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Depression is Common, Especially after Diagnosis

separator People who have diabetes tend to have higher rates of depression than the general population. It’s understandable. “There’s a grief and loss aspect to chronic illness,” says Mark Zipper, Ph.D., Director of Mental Health Services at Allina Medical Clinics. “There’s a lot of rigor to controlling diabetes. Suddenly patients have to come to grips with this. They’re thinking, ‘My life has now changed. I can’t go around and eat what I want the way I used to. I have to worry about eye exams, foot exams, testing my blood sugar…’

“The mind and the body join at the brain,” Dr. Zipper says. “When there’s a physical illness, there are likely to be psychological issues.”

Grief comes in stages
Dr. Zipper explains people who learn they have a chronic illness usually need to go through three phases, focusing on:

  • What’s lost
  • What’s left
  • What’s possible 

People need to consciously take themselves through this process, says Zipper. “They may not need a mental health counselor, but they do need to do a self-assessment. It’s normal at first to think of all the things they can’t do anymore. But after a point, they need to move through that into the next phase, and realize there’s a lot left to live for. Then to complete the process they need to be able to focus on what’s possible in their life.” When they can get to that point, they’re most likely to do well mentally.

Families are affected too
Spouses should go through the self-assessment together. “Spouses have lost a lot too,” Dr. Zipper says. “If you’re going around feeling sad about what you’ve lost, that affects your spouse. And having to make so many lifestyle changes affects your spouse too. So talking about it together is extremely helpful for both of you.”

A lot of people have a tendency to keep their thoughts and feelings about their condition to themselves. Dr. Zipper says it’s common for people to say they don’t want to bother their spouses about it. “But hey, guess what? They’re already bothered,” he says. “Chronic illness doesn’t just affect the afflicted.”

How do you know when you’re stuck and need help?
It’s normal to go through the phase where you focus on what you’ve lost, but how do you know when you’ve stayed there too long? “When you’re stuck there, you’re probably not complying with your treatment. It’s very easy for people with diabetes to be in denial. They think to themselves, “Right now, I feel just fine.’ They may start making deals, saying ‘Well, I’ll only check my sugar once a week’ ”

Everyone has their own timetable, but there comes a point when it’s time to move on. This is often where the spouse plays a key role, says Dr. Zipper. If things have been going on too long and the person with diabetes isn’t sticking with a treatment plan, is sad all the time and seems stuck, it’s time for the spouse to speak up. “Be assertive about your needs,” he says. “Insist on your right to a life. You have the right to say, ‘I need for us to go get some help.’ It will help the spouse even if the patient doesn’t go. But usually they do end up going.”

It’s also important for your primary care doctor to be communicating with your mental health professional about your situation. “Everything is connected,” says Dr. Zipper. “Your health care providers need to be talking with each other about your condition.”

Certainly, people with diabetes can be in a depression that has nothing to do with diabetes. As Dr. Zipper says, “Depression can also be caused by life. Whatever it’s about, go deal with it.”

Focus on a rich, meaningful life

People can take diabetes control so seriously that sometimes they can’t see the forest for the trees, explains Dr. Zipper. “If the whole point of your life is controlling your diabetes, that’s depressing. People need to change the focus, to think to themselves, ‘I want to control my diabetes so I can accomplish my goals and dreams, spend time with my grandkids, do the things I enjoy.’ The focus needs to shift to having a rich, meaningful life.”

Mark Zipper, Director of Mental Health Services, Allina Medical Clinics, March-2003
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