Diabetes and Depression
- 5.4k Downloads
Diabetes and depression occur together approximately twice as frequently as would be predicted by chance alone. Comorbid diabetes and depression are a major clinical challenge as the outcomes of both conditions are worsened by the other. Although the psychological burden of diabetes may contribute to depression, this explanation does not fully explain the relationship between these 2 conditions. Both conditions may be driven by shared underlying biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors. Depression is frequently missed in people with diabetes despite effective screening tools being available. Both psychological interventions and antidepressants are effective in treating depressive symptoms in people with diabetes but have mixed effects on glycemic control. Clear care pathways involving a multidisciplinary team are needed to obtain optimal medical and psychiatric outcomes for people with comorbid diabetes and depression.
KeywordsDepression Diabetes Screening Treatment Mechanisms
We would like to acknowledge the other members of the Planning Committee of the NIDDK conference: Christine Hunter, Wayne Katon, Irwin Lucki, Paul Muehrer, Norman Sartorius and Larry Cimino
Compliance with Ethics Guidelines
Conflict of Interest
Richard IG Holt has acted as an advisory board member and speaker for Novo Nordisk, and as a speaker for Sanofi-Aventis, Eli Lilly, Otsuka, and Bristol-Myers Squibb. He has received grants in support of investigator trials from Novo Nordisk. Mary de Groot and Sherita Hill Golden declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology Bull World Health Organ. 2000;78:413–26.Google Scholar
- 7.Willis T. Pharmaceutice rationalis sive diabtriba de medicamentorum operantionibus in humano corpore. Oxford; 1675.Google Scholar
- 9.International Conference on Diabetes and Depression. Available at: http://www.niddk.nih.gov/news/events-calendar/Pages/international-conference-on-diabetes-and-depression.aspx.
- 23.••Nouwen A, Nefs G, Caramlau I, Connock M, Winkley K, Lloyd CE, et al. Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium. Diabetes Care. 2011;34:752–62. This meta-analysis compares the prevalence of depression in people with known and undiagnosed diabetes and impaired glucose tolerance. The higher rates in those with diagnosed diabetes suggest that the knowledge of the diagnosis and the burden of managing the condition and its complications are associated with depressive symptoms rather than biological mechanisms such as hyperglycemia.PubMedCentralPubMedCrossRefGoogle Scholar
- 29.•Barnard K, Peveler RC, Holt RI. Antidepressant medication as a risk factor for type 2 diabetes and impaired glucose regulation: systematic review. Diabetes Care. 2013;36:3337–45. This systematic review examines the evidence for a causal relationship between antidepressants and diabetes.PubMedCentralPubMedCrossRefGoogle Scholar
- 54.Carper MM, Traeger L, Gonzalez JS, Wexler DJ, Psaros C, Safren SA. The differential associations of depression and diabetes distress with quality of life domains in type 2 diabetes. J Behav Med. 2013. [Epub ahead of print].Google Scholar
- 58.Aikens JE, Perkins DW, Piette JD, Lipton B. Association between depression and concurrent Type 2 diabetes outcomes varies by diabetes regimen. Diabetes Med. 2008;25:1324–9.Google Scholar
- 59.•Park M, Katon WJ, Wolf FM. Depression and risk of mortality in individuals with diabetes: a meta-analysis and systematic review. Gen Hosp Psychiatry. 2013;35:217–25. This meta-analysis shows that depression, even if mild, is also associated with premature mortality through a range of physical conditions.PubMedCentralPubMedCrossRefGoogle Scholar
- 64.•Roy T, Lloyd CE, Pouwer F, Holt RI, Sartorius N. Screening tools used for measuring depression among people with Type 1 and Type 2 diabetes: a systematic review. Diabetes Med. 2012;29:164–75. This systematic review provides evidence of the validated screening tools for assessing depression in people with diabetes.CrossRefGoogle Scholar
- 71.•Pouwer F, Tack CJ, Geelhoed-Duijvestijn PH, Bazelmans E, Beekman AT, Heine RJ, et al. Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomized controlled trial. Diabetologia. 2011;54:741–8. This randomized trial shows that depression screening per se does not improve clinical outcomes and therefore highlights the importance of linking screening to appropriate depression care pathways.PubMedCentralPubMedCrossRefGoogle Scholar
- 73.van der Feltz-Cornelis CM, Nuyen J, Stoop C, Chan J, Jacobson AM, Katon W, et al. Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2010;32:380–95.PubMedCrossRefGoogle Scholar
- 86.National Collaborating Centre for Mental Health. Common mental health disorders: identification and pathways to care CG123. 2011. London, National Institute of Health and Clinical Excellence.Google Scholar
- 89.Disability Rights Commission. Equal treatment: closing the gap. A formal investigation into physical health inequalities experienced by people with learning difficulties and mental health problems. London: Disability Rights Commission; 2006.Google Scholar