Current Psychiatry Reports

, Volume 13, Issue 1, pp 26–30 | Cite as

Diabetes and Depression

  • Antonio Campayo
  • Carlos H. Gómez-Biel
  • Antonio Lobo


In a context of the potentially epidemic nature of both diabetes mellitus and depression, and the negative effects reported in cases of comorbidity, this review suggests that the association of the two conditions is multifaceted. Increased risks of prevalent depression and incident depression among diabetic patients have been reported in community studies. Even more consistent is the finding supporting psychosomatic hypotheses regarding the increased risk of diabetes among depressed patients. A recent relevant finding is the increased risk of diabetes reported in depression that is commonly found in the community, namely nonsevere, persistent, untreated depression. In view of the negative implications of the comorbidity of depression and diabetes, the suggestion that all clinically relevant cases of depression found in the community should be treated seems logical. However, new studies seem mandatory to document the efficacy of treatment of depression and the safety of antidepressant use in cases of comorbidity.


Mood disorders Diabetes mellitus Metabolic syndrome Neuroendocrinology Liaison psychiatry 


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    David AS, Lishman WA: Lishman’s Organic Psychiatry: A Textbook of Neuropsychiatry, edn 4. Malden, MA: Blackwell Publishing; 2006.Google Scholar
  2. 2.
    Black PH: The inflammatory response is an integral part of the stress response: implications for atherosclerosis, insulin resistance, type II diabetes and metabolic syndrome X. Brain Behav Immun 2003, 17:350–364.CrossRefPubMedGoogle Scholar
  3. 3.
    Lobo A, Pérez-Echeverria MJ, Campayo A: Endocrine disorders. In Handbook of Liaison Psychiatry. Edited by Guthrie E, Lloyd GG. Cambridge, United Kingdom: Cambridge University Press; 2007:432–453.CrossRefGoogle Scholar
  4. 4.
    Murray CJ, Lopez AD: Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997, 349:1498–1504.CrossRefPubMedGoogle Scholar
  5. 5.
    King H, Aubert RE, Herman WH: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998, 21:1414–1431.CrossRefPubMedGoogle Scholar
  6. 6.
    Reynolds SL, Haley WE, Kozlenko N: The impact of depressive symptoms and chronic diseases on active life expectancy in older Americans. Am J Geriatr Psychiatry 2008, 16:425–432.CrossRefPubMedGoogle Scholar
  7. 7.
    Levenson JL: The American Psychiatric Publishing Textbook of Psychosomatic Medicine, edn 1. Washington, DC: American Psychiatric Publishing; 2005.Google Scholar
  8. 8.
    Anderson RJ, Freedland KE, Clouse RE, et al.: The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001, 24:1069–1078.CrossRefPubMedGoogle Scholar
  9. 9.
    Ali S, Stone MA, Peters JL, et al.: The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006, 23:1165–1173.CrossRefPubMedGoogle Scholar
  10. 10.
    Heckbert SR, Rutter CM, Oliver M, et al.: Depression in relation to long-term control of glycemia, blood pressure, and lipids in patients with diabetes. J Gen Intern Med 2010, 25:524–529.CrossRefPubMedGoogle Scholar
  11. 11.
    Lin EH, Katon W, Rutter C, et al.: Effects of enhanced depression treatment on diabetes self-care. Ann Fam Med 2006, 4:46–53.CrossRefPubMedGoogle Scholar
  12. 12.
    Egede LE, Ellis C: Diabetes and depression: global perspectives. Diabetes Res Clin Pract 2010, 87:302–312.CrossRefPubMedGoogle Scholar
  13. 13.
    • Lin EH, Rutter CM, Katon W, et al.: Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care 2010, 33:264–269. In this recent study, the complications of comorbid depression in cases of chronic diabetes are described, and potential underlying mechanisms are discussed. Depression is considered to have an important role in the development of the micro- and/or macrovascular complications and merits special attention. However, the authors recognize that new studies are needed to clarify the role of depression in long-term diabetes complications. CrossRefPubMedGoogle Scholar
  14. 14.
    Katon WJ: The comorbidity of diabetes mellitus and depression. Am J Med 2008, 121:8–15.CrossRefGoogle Scholar
  15. 15.
    Richardson LK, Egede LE, Mueller M: Effect of race/ethnicity and persistent recognition of depression on mortality in elderly men with type 2 diabetes and depression. Diabetes Care 2008, 10:880–881.CrossRefGoogle Scholar
  16. 16.
    Katon WJ, Lin EH, Williams LH, et al.: Comorbid depression is associated with an increased risk of dementia diagnosis in patients with diabetes: a prospective cohort study. J Gen Intern Med 2010, 25:423–429.CrossRefPubMedGoogle Scholar
  17. 17.
    Lobo A, Quintanilla MA, Saz P: Dementia. In The American Psychiatric Publishing Textbook of Psychosomatic Medicine, edn 2. Edited by Levenson JL. Washington, DC: American Psychiatric Publishing; 2010 (in press).Google Scholar
  18. 18.
    de Jonge P, Roy JF, Saz P, et al.: Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus: results from the ZARADEMP project. Diabetologia 2006, 49:2627–2633.CrossRefPubMedGoogle Scholar
  19. 19.
    • Nouwen A, Winkley K, Twisk J, et al.: Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia 2010 Aug 14 (Epub ahead of print). In a previous and relevant meta-analysis, Mezuk et al. [40•] documented the bidirectional association between depression and diabetes. However, Nouwen et al. (on behalf of the European Depression in Diabetes Research Consortium), in a new systematic review and meta-analysis of the literature, explored to what extent the association of diabetes and the onset of depression is different for studies using questionnaires than it is for those relying on diagnostic criteria for depression. They concluded that the risk of depression was significantly higher for studies relying on diagnostic criteria of depression than for studies using questionnaires. Compared with nondiabetic controls, individuals with type 2 diabetes have a 24% increased risk of developing depression. Google Scholar
  20. 20.
    Barglow P, Hatcher R, Edidin DV, et al.: Stress and metabolic control in diabetes: psychosomatic evidence and evaluation of methods. Psychosom Med 1984, 46:127–144.PubMedGoogle Scholar
  21. 21.
    • Lyketsos CG: Depression and diabetes: more on what the relationship might be. Am J Psychiatry 2010, 167:496–497. In this recent editorial related to the relevance of studying the association of diabetes and depression, Lyketsos emphasized the public health priority of identifying and treating depression. In his opinion, “Appreciating that depression may account for a significant number of new cases of diabetes further emphasizes the importance of this message.” However, he also considers that the notion that depression reduction outweighs the risk associated with antidepressant treatment is not settled and must be examined systematically in appropriately designed clinical trials. Studies to test hypotheses examining the possibly synergistic roles of behavioral factors and biological factors in the development of diabetes among individuals with depression might be a priority. Similarly, the urgent need to design randomized trials to study the potential “diabetogenic” effect of antidepressants is discussed in the editorial. CrossRefPubMedGoogle Scholar
  22. 22.
    Knol MJ, Heerdink ER, Egberts AC, et al.: Depressive symptoms in subjects with diagnosed and undiagnosed type 2 diabetes. Psychosom Med 2007, 69:300–305.CrossRefPubMedGoogle Scholar
  23. 23.
    de Jonge P, Rosmalen JG: Comment on: Knol MJ, Twisk JWR, Beekman ATF, Heine RJ, Snoek FJ, Pouwer F. (2006) depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia; 49: 837–845. Diabetologia 2006, 49:2797–2798.Google Scholar
  24. 24.
    Golden SH, Lazo M, Carnethon M, et al.: Examining a bidirectional association between depressive symptoms and diabetes. JAMA 2008, 299:2751–2759.CrossRefPubMedGoogle Scholar
  25. 25.
    Strik JJ, Honig A, Lousberg R, et al.: Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction. Psychosomatics 2001, 42:423–428.CrossRefPubMedGoogle Scholar
  26. 26.
    Mezuk B, Eaton WW, Golden SH, et al.: The influence of educational attainment on depression and risk of type 2 diabetes. Am J Public Health 2008, 98:1480–1485.CrossRefPubMedGoogle Scholar
  27. 27.
    Lobo A, Saz P, Marcos G, et al.: The prevalence of dementia and depression in the elderly community in a southern European population. The Zaragoza study. Arch Gen Psychiatry 1995, 52:497–506.PubMedGoogle Scholar
  28. 28.
    Campayo A, de Jonge P, Roy JF, et al.: Depressive disorder and incident diabetes mellitus: the effect of characteristics of depression. Am J Psychiatry 2010, 167:580–588.CrossRefPubMedGoogle Scholar
  29. 29.
    Eaton WW, Armenian H, Gallo J, et al.: Depression and risk for onset of type II diabetes. A prospective population-based study. Diabetes Care 1996, 19:1097–1102.CrossRefPubMedGoogle Scholar
  30. 30.
    Andersohn F, Schade R, Suissa S, et al.: Long-term use of antidepressants for depressive disorders and the risk of diabetes mellitus. Am J Psychiatry 2009, 166:591–598.CrossRefPubMedGoogle Scholar
  31. 31.
    Carnethon MR, Biggs ML, Barzilay JI, et al.: Longitudinal association between depressive symptoms and incident type 2 diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med 2007, 167:802–807.CrossRefPubMedGoogle Scholar
  32. 32.
    Egede LE: Diabetes, major depression, and functional disability among U.S. adults. Diabetes Care 2004, 27:421–428.CrossRefPubMedGoogle Scholar
  33. 33.
    Carnethon MR, Kinder LS, Fair JM, et al.: Symptoms of depression as a risk factor for incident diabetes: findings from the National Health and Nutrition Examination Epidemiologic Follow-up Study, 1971–1992. Am J Epidemiol 2003, 158:416–423.CrossRefPubMedGoogle Scholar
  34. 34.
    Marcus MD, Wing RR, Guare J, et al.: Lifetime prevalence of major depression and its effect on treatment outcome in obese type II diabetic patients. Diabetes Care 1992, 15:253–255.CrossRefPubMedGoogle Scholar
  35. 35.
    Musselman DL, Betan E, Larsen H, et al.: Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment. Biol Psychiatry 2003, 54:317–329.CrossRefPubMedGoogle Scholar
  36. 36.
    Golden SH: A review of the evidence for a neuroendocrine link between stress, depression and diabetes mellitus. Curr Diabetes Rev 2007, 3:252–259.CrossRefPubMedGoogle Scholar
  37. 37.
    Lehto SM, Heiskanen T, Hintikka J, et al.: Metabolic syndrome—the impact of depression. Ann Epidemiol 2008, 18:871.CrossRefPubMedGoogle Scholar
  38. 38.
    Vogelzangs N, Suthers K, Ferrucci L, et al.: Hypercortisolemic depression is associated with the metabolic syndrome in late-life. Psychoneuroendocrinology 2007, 32:151–159.CrossRefPubMedGoogle Scholar
  39. 39.
    Capuron L, Su S, Miller AH, et al.: Depressive symptoms and metabolic syndrome: is inflammation the underlying link? Biol Psychiatry 2008, 64:896–900.CrossRefPubMedGoogle Scholar
  40. 40.
    • Mezuk B, Eaton WW, Albrecht S, et al.: Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2008, 31:2383–2390. In our opinion, the study by Mezuk et al. completed at the time the best meta-analysis of the relationship between depression and diabetes. They emphasized the public health implications of this relationship and concluded that the association between depression and incident diabetes is more robust than the inverse association between diabetes and incident depression. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Antonio Campayo
    • 1
    • 2
    • 3
  • Carlos H. Gómez-Biel
    • 1
  • Antonio Lobo
    • 1
    • 2
    • 3
  1. 1.Hospital Clínico UniversitarioServicio de Psiquiatría (3ª Planta)ZaragozaSpain
  2. 2.Centro de Investigación Biomédica en Red de Salud Mental (CIBERsam)Ministry of Science and InnovationMadridSpain
  3. 3.Instituto Aragonés de Ciencias de la Salud (I+CS)ZaragozaSpain

Personalised recommendations