context: Diabetes is a serious condition, and living with it can be a challenge. It can take a toll on your emotions. People with the disease are twice as likely to get depressed as people who don't have it. Depression is a problem on its own, and it can also keep you from taking good care of yourself. That can lead to high blood sugar levels and diabetes complications. So if you think you might be depressed, tell your doctor. You can take some steps to feel better. Depression is a complex disease. Its root causes can be tied to genes, your environment, and emotions. Managing diabetes can be stressful and time-consuming. The lifestyle and diet-related limits can make life seem less fun. There are several warning signs, including: Sadness Anxiety Irritability Lack of interest in things you once enjoyed Pulling away from your social life Can't concentrate Insomnia (trouble falling and staying asleep) Lots of guilt or feeling worthless Loss of energy, or fatigue Changes in appetite Observable mental and physical sluggishness Thoughts of death or suicide If you (or someone you love) has diabetes and show signs of depression, tell your doctor right away. Your doctor will make the call based on the symptoms you tell him about. Lab tests aren't used to diagnose depression. Your doctor will work with you to control your depression. If he suggests you try medication, he can prescribe one or more of these antidepressants: Selective serotonin reuptake inhibitors ( SSRIs) affect the way your brain uses a chemical called serotonin. Changing the balance of this chemical may help your brain cells receive messages better and boost your mood. Examples of this type of antidepressant include citalopram ( Celexa), escitalopram ( Lexapro), fluoxetine ( Prozac), paroxetine ( Paxil), and sertraline ( Zoloft). Serotonin norepinephrine reuptake inhibitors ( SNRIs) block the reabsorption of both serotonin and norepinephrine. Like SSRIs, they improve the way your brain sends and receives messages. Examples of this type of antidepressant are desvenlafaxine ( Khedezla, Pristiq), duloxetine ( Cymbalta), levomilnacipran ( Fetzima), venlafaxine ( Effexor) Tricyclic antidepressants boost the levels of certain chemicals in your brain that help nerve cells communicate with each other. If these chemicals are out of balance or don't work like they should, messages might not make it through your brain correctly, and that can lead to depression. Common tricyclics include amitriptyline ( Elavil), desipramine ( Norpramin), doxepin ( Sinequan), imipramine ( Tofranil), and nortriptyline ( Pamelor). Norepinephrine and dopamine reuptake inhibitors ( NDRIs) are another class of reuptake inhibitors, but they're represented by only one drug: Buproprion ( Wellbutrin). Many patients with diabetes and depression benefit from this drug. Side effects for each type of antidepressant often go away or become easier to handle over time. To help out until you get used to the drug, your doctor may start you out on a small dose and slowly build up to a higher amount. While studies are not conclusive, there is some evidence that combining tricyclics and SSRIs may actually increase the risk of developing diabetes. That may be a result of weight gain from taking tricyclics. However, there is also evidence that antidepressants may help control blood sugar levels in those who already have type 2 diabetes. Counseling, or psychotherapy, especially in combination with medication, can also help manage depression. Meeting with a support group can be good for you, too. Talk to your doctor about where you can turn for more help.