Aims : To clarify the relationship between depression and glucose metabolism using sensitive measures of insulin resistance, and to assess if remission of depression results in enhanced insulin sensitivity. Methods : An intervention study to quantify changes in insulin sensitivity before and after treatment of depression was carried out. Twenty six Pakistani women with newly diagnosed depression underwent euglycemic insulin clamp to measure insulin sensitivity at inclusion and again after treatment of depression 6 - 8 weeks later. Twenty-three individuals completed both tests. Results : Significant improvement of insulin sensitivity was observed following the treatment of depression. The improved insulin sensitivity remained statistically significant after controlling for confounding factors. Conclusions : This study establishes a relationship between depression and insulin resistance. It demonstrated that insulin sensitivity can be improved by treating depression.
T. B. Ustun, J. L. Ayuso-Mateos, S. Chatterji, et al., “Global Burden of Depressive Disorders in the Year 2000,” The British Journal of Psychiatry, Vol. 184, 2000, pp. 386-392. doi:10.1192/bjp.184.5.386
P. J. Lustman, R. J. Anderson, K. E. Freedland, et al., “Depression and Poor Glycemiccontrol: A Meta-Analytic Review of the Literature,” Diabetes Care, Vol. 23, No. 7, 2000, pp. 934-942. doi:10.2337/diacare.23.7.934
M. De Groot, R. Anderson, K. E. Freedland, et al., “Association of Depression and Diabetes Complications: A Meta-Analysis,” Psychosomatic Medicine, Vol. 63, No. 4, 2001, pp. 619-630.
D. J. Wexler, R. W. Grant, E. Wittenberg, et al., “Correlates of Health Related Quality of Life in Type 2 Diabetes,” Diabetologia, Vol. 49, No. 7, 2006, pp. 1489-1497. doi:10.1007/s00125-006-0249-9
L. E. Egede, P. J. Nietert and D. Zheng, “Depression and All-Cause and Coronary Heart Disease Mortality among Adults with and without Diabetes,” Diabetes Care, Vol. 28, No. 6, 2005, pp. 1339-1345. doi:10.2337/diacare.28.6.1339
X. Zhang, S. L. Norris, E. W. Gregg, et al., “Depressive Symptoms and Mortality among Persons with and without Diabetes,” American Journal of Epidemiology, Vol. 161, No. 7, 2005, pp. 652-660. doi:10.1093/aje/kwi089
W. Sarah, R. Gojka, A. Green, et al., “Global Prevalence of Diabetes,” Diabetes Care, Vol. 27, No. 5, 2004, pp. 1047-1053.
M. J. Knol, J. W. R. Twisk, A. T. F. Beekman, et al., “Depression as a Risk Factor for the Onset of Type 2 Diabetes Mellitus. A Meta-Analysis,” Diabetologia, Vol. 49, No. 5, 2006, pp. 837-845. doi:10.1007/s00125-006-0159-x
J. M. McCaffery, R. Niaura, J. F. Todaro, et al., “Depressive Symptoms and Metabolic Risk in Adult Male Twins Enrolled in the National Heart, Lung, and Blood Institute Twin Study,” Psychosomatic Medicine, Vol. 65, No. 3, 2003, pp. 490-497. doi:10.1097/01.PSY.0000041545.52924.82
E. C. Suarez, “Sex Differences in the Relation of Depressive Symptoms, Hostility, and Anger Expression Indices of Glucose Metabolism in Non Diabetics,” Health Psychol, Vol. 25, No. 4, 2006, pp. 484-492. doi:10.1037/0278-6133.25.4.484
W. W. Eaton, H. Armenian, J. Gallo, et al., “Depression and Risk for Onset of Type 2 Diabetes: A Prospective Population-Based Study,” Diabetes Care, Vol. 19, No. 10, 1996, pp. 1097-1102. doi:10.2337/diacare.19.10.1097
N. Kawakami, N. Takatsuka, H. Shimizu, et al., “Depressive Symptoms and Occurrence of Type 2 Diabetes among Japanese Men,” Diabetes Care, Vol. 22, No. 7, 1999, pp. 1071-1076. doi:10.2337/diacare.22.7.1071
F. Talbot and A. Nouwen, “A Review of the Relationship between Depression and Diabetes in Adults: Is There a Link?” Diabetes Care, Vol. 23, No. 10, 2000, pp. 1556-1562. doi:10.2337/diacare.23.10.1556
M. Chiba, S. Suzuki, Y. Hinokio, et al., “Tyrosine Hydroxylase Gene Microsatellite Polymorphism Associated with Insulin Resistance in Depressive Disorder,” Metabolism, Vol. 49, No. 9, 2000, pp. 1145-1149. doi:10.1053/meta.2000.8611
D. A. Lawlor, G. Davey Smith and S. Ebrahim, “Association of Insulin Resistance with Depression: Cross Sectional Findings from the British Women’s Heart and Health Study,” British Medical Journal, Vol. 327, 2003, pp. 1383-1384. doi:10.1136/bmj.327.7428.1383
R. A. DeFronzo, J. D. Tobin and R. Andres, “Glucose Clamp Technique: A Method for Quantifying Insulin Secretion and Resistance,” American Journal of Physiology, Vol. 237, No. 3, 1979, pp. E214-E223.
M. Zimmerman, M. A. Posternak and I. Chelminski, “Derivation of a Definition of Remission on the Montgomery-Asberg Depression Rating Scale Corresponding to the Definition of Remission on the Hamilton Rating Scale for Depression,” Journal of Psychiatric Research, Vol. 38, No. 6, 2004, pp. 577-582. doi:10.1016/j.jpsychires.2004.03.007
A. Holmang and P. Bjorntrop, “The Effects of Cortisol on Insulin Sensitivity in Muscle,” Acta Physiologica Scandinavica, Vol. 144, No. 4, 1992, pp. 425-431. doi:10.1111/j.1748-1716.1992.tb09316.x
S. Asghar, A. Hussain, A. K. A. Khan, et al., “Prevalence of Depression and Diabetes: A Populationbased Study from Rural Bangladesh,” Diabetic Medicine, Vol. 24, No. 8, 2007, pp. 872-877. doi:10.1111/j.1464-5491.2007.02136.x
F. Fareeha, S. Asghar, A. Hussain, et al., “Depression and Diabetes in High-Risk Urban Population of Pakistan,” The Open Diabetes Journal, Vol. 3, 2010, pp. 1-5. doi:10.2174/1876524601003010001
N. Zahid, S. Asghar, A. Hussain, et al., “Depression and Diabetes in a Rural Community in Pakistan,” Diabetes Research and Clinical Practice, Vol. 79, No. 1, 2008, pp. 124-127. doi:10.1016/j.diabres.2007.07.006
R. J. Anderson, K. E. Freedland, R. E. Clouse, et al., “The Prevalence of Comorbid Depression in Adults with Diabetes: A Meta-Analysis,” Diabetes Care, Vol. 24, No. 6, 2001, pp. 1069-1078. doi:10.2337/diacare.24.6.1069
S. H. Golden, J. E. Williams, D. E. Ford, et al., “Depressive Symptoms and the Risk of Type 2 Diabetes: The Atherosclerosis Risk in Communities Study,” Diabetes Care, Vol. 27, No. 2, 2004, pp. 429-435.
American Diabetes Association, “Diagnosis and Classification of Diabetes Mellitus,” Diabetes Care, Vol. 30, No. S1, 2007, pp. S42-S47. doi:10.2337/dc07-S042
D. L. Musselman, E. Betan, H. Larsen, et al., “Relationship of Depression to Diabetes Types 1 and 2: Epidemiology, Biology, and Treatment,” Biological Psychiatry, Vol. 54, No. 3, 2003, pp. 317-329. doi:10.1016/S0006-3223(03)00569-9
J. M. Olefsky and G. Kimmerling, “Effects of Glucocorticoids on Carbohydrate Metabolism,” American Journal of the Medical Sciences, Vol. 271, No. 2, 1976, pp. 202- 210. doi:10.1097/00000441-197603000-00009
P. Linkowski, J. Mendlewicz, R. Leclercq, et al., “The 24-Hour Profile of Adrenocorticotropin and Cortisol in Major Depressive Illness,” The Journal of Clinical Endocrinology & Metabolism, Vol. 61, No. 3, 1985, pp. 429- 438. doi:10.1210/jcem-61-3-429
J. F. Mortola, J. H. Liu, J. C. Gillin, et al., “Pulsatile Rhythms of Adrenocorticotropin (ACTH) and Cortisol in Women with Endogenous Depression: Evidence of Increased ACTH Pulse Frequency,” The Journal of Clinical Endocrinology & Metabolism, Vol. 65, No. 5, 1987, pp. 962-968. doi:10.1210/jcem-65-5-962
P. Boyce and E. Barriball, “Circadian Rhythms and Depression,” Australian Family Physician, Vol. 39, No. 5, 2010, pp. 307-310.
M. S. McKay and K. K. Zakzanis, “The Impact of Treatment on HPA Axis Acitivity on Unipolar Major Depression,” Journal of Psychiatric Research, Vol. 44, No. 3, 2010, pp. 183-192. doi:10.1016/j.jpsychires.2009.07.012
A. Appels, F. W. Bar, J. Bar, et al., “Inflammation, Depressive Symptomatology, and Coronary Artery Disease,” Psychosomatic Medicine, Vol. 62, No. 5, 2000, pp. 601-605.
B. W. Penninx, S. B. Kritchevsky, K. Yaffe, et al., “Inflammatory Markers and Depressed Mood in Older Persons: Results from the Health, Aging and Body Composition Study,” Biological Psychiatry, Vol. 54, No. 5, 2003, pp. 566-572. doi:10.1016/S0006-3223(02)01811-5
P. K. Ranjekar, A. Hinge, M. V. Hegde, et al., “Decreased Antioxidant Enzymes and Membrane Essential Polyunsaturated Fatty Acids in Schizophrenic and Bipolar Mood Disorder Patients,” Psychiatry Research, Vol. 121, No. 2, 2003, pp. 109-122. doi:10.1016/S0165-1781(03)00220-8
A. Serretti and L. Mandelli, “Antidepressants and Body Weight: A Comprehensive Review and Meta-Analysis,” Journal of Clinical Psychiatry, Vol. 71, No. 10, 2010, pp. 1259-1272. doi:10.4088/JCP.09r05346blu
M. B. Raeder, I. Bjelland, V. S. Emil et al., “Obesity, Dyslipidemia, and Diabetes with Selective Serotonin Reuptake Inhibitors: The Hordaland Health Study,” Journal of Clinical Psychiatry, Vol. 67, No. 12, 2006, pp. 1974-1982. doi:10.4088/JCP.v67n1219
C. Lauren, Brown, R. M. Sumit, et al., “Type of Antidepressant Therapy and Risk of Type 2 Diabetes in People with Depression,” Diabetes research and Clinical Practice, Vol. 79, No. 1, 2008, pp. 61-67.