many neglect inquiring about the patient's diet and exercise habits. Typically I find they go straight to prescribing meds. That's like a mechanic judging what's wrong with your car without popping the hood!

    June 19, 2008 at 00:20 | Report abuse | Reply
  6. Lisa

    I have both medical conditions and am being treated. The depression came first. I have been in and out of mental health counseling with no real success. I get so frustrated with being told by every medical professional to test my glucose level 4 times a day besides the quarterly hemoglobin blood work. I have even undergone gastric bypass with little success. The financial burden is catching up and continues the cycle of depression, time lost from work for therapy, doctor visits, and lab visits. The stress of living with diabetes is overwhelming. I do not feel any better emotionally with exercise. In fact, it continues the cycle of joint and muscle pain. I also have a battle trying to eat right when the person I live with won't encourage me by eating right with me. He wants to buy me high fat/sugar treats!

    My insurance company has a system where a nurse calls monthly to check on me and this new person "rags" me about getting copies of my lab results and how come I don't test 4 times a day. Shame on me, I don't know my exact cholesterol numbers! This illness was diagnosed in 1995 and continues to haunt my dreams. My life is consumed with medical knowledge but no real answers to taking control of my life! Best wishes to those with the double whammy of diabetes and depression!

    June 20, 2008 at 12:04 | Report abuse | Reply
  7. Kim

    Lisa, I used to feel the same way, being "ragged" on because I won't test. I get depressed over the numbers and it's a vicious cycle to get trapped in – depression and test numbers. I watched my mother battle diabetes and depression and shots, and I refuse to be controlled by either. I walk, I try to make conscious decisions about what to eat and drink, i.e., diet vs. regular soda, unsweetened iced tea vs. sweetened, etc. If I feel good – great – if not, walk a little more is how I handle it.

    June 20, 2008 at 13:10 | Report abuse | Reply
  8. Fran Smyth

    Very pompous Merri; are you an MD or did you stay at a Holiday Inn Express last night? I am 5'7", 135, and have both depression and diabetes. I run 2 miles every morning and eat a healthy diet. What's your next bright idea?

    In my case, the depression came first. I will definitely follow the studies to learn more about this possible link.

    June 20, 2008 at 23:44 | Report abuse | Reply
  9. Dot

    As we know, correlation (i.e. in this case of diabetes and depression) does not necessarily imply the existence of a causal relationship. It may not be that one produces the other, but simply that they are both frequently seen together. Perhaps there is an additional variable – possibly the individuals' physical and mental/emotional reaction to sugar is producing both the diabetes *and* the depression.

    June 21, 2008 at 01:21 | Report abuse | Reply
  10. gp

    I have both as well and am very frustrated by the fact that the medical community seems to keep studying this combination, and pointing out how important it is to treat both, but no one offers any help in finding quality counseling in order to facilitate this treatment. My diabetes is actually under good control, with my last A1C at 5.6, but the depression and the struggle to maintain that control continues. Sure, I get antidepressants from my doctor. But antidepressants just cover up the symptoms and don't fix the depression. Exercise can take the edge off too, but it also doesn't fix the underlying depression. For me at least, I know that counseling is the key, but finding a therapist/counselor that actually understands the dynamics involved in the diabetes/depression combination is very difficult (and the struggle involved in the search just exacerbates the depression!). I wish someone would offer an internet resource to help diabetics locate qualified counselors in their own area of the country, but I have found no such resource up to this point.

    June 21, 2008 at 12:12 | Report abuse | Reply
  11. BoulderB

    I've been a type 1 diabetic for eight years. I have definitely had more trouble with depression since I was diagnosed. Having low blood sugar or rapid changes in blood sugar can make you feel like the world in caving in on you. Managing it the best you can and staying healthy has been the best solution.

    June 23, 2008 at 12:44 | Report abuse | Reply
  12. Kathleen A. Bayes

    Oh Please – when are doctors going to begin to look at the interaction of physical and psychological? – Why do we continue to think that physicial things have no effect on the brain and brain things have no effect on the physical. Depression is a brain disorder – and is it possible that the body's failure to metabolize glucose might just maybe impact the brain too?
    The old excuse of "blaming the victim" for not eating right or not exercising is very much in the same vein as it was to blame the victim or the family for schizophrenia or bipolar. The drug companies want to do that too. Lilly very much blamed the patient on zyprexa when that patient developed diabetes after massive weight gain – "if they would just eat right and behave". Now we know zyprexa was the cause of a lot of the problem and patients have recovered in a lawsuit.
    I suspect psychiatric issues lead to development of polymialgia, fibromialgia, rheumatoic arthrits migrane headaches – and who knows how much else. I see it in our psych patients all the time.

    June 23, 2008 at 13:58 | Report abuse | Reply
  13. Marcia

    I have had type 2 for 5 years. In my case, it is caused by genetics (strong family history) and steroids taken to control asthma. I recently was prescribed a diabetes drug since a flu episode triggered lack of control. (For previous 5 years, diet and exercise have worked). I found that the medication caused me to lose some of the control I had over my diet and nausea, and also caused depression. I have since weaned off the medicine and the diet control is back and my depression has lifted. Have there been studies on the diabetes drugs perhaps causing depression?

    June 23, 2008 at 14:32 | Report abuse | Reply
  14. fefe

    Like one of the other bloggers I had to forgo food and drink for 12 for blood work. Prior to that I had been on paxil lexapro valuim and zanax for panic attacks which later I was told led to me being depressed. I do have high blood pressure and cholestrol that is kept in check with many meds. Before the depression diagnois ,I walked did water arobics and dance exercise. My weight stayed down and steady. After the results from blood work came back the PA told me my cholestrol was down and that I had diabetes. They prescribed metoforin(?) and that was that. No further testing or any thing. This all took place 3 month ago. Now I don't feel like exercising or doing anything but trying to go to work. I miss about 2 day a week from the effects of the med (all of them–bp heart etc). I would like to know more
    but my doc just does the usual during office visit and does not discuss anything. If there is a sight on the net that you have foud helpful I would like to know.

    June 23, 2008 at 15:07 | Report abuse | Reply
  15. Dianna

    I have type 2 diabetes and happily no depression. I work diligently to keep my AIC at appropriate levels. I have NEVER been overweight, and ALWAYS been in good physical condition.

    I believe that the AIC can be a sort of downer for some folks – as if it is a report card of one's efforts. Sometimes despite all the best info, the AIC is askew. Keeping the number in perspective is my saving grace. Don't let your health care provider belittle you for your AIC level. Seek professionals that will partner and encourage you!

    June 23, 2008 at 15:09 | Report abuse | Reply
  16. Melinda Wensell

    I guess I've been lucky. My depression came first and, after trying at least four different medications, found that Cymbalta is what works for me. I developed Type 2 diabetes in 1997. I am 5'9" tall and weigh 140 pounds. I keep good control by taking metformin (Glucovance) tablets, coupled with a fairly new injectable drug, Byetta which practically killed my appetite. My A1c is 6.5. I am not much of an exerciser, though. I love to walk, but can't do it very often due to the neuropathy in my feet. I am also bad about testing. I only do it when I feel bad and have had some close calls with low blood sugar. I eat a lot of fast food because I am lazy and won't pack a lunch to take to work. I only eat breakfast and lunch and don't eat anything after 2:00pm. I have insomnia and have to take Ambien CR to sleep every night. Does anyone else consistently depend on sleep medications?

    June 23, 2008 at 15:09 | Report abuse | Reply
  17. RS

    I was diagnosed with depression approximately 16 years ago and have been on meds since; then I was diagnosed with Insulin Reistence (prediabetes) for at least 7. So, in my case, depression came first.

    June 23, 2008 at 19:38 | Report abuse | Reply
  18. Cammy S. Kinstedt

    Dear folks,

    I was diagnosed with depression in my early 20s, then with bi-polar disorder in my early 40s. I got the lovely dianosis of diabetes just two years ago at the tender young age of 49. I keep my type II under control with diet and exercise, though recent blood readings are showing that may not be good enough. Sigh. I try to stay upbeat through it all, but sometimes I just get a little depresssed. I love your show. Thanks for all you do. – Cammy

    June 23, 2008 at 22:14 | Report abuse | Reply
  19. Cody

    I always had indicators that something wasn't quite right with my blood glucose. The first time I had an inkling something was "wrong" I was about 5 years old and was out walking with my mother when it suddenly felt like black clouds had moved over me and I suddenly just felt terrible. At around 6, I had my first asthma attack running outside in cold fall weather while people were burning leaves.

    The only real "depression" I experienced was just when my hormones started up at around age 13. Then once in my 20s I'd exercised, skipped dinner, and when I awoke the next morning my tongue felt thick and I was very weak. I actually crawled to the refrigerator and ate some stewed tomatoes and then I felt like myself again in about 15 minutes. I had some other signs, but nothing ever showed up on tests. Then, I felt depressed when I started perimenopause in my late 40s. In my early 50s, I had to be on asthma medication for a couple of years after the house next door burned down. Then I was diagnosed with type 2 diabetes a couple of years later. Diet and exercise help a lot, but if the barometric pressure changes or a weather system blows in, my blood glucose becomes unpredictable. I've tried several different meds, but decided I do better with diet and exercise for now. That may change, but I don't want to be on any medication I may not be able to afford or obtain in an emergency such as flooding unless I absolutely have to be.

    So I think I always had indicators that something was amiss with my blood glucose, but it was too subtle to tip off the doctors.

    June 23, 2008 at 22:52 | Report abuse | Reply
  20. Sammy May

    I have had type 2 for seven years. My father and all of his siblings also were diabetic. Stress of worrying about testing can cause diabetes to worsen–as can any kind of stress. At the onset, I was told to test once a day, at different times to see where the peaks and valleys occurred. One of my aunts had told me it is ridiculous to test often because of fluctuations which are meaningless. To test her theory I checked my sugar 3 times, one right after the other. The count was lower each time with the third being 12 points lower than the first. Guess she was right. Once the medication amount has been determined and an average is found, why keep testing so often? Of course there will be ups and downs; there are ups and downs in people who are not diabetic. Also, it is important to eat during the day so there is not a low blood sugar problem. It is good to eat some protein before bed to help keep the level even throughout the night.

    June 24, 2008 at 00:15 | Report abuse | Reply
  21. mt

    I am female, in my early 50's, and have had chronic depression since adolescence. Have used many meds over the years, most currently on Cymbalta. I was diagnosed as Type 2 about 4 years ago, also with a family history (mother and her mother), so I had tried for many years to delay the point of full-blown Type 2 with diet.
    I take Avandamet, and also have cholesterol issues so I take Lipitor (also common among diabetics). I'm not sure how the depression connects to the diabetes. Which is the cart and which is the horse?
    I know my mother felt very 'discriminated' against for being Type 2 (that was the word she would use), that was in the 1960's-80's, but I'm not sure I'd say she had chronic depression. I do try to exercise, more to look thinner. It hurts, because I have arthritis, mostly in my knees. I can't say it changes my mood whether I'm in exercise mode or not. Oh, and like Melinda, I've suffered from insomnia since adolescence and sometimes take Ambien CR, but I'm afraid to use it every night.
    It all seems to connect together somehow, to me, but doctors always treat each condition as totally separate.

    June 24, 2008 at 01:36 | Report abuse | Reply
  22. C Anne

    My experience had depression coming before Type 1 diabetes when I was in my 20's, but I'm not sure how closely they were connected. At least, the many doctors I've seen over the years never suggested there was a connection. I do get frustrated and depressed when my A1C and cholesterol tests come back, as I am a vegan and exercising daily. And sometimes, when my blood sugar is over 250, I do feel cranky, irritable and depressed, probably because of the poor quality blood hitting my brain. But ever since I was diagnosed, blood sugar has fluctuated vastly, where I could get readings of 40 to 400 in a single day. I do not take any medication for depression, even though it is with me always, and I rely on meditation, exercise and staying in contact with family and friends for support. Its working so far.

    To Sammy Mae: I would disagree with your aunt; the numbers are not meaningless. Yes, testing at any particular point in time is a snapshot of where you are, but it is a valuable tool to use it as a point on a spectrum, and not a point in a vacuum. Testing frequently allows me to see the pattern of increase or decrease in blood sugar. This means I can see trends of increased or decreased blood sugar and prepare accordingly. Testing before and after exercise gives me a feel for the range during that time, allowing me to decide if I should have or not have a snack, preventing possible lows later on. When I don't do this, I end up with readings as low as the mid 20's to mid-teens. Without testing, I could end up dead.

    June 25, 2008 at 12:37 | Report abuse | Reply
  23. Lee, Yorktown Virginia

    There are some studies that suggest that a large number of people with depression might have undetected thyroid conditions. We all know that an untreated thyroid condition can lead to other endocrine or autoimmune conditions, like diabetes.

    June 26, 2008 at 11:36 | Report abuse | Reply
  24. Sheri

    58% of the population with diabetes have sleep apnea. (Diabetes Care. 2003 Mar;26(3):702-9)

    59% of the population with depression have sleep apnea. (Psychiatry Clin Neurosci. 2009 Jun;63(3):385-91.)

    Sufficient good quality sleep is as important as diet and exercise as sleep disorders are proving to be the underlying factor in many of our cronic illnesses. If you notice that you are feeling tired during the day and are snoring at night, please tell your physician and have your sleep evaluated. Treatment is available and can save your life.

    July 4, 2009 at 11:05 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.