Coping strategies for anxiety and depression
Jonathan E. Prousky, ND, MSc
The mental health impact of a disease such as diabetes is often overlooked. Through mind and body techniques, and stress management, depression can be lifted.
An often forgotten, and even neglected, aspect of type 2 diabetes is the mental health burden that patients with this disease face. Thankfully, there are lifestyle strategies and natural supplements that may help patients cope with diabetes-related stress and depression.
Diabetes: mind and body
Diabetes mellitus is a metabolic disorder caused by an absolute or relative lack of insulin. Type 1 diabetes mellitus typically begins in childhood with the inability of the pancreas to secrete insulin and properly regulate blood sugar. The more common type 2 diabetes mellitus typically begins in adulthood due to poor lifestyle habits, and is characterized by insensitivity to insulin, which cannot be overcome by the pancreas.
There is much hope today for patients with both types of diabetes, since many natural health products and pharmaceuticals are available to improve blood sugar regulation while also reducing risk factors for kidney failure, nerve damage, blindness, and cardiovascular events such as strokes and heart attacks.
However, many clinicians approach type 2 diabetes by primarily focusing on the hormonal, visual, nerve, cardiovascular, and kidney issues, yet seldom discuss and manage the mental health implications of living with the disease. Type 2 diabetes affects both the mind and body, so it is imperative that clinicians take a holistic approach in their management of the disease.
Mental health concerns
The mental health burden that patients with diabetes face is worrisome. Compared to non-diabetic patients, there is a two-fold increase in the severity of depression and anxiety among diabetes patients. The combination of psychological disorders and diabetes is especially damaging because it can have a negative impact on psychosocial and medical outcomes.
Among type 2 diabetes patients, those with depressive symptoms will likely report more stress associated with having the disease, leading to an increase in negativity, which, in turn, is associated with more avoidance and passive behaviour. This is a vicious cycle, since the increase in avoidance and passive behaviour lead to more depressive symptoms or greater diabetes-related stress.
Depression and anxiety can also lead to other seemingly unrelated health concerns. For instance, a recent study showed that compared to healthy subjects, type 2 diabetes patients with severe depression and anxiety have a higher prevalence of gastrointestinal symptoms.
There is even a specific personality trait attributed to type 2 diabetes, known as the “Type D (distressed) personality.” Type 2 diabetes patients with Type D personality experience increased loneliness, stress, and emotional distress.
While it is evident that type 2 diabetes increases the likelihood of having mental health concerns and being less able to manage the daily stresses of life, the good news is that there are numerous strategies that can empower patients to better manage their psychological health and overcome these issues.
One of the best strategies is to engage in yoga several times each week. Yoga helps to build body awareness and is great at calming the nervous system. It involves numerous postures that integrate or unite the body and mind. With experience the participant learns to breathe more fully and completely.
According to a study from 2011, yogic practices “enhance muscular strength and body flexibility; promote and improve respiratory and cardiovascular function; promote recovery from and treatment of addiction; reduce stress, anxiety, depression, and chronic pain; improve sleep patterns; and enhance overall well-being and quality of life.”
Another recent study showed that regular yoga among patients with type 2 diabetes significantly improved quality of life. Previous studies have shown yoga to help control the symptoms and complications associated with having type 2 diabetes.
By regularly practising yoga, type 2 diabetes patients may have less psychological distress and better management of their disease. The other benefit is the potential absence of side effects, since yoga is essentially side-effect free when practised correctly.
Mindfulness training is a form of meditation that helps people focus attention on the present and encourages a positive attitude toward that experience.
Some provincial health plans or extended health care plans will cover most of the costs associated with participating in such programs. However, some programs charge additional fees, such as for course materials, so it’s always best to double check. Programs are often offered at local hospitals or health care facilities.
The rationale for this type of meditation has been validated in the medical literature, especially for chronic conditions such as diabetes. Mindfulness-based programs are thought to improve medical outcomes and the ability to cope with clinical problems that often accompany chronic conditions. Similar research has shown that participating in this form of meditation may benefit patients’ ability to cope with diabetes-related symptoms, as well as more generally improve their quality of life and well-being.
Specific research on type 2 diabetes has shown that mindfulness-based training can improve pain, sleep, and worrying and decrease depression, anxiety, and general psychological distress.
A lesser known therapy that may facilitate better mental health among type 2 diabetes patients is therapeutic massage. Results from scientific literature have been mixed. However, older studies have noted that it results in greater relaxation compared to resting alone and is thought to induce the relaxation response. The relaxation response brings more balance to stress hormones in the body and improves the utilization of insulin.
These studies have also noted that massage therapy has been shown to reduce anxiety in many groups, including individuals with type 2 diabetes. Other benefits of therapeutic massage include increased blood circulation, especially to the lower limbs.
It is best to complement yoga, mindfulness, and/ormassage therapy with natural medicines that may further de-stress the nervous system and help to reduce symptoms of anxiety and depression. Always check with your health care practitioner to make sure a supplement is right for you.
One of my favourite natural medicines for type 2 diabetes is the trace mineral chromium, which is thought to increase the sensitivity of insulin in the body. It has been well studied and can safely enhance the effectiveness of blood sugar-stabilizing medications by improving blood sugar control (double check with your health care practitioner before combining with medications). A large meta-analysis showed that supplemental chromium reduces both glycosylated hemoglobin and fasting blood sugar levels.
The less well-known benefits of supplemental chromium involve its ability to reduce certain symptoms of depression, including carbohydrate craving, as demonstrated by a 2005 study.
The other natural medicine that I often prescribe to type 2 diabetes patients with mental health issues is the herbal medicine Rhodiola rosea. I particularly like rhodiola since it has virtually no interactions with medication and therefore can be safely combined. Again, ask your health care practitioner to be safe.
Human studies support the use of rhodiola for the treatment of anxiety, mild to moderate depression, fatigue (burnout), and life stress. Very preliminary research on rats has shown it to reduce binge eating, which can be a problem among type 2 diabetes patients and may contribute to guilt and psychological distress.
Over the past 14 years I have treated hundreds of patients with mental health issues, including those with type 2 diabetes. In the majority of cases, the additions of lifestyle modifications and specific natural health products have successfully improved quality of life and medical outcomes.