The association between depression and diabetes may be bi-directional meaning that diabetes may lead to the development of depression or vice versa . Diabetes has been shown to be one of the most psychologically and behaviorally demanding medical illnesses . Although early diabetes
may be largely asymptomatic, the threat or eventual development of long term complications, and the progressively more complex treatment regimens employed to maintain glycemic, lipid and blood pressure control in order to prevent these late complications, are perceived as a burden by the patient and
may predispose to depression. Patients often report feelings of fear, anger, resentment and devastation at the time of diagnosis; and feelings of social isolation are evident throughout all stages of disease . Feelings of vulnerability are also known to increase with longer diabetes duration and the appearance
of complications . Conversely, there is an increased risk of depressed people developing diabetes , with most
but not all of the risk being attributed to lifestyle factors . Depressed patients aremore likely to lead a sedentary lifestyle , have a poor diet and smoke , all of which are known risk factors for the development of type 2 diabetes.