Pull Yourself Together!

The Slough of Despond; shortly after consuming yet another diabetic.

ShootUp’s resident Type 2 Terry gives a personal insight into the complication of diabetes we often forget…depression. 

How often has that been said to you?  Maybe not very often, because people have learned to avoid using this somewhat patronising phrase when people are suffering from depression.  There, I’ve said it, the big ’D’ word; depression.

So what does depression have to do with diabetes?  That’s probably a stupid question; I would be very surprised if everyone that lurks around on ShootUp hasn’t suffered from depression at some time or another.  If you’re a T1 who’s been unfortunate enough to be diabetic from childhood, I’d be willing to bet that your teenage years were punctuated by bouts of it.  Periods when you rejected your treatment regime and tried to believe diabetes did not exist.  I still get them even now.

If, like me, you are a T2 who was diagnosed in middle age, the crunch didn’t really come until the words, “We’ll have to put you on insulin,” were uttered.  I’m not trying to elicit any sympathy here, just explaining where I was in my life when depression first hit me.

I was particularly unlucky, a long term relationship had just ended in the October of 2005, I was put on insulin in January 2006, and my mother died in the February, not a great concatenation (Damn!  I love that word!) of events, and depression welcomed me with open arms.  The night my mother died I started smoking again after fourteen months nicotine free.

I’ve just re-read that last sentence and realise I’ve imbued depression with anthropomorphic attributes.  (Try saying that after a Shoot Up Night Out!)  Wasn’t it Winston Churchill who called depression his ‘Black Dog’?  Maybe this monster really does seem as if it’s alive in its malevolence, though Chaucer’s inanimate Slough of Despond works well too, now there was a man before his time!  However you visualise it though, depression is an evil thing.

It’s the side effect of diabetes that’s never mentioned, everyone talks about neuropathy, macular degeneration, and nephritis, but nobody mentions depression.  Just the symptoms are depressing, so instead of trying to remember all that I felt, here’s a list of symptoms as provided on the BUPA website:

“If you have depression, you may have a number of different symptoms including:

• a continuous low mood, which may be worse in the mornings
• feeling irritable
• crying a lot
• a loss of interest in your social life
• a loss of self-confidence
• a lack of energy
• tiredness and poor concentration
• difficulty in making decisions
• feeling helpless, worthless or hopeless
• feeling guilty
• thoughts about death and suicide
• anxiety
• a loss of sex drive (libido)
• trouble sleeping – possibly taking one or two hours to go to sleep or waking up earlier than usual
• disturbed eating patterns – either loss of appetite or eating too much
• unexplained or worsening aches and pains
• physical slowness.”

I have to say that sadly, I recognise quite a number of those symptoms, maybe you do too.

If you do recognise any of those symptoms, but you’ve done nothing about them there are two things you need to do.  The first is to believe that you really do suffer from depression.  The second is to talk to someone about it!  When you’re depressed (we’re talking real clinical depression here, not just feeling sad for some reason) one of the first hurdles is actually admitting to yourself that you have a problem.  The second, and often the most difficult, is talking about it.

So, once you’ve admitted to yourself you have a problem, who are you going to talk to?  If you look on any of the websites they’ll always tell you to talk to your GP, but my (very unprofessional) suggestion is to talk to the one you love, the one who is nearest and dearest to you, and has been suffering the fallout from your problem.  If they tell you that you aren’t depressed, and to “Pull yourself together!” then maybe you should be looking for someone else.  In reality, they’ll sympathise with you, and tell you how worried they’ve been.

It’s not easy, I know, and unfortunately I didn’t really have anyone close enough to make a difference, one of the downsides to living alone.  I did talk to my GP though, and got a lot of help, my DSN at that time was a rock, and I could always talk to her, at one time I was seeing her every week.  Some of that help was chemical in the form of Fluoxitine capsules, (if you look it up it’s a generic form of Prozac)

There are indications that Fluoxitine shouldn’t be used if a patient has diabetes, but there are other drugs that can be prescribed, and anyway, the contra-indications may not be for you, your doctor will know.  If you do go onto medication, there may be a period in the initial few weeks where your doctor wants to see you every week anyway (I saw my DSN by choice, but the doctor saw me regularly too).  The immediate effects of anti-depressants can be a slight worsening of the situation.  Your doctor may recommend counselling as an alternative to drug therapy.  Personally I think counselling is widely overrated, but it may work well for some people, I only know, that having done the first year of a counselling course, I’m not one of them.

I don’t know if any of my fellow ‘Shoot Uppers’ are old enough to remember, but there used to be an advertisement on TV for a headache remedy, I think it may have been Anadin, but I could be wrong.  The tag line for the advert was, “Leave me alone, I’ll be all right soon…”  Sadly, many people with depression say the same thing, hoping it will go away.  Depression though is much more insidious than a headache, and it won’t just go away; in really bad cases it may even need psychiatric help, so don’t dismiss it out of hand.

Don’t feel as though it’s something to be ashamed of either!  Part of the depression is to feel as though one is less than a person for admitting it, don’t be fooled!  If you can relate to any of the symptoms mentioned above, you need help, it’s not ‘being silly’, it’s not ‘wasting the doctor’s time’, you have a real illness that needs real treatment, believe me.

Me?  Well, I’m much happier now; I’m off the drugs and have been for a couple of years now.  I still get problems with sleeping, but that’s often more to do with the neuropathy than depression.  I never really have got back into the swing of doing housework, so I have to ask the spiders if I’m allowed open a window.  Overall though, my life is good, but I keep my eye open, looking over my shoulder for Churchill’s ‘Black Dog’!

Terry Ozbourne