Is depression really like diabetes? Yes – in more ways than you think

It’s often said that depression is just like diabetes.

The aim is usually to encourage people to speak up about their mental health problems, by pointing out that they’re no more worthy of shame than other illnesses.

The comparison seems to go down pretty well with most folks. But not with everyone. Some people hate it.

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So how much do the two conditions really have in common? A lot, I reckon. Their similarities run deep, but perhaps not in the ways that you’d considered.

To begin with, depression seems to me to compare more closely with Type 2 Diabetes than Type 1, for many reasons.

Whereas Type 1 always involves the same underlying problem – destruction of pancreas cells leading to a lifelong need for insulin – Type 2 is a more variable biological state, just like depression. In Type 2 Diabetes, high sugar levels are primarily caused by the body not being as responsive to insulin as it should be, but insulin levels are often low as well. Other hormones like glucagon and incretin are out of kilter too. This is akin to depression, in which we know that it’s not just serotonin that’s important at the biological level. Other neurotransmitters like noradrenalin and dopamine (and many others) are all involved.

The concept of depression sometimes gets criticised because it’s different for everyone, not like ‘real’ illnesses. But the biological state of any one person with diabetes won’t identically match that of any other any more than one depressed person’s brain will match another. They’re both illnesses with a lot of variation that we treat as one thing because the end results (high blood sugar or low mood) are relatively similar across people and treatments can be developed to tackle them.

Sure, diabetes has an objective test in blood sugar readings, whereas diagnosing depression relies heavily on rating someone’s sadness in at least a partially subjective sense, but just because mood is hard to measure doesn’t mean it’s not a real problem. And both blood sugars and mood ratings are tips of icebergs, the diagnostic variables that we choose to measure in conditions that affect much more. Diabetes will make you feel tired, give you headaches, make you drink lots and pee lots and eventually ruin your eyes and kidneys if left unchecked. Depression affects your sleep, appetite and sex drive and might lead to suicide.

Also, neither Type 2 Diabetes nor depression have one simple cause. Both are caused by a collection of individually small risk factors. With diabetes the big dangers are things like obesity, high cholesterol, poor diet and sedentary lifestyle, whereas with depression it’s things like recent adverse life events, a tough childhood and a lack of social support. Diabetes and depression both have a huge genetic component, but neither has a single-gene cause.

Taking things further, the treatment for both Type 2 Diabetes and depression is almost uncannily similar. The first step for both – and people never seem to know this – is not medication, unless the problem is severe. For diabetes it’s a change to a healthier lifestyle, whereas with depression it’s self-help and perhaps talking therapy. Both conditions can fully remit with those kinds of interventions, or partially remit, or remain a problem for life. When medication is needed it comes in the form of artificial chemicals that try to assist the body in doing what it does when it’s healthy. Drugs like metformin are first choice in Type 2 diabetes, and they certainly aren’t ‘natural’, but even injectable insulins aren’t the same as insulin produced by a real pancreas. Just like depression we don’t know who will respond to a particular diabetes treatment, how much, or why.

It’s ironic that some people think depression is something sufferers are to blame for and can fix for themselves (‘pull yourself together!’) when in reality it might be Type 2 diabetes with the risk factors and treatments that are most controllable by the person with the illness. It’s probably easier to shift your Type 2 diabetes by avoiding junk food, exercising and losing weight than it is to ease your depression by taking away life stressors like a busy job and magically undoing an abusive childhood.

So depression certainly isn’t identical to diabetes, but they do share a lot of common ground. They’re both illnesses with variable and complex biological states, tests which don’t show how widespread the problems can be, ranges of risk factors and treatments and unpredictable outcomes. Next time you hear someone say that ‘depression is just like diabetes’, you can agree with them – perhaps more than they’ll realise.

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About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

8 Responses to Is depression really like diabetes? Yes – in more ways than you think

  1. Alex thank you. As someone with a history of clinical depression and NIDDM now on insulin ( latest research from ADA 2015 says on more than one insulin reduces adherence) it made interesting reading. I agree with you in general however here I disagree.

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    I have struggled with my weight my whole life. I have worked really hard with health psychologists, personal trainers and other professionals often at huge personal financial expense. It is NOT easier. If you look at the work by Dr Paul Chadwick a senior clinical health psychologist (MEND programme for kids and weight management /diabetes) also a senior trainer in CBT for diabetes and Professor Ismail’s work with her team at KCL you will see how complex the behavioural issues are even with NIDDM http://www.kcl.ac.uk/ioppn/depts/pm/people/acaprof/khalidaismail.aspx

    Although in mental health the lack of talking therapies for all types of depression and trauma is shambolic there is even less for DM . In my locality Barnet there is no clinical health psychology for diabetes unless under the Royal Free diabetes service. If under another DM service you have no access in Barnet. I have to use the health psychology service in Tottenham.

    The risk factors in diabetes are massive and the despair of depression is massive too and the worry and risk of suicide means yes the parallels are there as self help has a huge part to play. Both illnesses lack the resources much needed to help get symptoms under control and reduce complications developing as good control means a happier person. I am happy when m y HbA1c comes back at 6.8% but it feels like I am under scrutiny and am told I am not doing well enough if it came back high like last year before I got good glycaemic control after a chaotic ‘sick year ‘. I felt under judgement and treated like a five year old. I am not stupid I know the rules. Do x and y and the results will prove themselves. However dark days mean pricking my finger doesn’t get done. That junk food gets eaten and I sink not exercise. However the good days make managing both a doddle. Both conditions respond well to good quality CBT which is EBP and supportive counselling/therapy on top of medical intervention if necessary.

    In diabetes the adherence is massively hard ( ref Prof Jane Speight and others LIke Prof Ismail) and in depression the adherence to self help even if you are on meds and have good therapy is very hard. Motivation for exercise is jolly hard when you wake up feeling like the whole day seems like a year and nothing to get up for despite motivational therapy.( That is why Prof Paul Gately does well with the kids weight loss/ better lifestyle camps and long term outcomes as on your own it is hard but in a group with support…..)
    Does a publication in The Lancet for me empower me to jump up and eat better and go for a walk? Of course not….
    Pre contemplation is hot in exercise.
    However it is a welcome piece as ever Alex you writing is from the heart and clinical expertise/experience and I value your motivation for writing such good stuff.
    If anyone is struggling with NIDDM there are good clinical health psychologists out there as per NICE that should help you – ask for one and sit on a waiting list but like depression don’t suffer in silence.

    • Good to see that you have brightened up your blog with one of my cartoons. Want to use some more? Go nuts. Here’s where to find them… http://www.auntiepsychiatry.com

  2. Claire says:

    I don’t like the comparison to diabetes. I had a psychiatrist in the past tell me depression was just like diabetes and that I needed to take medicine to correct my chemical imbalance. I sincerely thought, based on his misrepresentation, that I had a serotonin deficiency. Once I learned that what he told me wasn’t quite accurate, I felt mislead. He didn’t need to dumb it down or misrepresent it to get me to take medication. I would have preferred he simply told the truth – I think this medication could help. That would have been sufficient.

  3. Health Tips says:

    Thanks for your nice post Alex.

  4. Reblogged this on Chaos Theory and Pharmacology and commented:
    […] “One of the reasons could be because the practice of psychiatry is based solely on the biomedical model which sees all symptoms as arising from some fault in the brain for which the only cure is medication – the same way as insulin is the cure for diabetes. When a mental health problem is considered to originate from a ‘chemical problem’ in the brain, the specialists can easily justify why it is important first to put that ‘chemical imbalance’ right. This approach consequently leads to the treatment of a ‘diagnosis’ rather than the human being. The patient all too easily becomes a dehumanised object and the doctor the all knowing expert.”[…]— Dorrit Cato Christensen

    Read more: http://davidhealy.org/doctor-munchausen-dear-luise/

  5. Pingback: Is depression really like diabetes? Yes – in more ways than you think | BethCanReflect's Blog

  6. Reblogged this on BethCanReflect's Blog and commented:
    This blog makes a very informed and well argued point that I wouldn’t have considered before this. Really Interesting

  7. Nicole Lascurain says:

    Hi Alex,

    First off, I came across your site and wanted to say thanks for providing a great diabetes resource to the community.

    This hilarious list, 29 Things Only a Person with Diabetes Would Understand, has really resonated with our followers because it provides emotional support and understanding in a comical way, and I thought you might enjoy it as well: http://www.healthline.com/health/diabetes/would-understand

    Naturally, I’d be delighted if you share this list on https://psychiatrysho.wordpress.com/2015/06/10/is-depression-really-like-diabetes-yes-but-maybe-not-how-you-imagined/ , and/or on social , especially because they could really relate. Either way, keep up the great work Alex!

    All the best,

    Nicole Lascurain | Assistant Marketing Manager
    p: 415-281-3100 | e: nicole.lascurain@healthline.com

    Healthline
    660 Third Street, San Francisco, CA 94107
    http://www.healthline.com | @Healthline

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