Anyone can have a bad day – situations like a flat tire on the way to work, dealing with an angsty teenager or having a flight canceled may challenge the most positive person’s mood. But coping with a chronic condition such as diabetes may be like stringing months and years of “bad days” together, and may significantly affect one’s mood and behaviors. To learn more about the connection between diabetes and depression, we turned to Dr. Paul Ciechanowski, who has conducted research on diabetes and depression for more than 15 years and summarizes many of his and others’ findings in a paper on “diapression.” According to his findings, one in eight individuals who live with diabetes has major depression, and another one-fifth may have less severe but clinically significant depressive symptoms.
Paul first became interested in the biology of the brain in high school. “I was doing an Honors Program in biochemistry,” he said, “and the teacher drew a norepinephrine, serotonin and dopamine molecule on the board and told us these were building blocks responsible for behavior and mood. I thought that was just fascinating.” That was when Paul knew he wanted to be a physician.
With interests in medicine, disease processes and psychiatry, Paul became board certified as both a family physician and psychiatrist. “I’m what you call a ‘boundary spanner,’” he said. “That means I’m on the cusp of two disciplines. One is general medicine; one is psychiatry. It allows me to investigate that boundary between behavior change and conditions such as diabetes.”
Through his research and work with patients at the University of Washington Medical Center Diabetes Care Center, Paul developed the concept of “diapression.” “Depression manifests differently in someone who lives with diabetes than in someone without diabetes,” he said. “Often a person who lives with diabetes experiences a soup of symptoms. They may stop monitoring their blood sugar level or they may stop filling their prescriptions. I’ve seen patients who are irritable and stop reaching out to others for support. They may think that what they are experiencing is a worsening of their diabetes and may often not realize that what is driving all of it are depressive symptoms.”
This often leads to a vicious cycle of feeling overwhelmed, and eventually, just giving up on trying to manage their diabetes. “It could be because they stopped monitoring their blood sugar level, but it’s also because of our biological signs and symptoms of depression,” he said. “Depression increases fight or flight hormones and increases anxiety levels. Plain and simple, a person’s blood sugar level is harder to manage biologically when you’re depressed. Neuropathy pain may also be amplified.”
Paul takes an integrated approach when helping people living with diabetes. “We focus on problem solving, and helping people not feel overwhelmed,” he said. “We look at emotional eating, nutrition and diet, attending healthcare visits and work on their coping strategies to help manage not only their diabetes but all the other stressors in their lives.”
Adding more activity, both physical and social, can also help with depression symptoms. “When people engage in physical activity and reach out to others, their depression is more likely to diminish. What’s wonderful is not only can we watch their depression symptoms sometimes decrease over time, but their physical activity is also likely to improve. They’re more likely to engage with others. They may start to test their blood sugar and take their medication again, and then we potentially see changes in their A1C, blood pressure and cholesterol,” he said.
For loved ones or colleagues of someone who may be dealing with depression, it may help to be aware of how depression may manifest. “People who spend time with a depressed person can take it personally, because the depression may manifest as irritability, isolation or lack of interest in activities. I tell them, ‘QTIP – Quit Taking It Personally.’ It’s the depression, not their relationship.”
There are additional resources that may be available for support. “The primary care provider is one place to start,” he said, “but also, if there are specific issues like stressful life events, an employee assistance program at work may also be able to offer assistance. Those are usually free for the first sessions and completely confidential.”
In addition to his medical work, Paul is also the founder of Samepage, which provides education materials and online tools to potentially make healthcare visits more productive. “As a researcher, I’ve realized that poor outcomes can often be explained by lack of communication between healthcare provider and patient as well as the patient’s support network,” he said. “Samepage offers a free online tool called VisitPrep® that helps patients come prepared with the questions in mind, ranked in order of importance. This may help them have more meaningful dialogues with their healthcare providers.”
All the work Dr. Ciechanowski has done to increase awareness about what depression looks and feels like for those living with diabetes, as well as his efforts to help people make more of their time with their healthcare providers is very impressive. Our thanks to Dr. Ciechanowski for taking the time to talk with us.
Head of Patient Insights, Sanofi US Diabetes
Disclosures: Dr. Paul Ciechanowski received no compensation for this post. All opinions contained in this post reflect those of the interviewee, and not of Sanofi US, its employees, agencies or affiliates.
VisitPrep is a registered trademark of Samepage, Inc.