This one’s a toughie. It’s about feelings and thoughts and things we try to keep inside, and don’t often share with people, but if anything that’s why I thought it was important to try and write something about it. It’s also highly personal to me, and something I’ve not talked to many people about before.
First up, I should clarify, we all feel down at times, and we all feel anxious. That isn’t what this post is about. It’s about those times that those thoughts come and get stuck. You feel like you’re trapped in a never ending cycle of worrying and it takes all the energy and motivation you have to drag yourself out of bed in the morning.
This is the part where I get all confessional, and tell you all that I’ve experienced depression and anxiety for a very long time, both before and after my diagnosis with diabetes.
My anxiety is almost always there, prodding away at me like a backseat driver. Sometimes it’s better, sometimes it’s much worse. When it’s much worse, I get depressed.
My anxiety tells me I’m not good at stuff, and it tells me that I don’t belong. It makes me forensically overanalyse almost every human interaction I ever have, and try to work out if I’ve been a dick or if I was ok, or if someone secretly hates me.
It also makes me worry about stuff, whether it warrants worrying about or not. Sometimes I even worry about worrying. It’s a real treat. Sometimes it sneaks up behind me and unleashes a load of adrenaline, making me feel like my heart is gonna crawl out of my body through my throat, or making me wake up in a cold sweat. And as we all know, these are helpfully not dissimilar to the symptoms of hypos.
When the anxiety gets bad and I can’t shift it, it makes me depressed. I can’t sleep at night because I am worrying, so I feel tired and run down, and this depresses my mood, and as I fall into depression the sleep gets worse. And so the cycle goes until it takes everything I’ve got to get up and dress myself. Anxiety and depression are very closely related, but you may experience one without the other, or have them together at the same time.
Maybe we should go for some textbook-type definitions, so we know what we’re talking about. These will be brief, and there’s loads more detail to be found online, like Rethink.
Depression isn’t just feeling sad. It’s when those feelings won’t shift, for weeks or months. It can be difficult to see the positive side of anything. It can also have physical symptoms too, like sleep disturbance (in depression people typically wake very early in the morning, but can also struggle to get to sleep), loss of appetite and loss of sex drive.
Depression can be triggered by specific things (stresses in life, for example) or it can just come out of nowhere.
We all worry about things, about money, work, school, relationships, etc. Anxiety becomes a problem when these worries become very noticeable or difficult to live with.
This might mean you feel on edge and have difficulty sleeping or concentrating. You might also have physical symptoms, like sweating, hot flushes, shaking and fast heart beat.
Types of anxiety
There are a lot of different types of anxiety disorder, many of them linked to the types of thoughts or situations that can trigger then anxiety, or the types of behaviour that they can result in.
Effect of Diabetes
People with any long-term condition, like diabetes, are more likely to become depressed than the general population. There are a bunch of competing theories about why this is, but to be honest why it happens isn’t all that important, it’s much more important to be able to spot it when it’s coming to make sure that it doesn’t go on unchecked for too long.
Impact on Diabetes
The impact that anxiety and depression can have on diabetes varies from person to person.
One of the most important things to spot is when your diabetes is what is making you anxious or depressed. We all have tough times, where we just can’t batter down the BG no matter how low carb we eat or how much rage-bolusing we do. Equally, when we can’t get it right at the other end it’s just as tough. Hypo after hypo can make us anxious about doing stuff – and makes it all the more tempting just to stay in bed alternating between lucozade and boluses.
For me, I also find that depression and anxiety make my BG control worse. Depression in particular makes it harder to care about my diabetes, and the resulting poor control makes me feel worse, and so the cycle continues. High BGs make us feel crappy and make it more likely we’ll be tired and ill-feeling, which doubles down on the depression. Waking up to pee in the night makes the sleep disturbance worse too. If you’re up worrying until 2am, wake up at 3 and 4 to pee and then lie awake in bed from 5.30am you tend not to be too filled with energy.
In summary, diabetes can trigger our anxiety and depression, and it can also make it worse even when it hasn’t be the main cause. Good stuff!
Admitting you might need a hand with things is one of the most important steps in starting to get on top of depression and anxiety. It’s also something that is really hard to do, and requires a massive amount of bravery.
Who to tell you need help doesn’t really matter as a first step. Depression and anxiety can make things difficult at home and so telling partners or parents can be a useful first step – at least getting some understanding of why you’re being the way you are.
Ultimately, the person I spoke to who was most helpful was my GP. It took me a long time to get the guts to go, and before I went I rehearsed in my head what I’d say. She listened to me non-judgmentally, and aside from some standard questions they have to ask (about whether or not you’ve thought about hurting yourself, for example), it was all a very personal conversation.
She also told me about the options available and, importantly, asked me what I’d like to do next. When so much feels out of control being offered this small amount of choice really helped.
I wanted to try medication, and started on some tablets straight away. Most people get prescribed anti-depressants from a group called SSRIs (selective serotonin reuptake inhibitors, for the nerds out there). There are a few of them, but the most common one used first line is citalopram.
I’ve now been taking it nearly a year, with an ill-advised two month break where I stopped it myself. TIP: Don’t do this without talking to your doctor.
It has made life liveable for me. It doesn’t fix everything, nothing can do that, but it takes the edge off my anxiety enough that I can sleep at night and get through the day.
There are talking therapies available, CBT is the main one available on the NHS, and this is where a therapist will help you to identify triggers and find ways to change the way you think and react to them. I personally didn’t find this that helpful, but lots of people do – unfortunately there’s no one-size fits all when it comes to wobbly brains.
The most important thing you can do to help yourself is get good at spotting when you’re starting to dip into depression or your anxiety is getting out of hand. This is easier said than done, but something that time will give you.
Beyond that, the most important things are finding ways to self-care. Finding ways to manage your feelings and essentially keep the train on the track is key. There are a bunch of ways to do this.
- Take time off to take care of yourself if you can.
This isn’t always easy, but a day off, a quiet night, an empty weekend can all help. Making your world small for a short time can help to settle symptoms and stop mood from dropping.
- Find the little things that help.
Go for a run, go for a walk, have a long hot bath, read a book you love, watch some shit telly, get a takeaway. Treat yourself. Find something you like and do it. I lie in the bath for hours, I walk for miles. All of these things help clear my head, and push difficult thoughts away for a bit.
- Find people you can be around when it’s bad.
This can sometimes be tough. Some people aren’t good to be around when you’re feeling low or anxious, others aren’t happy to be around you. If you can find people who can put up with you and you can have near you this is fantastic. Try to talk to them, explain what’s going on. This is one of the things I find hardest, but if you can do it, you’ll be winning.
- Try to keep on top of your sugars
This doesn’t mean hitting the target range all the time, but if you can keep down in the low teens to high single digits at least, it’ll help stop that unhelpful spiral.
- Give yourself a break.
Depression and anxiety both have a tendency to make us super critical of ourselves. Try to remind yourself you’re doing ok. As with life, depression and anxiety are often marathons rather than sprints – there will be times when you can get a little better each day, and others where you will slip back. Don’t be hard on yourself when things get harder, and give yourself a pat on the back when they get a bit easier. It’s not your fault. Brains are weird and often annoying, and you shouldn’t feel bad because yours has decided to be a dick.
As ever, comments and feedback to me @k_d85, and if you have an idea for something you think we should cover (or if you’d like to contribute something), let me know.