Is It Major Depressive Disorder or Diabetes Distress?

Dr. Beverly Adler, Clinical Psychologist and Certified Diabetes Educator, clarifies the difference between MDD and diabetes distress. 

Depression literature demonstrates that diabetes and Major Depressive Disorder (MDD) occur together approximately twice as frequently as compared to those without diabetes. Diabetes distress, on the other hand, arises from the stresses of living with diabetes. In order for you to know which emotional process you are dealing with, you need to know which symptoms go with each diagnosis.

Is it Major Depressive Disorder?

Diagnostic criteria for Major Depressive Disorder (DSM-5)

Five (or more) of the following symptoms for the same 2-week period:

1. Depressed mood most of the day, nearly every day as indicated by feeling sad, empty, hopeless, or appearing tearful to others.

2. Markedly diminished interest or pleasure in all, or almost all, activities.

3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

4. Insomnia (inability to sleep) or hypersomnia (excessive daytime sleepiness or sleeping more than 9 hours in a 24-hour period) nearly every day.

5. Psychomotor agitation (a feeling of anxious restlessness) or psychomotor retardation (a slowing down of physical and emotional reactions).

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. 

Additionally, the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The episode is not attributable to the physiological effects of a substance or to another medical condition.

Is it Diabetes Distress?

Note: Diabetes Distress is not an actual diagnosis in the DSM-5

Diabetes distress can stem from a range of areas related to living with the burden of chronic illness:

1. Emotional burden – for example: feeling angry, scared, and/or depressed when you think about living with diabetes.

2. Physician-related distress – for example: feeling that your doctor doesn’t give you clear enough directions on how to manage your diabetes.

3. Regimen-related distress – for example: not feeling motivated to keep up your diabetes self-management.

4. Interpersonal distress – for example: feeling that friends or family are not supportive enough of self-care efforts.

Diabetes distress can result from the demands that diabetes self-management requires, such as obligations of diet, physical activity, blood glucose monitoring and taking medications. Other equally important but less frequently acknowledged stresses can center around fears about the future, concerns about complications, and difficulties dealing with caring – but potentially intrusive – friends and family members. 

Diabetes distress is conceptually distinct from MDD

Diabetes distress is different from clinical depression. Diabetes distress is more aligned with the views of people living with diabetes and the role of emotional distress coping with diabetes than the MDD model. Diabetes distress is closely associated with diabetes self-management and glycemic control, while MDD is not. 

Diabetes distress is an unhealthy style of coping that develops from living with the burden of a chronic illness. Researchers found that diabetes distress is linked to A1c results, while MDD is not. They suggest that A1c and diabetes distress can influence each other over time. People with diabetes with poor glycemic control may then experience distress, which could lead to sustained poor diabetes management. Conversely, people with diabetes experiencing significant diabetes distress may be less likely to practice self-care behaviors, which could then negatively impact their A1c level.

Depressive-like symptoms, such as changes in sleep, changes in appetite, or concentration disturbances, may be more likely to be due to the effects of high or low blood glucose. Emotional distress, within the context of the experience of a person with diabetes managing their diabetes, does not require psychiatric medications for relief.

Treatment

If you, or somebody that you know, is experiencing MDD and if it is unrelated to diabetes, it can be treated with psychiatric medications, such as anti-depressants, and psychotherapy (Cognitive Behavior therapy (CBT) is one of the most effective treatments). The focus of CBT treatment is to challenge “irrational/unreasonable beliefs” that cause depression. These may include a variety of emotional reactions including anger, shame, fear, shock, and guilt.

If you, or somebody that you know, is experiencing diabetes distress, it can be managed and reduced using CBT strategies to change maladaptive thoughts and behaviors thereby reducing emotional distress without the addition of psychiatric medication. By teaching you to recognize these thoughts, you can challenge your negative thoughts and change your thinking to rational/reasonable thoughts and actions.

The benefit of utilizing CBT for diabetes distress is improvement in your attitude toward living with diabetes as well as your self-management. People with diabetes have reported reduced feelings of depression, anxiety, anger, frustration, and guilt as a result of therapy. Diabetes-focused psychotherapy which addresses both mood and diabetes self-care can lead to improved blood glucose management. Along with improved thoughts and actions, you can feel empowered, instead of overwhelmed, to manage your diabetes.