A Review of the Association Between Depression and Insulin Resistance: Pitfalls of Secondary Analyses or a Promising New Approach to Prevention of Type 2 Diabetes?
- 715 Downloads
We review the validity of the evidence for an association between depression and the risk of insulin resistance (IR). We describe the potentially plausible biological and behavioral mechanisms that explain how depression increases the risk of IR and consequent overt diabetes. We have identified gaps in the literature to guide future research. Evidence for bidirectional associations between depression and IR is inconsistent. Results showing positive associations between depression and IR are derived from cross-sectional studies, whereas negative findings are typically reported in cohort studies. On the other hand, tentative trial evidence suggests that the effective treatment of depression can improve IR, and that lifestyle programs improve IR and reduce depressive symptoms. These emerging themes could lead to potential new multidisciplinary approaches to preventing diabetes.
KeywordsDiabetes Depression Insulin resistance (IR) Hypothalamic-pituitary-adrenal (HPA) axis Homeostatic model assessment (HOMA) Type 2 diabetes Prevention
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.World Health Organization. The global burden of disease: 2004 Update. WHO Press; 2008.Google Scholar
- 4.••Nouwen A, Nefs G, Caramlau I, et al. Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes. Diabetes Care. 2011;34(3):752–762. This review shows that the prevalence of depression is similar in people with pre-diabetes compared with those with normal fasting plasma glucose and undiagnosed diabetes, but higher in people with known diabetes.PubMedCrossRefGoogle Scholar
- 16.Shen Q, Bergquist-Beringer S, Sousa VD. Major depressive disorder and insulin resistance in nondiabetic young adults in the United States: the National Health and Nutrition Examination Survey, 1999–2002. Biological Research for Nursing 2010. [Epub ahead of print].Google Scholar
- 22.Kauffman RP, Castracane VD, White DL, et al. Impact of the selective serotonin reuptake inhibitor citalopram on insulin sensitivity, leptin and basal cortisol secretion in depressed and non-depressed euglycemic women of reproductive age. Gynecol Endocrinol. 2005;21(3):129–37.PubMedCrossRefGoogle Scholar
- 24.Chen YC, Lin WW, Chen YJ, et al. Antidepressant effects on insulin sensitivity and proinflammatory cytokines in the depressed males. Mediators of Inflammation; 2010. [Epub 2010 May 18].Google Scholar
- 25.Atlantis E, Lange K, Goldney RD, et al. Specific medical conditions associated with clinically significant depressive symptoms in men. Soc Psychiatry Psychiatr Epidemiol 2010.Google Scholar
- 34.•Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220–229. This systematic review showed for the first time bidirectional associations between obesity and depression, and provides support for the hypothesis that lifestyle behaviors (unhealthy eating and physical inactivity) mediate the association between depression and diabetes.PubMedCrossRefGoogle Scholar
- 37.Patten SB, Williams JVA, Lavorato DH, Eliasziw M: A longitudinal community study of major depression and physical activity. General Hospital Psychiatry; 2009;31:571–575.Google Scholar
- 49.•Ye Z, Chen L, Yang Z, et al. Metabolic effects of fluoxetine in adults with type 2 diabetes mellitus: a meta-analysis of randomized placebo-controlled trials. PLoS One. 2011;6:e21551. This systematic review shows significant treatment effects of fluoxetine on reducing weight, triglyceride, and glycated hemoglobin levels in obese people with type 2 diabetes mellitus, which should be taken into account in the pharmacologic management of depression in individuals with excess body weight and diabetes.PubMedCrossRefGoogle Scholar