201
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Chien IC, Wu EL, Lin CH, Chou YJ, Chou P. Prevalence of diabetes in patients with major depressive disorder: a population-based study. Compr Psychiatry 2012; 53:569-75. [PMID: 21821237 DOI: 10.1016/j.comppsych.2011.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/14/2011] [Accepted: 06/18/2011] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We conducted this population-based study to detect the prevalence and associated factors of diabetes in patients with major depressive disorder (MDD) in Taiwan. METHODS The National Health Research Institute provided a database of 1,000,000 random subjects for health service study. We obtained a random sample of 766,427 subjects 18 years or older, in 2005. Study subjects who had at least one service claim during 2005 for either outpatient or inpatient care, with a primary diagnosis of MDD or with a primary or secondary diagnosis of diabetes, were identified. RESULTS The 1-year prevalence of diabetes in patients with MDD was higher than that in the general population (11.65% vs 6.53%; odds ratio, 1.53; 95% confidence interval, 1.39-1.69) in 2005. Compared with the general population, patients with MDD had a higher prevalence of diabetes in all age groups, except age 18 to 29 years; among men and women; among all insurance amount groups; among those living in the northern and southern regions; and among residents living in urban, suburban, and rural areas. A higher prevalence of diabetes in patients with MDD was associated with increased age, use of antipsychotic agents, use of mood stabilizers, and residence in suburban areas. CONCLUSIONS Patients with MDD had a much higher prevalence of diabetes in young adult age group and in men than in the general population. Consequently, we must emphasize prevention, early detection, and adequate treatment of diabetes in patients with MDD.
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Affiliation(s)
- I-Chia Chien
- Department of Health, Taoyuan Mental Hospital, Taoyuan, Taiwan.
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202
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Sacerdote C, Ricceri F, Rolandsson O, Baldi I, Chirlaque MD, Feskens E, Bendinelli B, Ardanaz E, Arriola L, Balkau B, Bergmann M, Beulens JWJ, Boeing H, Clavel-Chapelon F, Crowe F, de Lauzon-Guillain B, Forouhi N, Franks PW, Gallo V, Gonzalez C, Halkjær J, Illner AK, Kaaks R, Key T, Khaw KT, Navarro C, Nilsson PM, Dal Ton SO, Overvad K, Pala V, Palli D, Panico S, Polidoro S, Quirós JR, Romieu I, Sánchez MJ, Slimani N, Sluijs I, Spijkerman A, Teucher B, Tjønneland A, Tumino R, van der A D, Vergnaud AC, Wennberg P, Sharp S, Langenberg C, Riboli E, Vineis P, Wareham N. Lower educational level is a predictor of incident type 2 diabetes in European countries: the EPIC-InterAct study. Int J Epidemiol 2012; 41:1162-73. [PMID: 22736421 DOI: 10.1093/ije/dys091] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340, 234, 3.99 million person-years of follow-up). A random sub-cohort of 16,835 individuals and a total of 12,403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. RESULTS Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). CONCLUSION This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.
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203
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Torrente MP, Gelenberg AJ, Vrana KE. Boosting serotonin in the brain: is it time to revamp the treatment of depression? J Psychopharmacol 2012; 26:629-35. [PMID: 22158544 PMCID: PMC3325323 DOI: 10.1177/0269881111430744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abnormalities in serotonin systems are presumably linked to various psychiatric disorders including schizophrenia and depression. Medications intended for these disorders aim to either block the reuptake or the degradation of this neurotransmitter. In an alternative approach, efforts have been made to enhance serotonin levels through dietary manipulation of precursor levels with modest clinical success. In the last 30 years, there has been little improvement in the pharmaceutical management of depression, and now is the time to revisit therapeutic strategies for the treatment of this disease. Tryptophan hydroxylase (TPH) catalyzes the first and rate-limiting step in the biosynthesis of serotonin. A recently discovered isoform, TPH2, is responsible for serotonin biosynthesis in the brain. Learning how to activate this enzyme (and its polymorphic versions) may lead to a new, more selective generation of antidepressants, able to regulate the levels of serotonin in the brain with fewer side effects.
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Affiliation(s)
- Mariana P Torrente
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Alan J Gelenberg
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Kent E Vrana
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
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204
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Zahra S, Hossein S, Ali KV. Relationship between Opium Abuse and Severity of Depression in Type 2 Diabetic Patients. Diabetes Metab J 2012; 36:157-62. [PMID: 22540053 PMCID: PMC3335898 DOI: 10.4093/dmj.2012.36.2.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 09/08/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Opium use in diabetic populations is associated with major depressive disorder (MDD). This study was designed to investigate the relationship between opium use and severity of depression in Iranian diabetic patients. METHODS In this case-control study, 642 type 2 diabetic patients were recruited from those presenting at two outpatient clinics at the Akhavan Hospital in Kashan, Iran; of them, 600 diabetic patients were included in the study and divided into two groups: opium-abusers (150 patients) and non-opium-abusers (450 patients). Clinical and demographic information was obtained through a detailed questionnaire. Depression symptomalogy and severity were assessed with the Beck Depression Inventory (BDI), and a corresponding diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders-IV, Text Revision, 2000 (DSM-IV TR) criteria. RESULTS The mean depression score was higher in the opium abuse group than in the non-abuser group (29.27±1.44 vs. 18.29±1.31, P<0.001). In general, a significant association was found between opium abuse and depression among patients (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.87 to 7.44; P=0.001). No significant relationship was found between dysthymia and opium abuse (OR, 0.68; 95% CI, 0.18 to 1.192; P=0.155), while MDD was significantly higher in the opium abuser group (OR, 7.32; 95% CI, 5.20 to 12.01; P<0.001). CONCLUSION Depression is more frequent in opium-dependent diabetic patients, and its severity is also greater. Given these findings, opium-dependent diabetic patients should be advised about the increased risks of depression and related comorbidities.
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Affiliation(s)
- Sepehrmanesh Zahra
- Department of Psychiatry, Kashan University of Medical Sciences, Kashan, Iran
| | - Sarmast Hossein
- Emergency Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Kord Valeshabad Ali
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- National Elites Foundation, Tehran, Iran
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205
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Bot M, Pouwer F, Zuidersma M, van Melle JP, de Jonge P. Association of coexisting diabetes and depression with mortality after myocardial infarction. Diabetes Care 2012; 35:503-9. [PMID: 22301118 PMCID: PMC3322704 DOI: 10.2337/dc11-1749] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Diabetes and depression are both linked to an increased mortality risk after myocardial infarction (MI). Population-based studies suggest that having both diabetes and depression results in an increased mortality risk, beyond that of having diabetes or depression alone. The purpose of this study was to examine the joint association of diabetes and depression with mortality in MI patients. RESEARCH DESIGN AND METHODS Data were derived from two multicenter cohort studies in the Netherlands, comprising 2,704 patients who were hospitalized for MI. Depression, defined as a Beck Depression Inventory score ≥10, and diabetes were assessed during hospitalization. Mortality data were retrieved for 2,525 patients (93%). RESULTS During an average follow-up of 6.2 years, 439 patients died. The mortality rate was 14% (226 of 1,673) in patients without diabetes and depression, 23% (49 of 210) in patients with diabetes only, 22% (118 of 544) in patients with depression only, and 47% (46 of 98) in patients with both diabetes and depression. After adjustment for age, sex, smoking, hypertension, left ventricular ejection fraction, prior MI, and Killip class, hazard ratios for all-cause mortality were 1.38 (95% CI 1.00-1.90) for patients with diabetes only, 1.39 (1.10-1.76) for patients with depression only, and as much as 2.90 (2.07-4.07) for patients with both diabetes and depression. CONCLUSIONS We observed an increased mortality risk in post-MI patients with both diabetes and depression, beyond the association with mortality of diabetes and depression alone.
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Affiliation(s)
- Mariska Bot
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, the Netherlands.
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206
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Kim C. Does Menopause Increase Diabetes Risk? Strategies for Diabetes Prevention in Midlife Women. WOMENS HEALTH 2012; 8:155-67. [DOI: 10.2217/whe.11.95] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Menopause is a significant milestone for midlife women. The characteristic changes in sex hormones and associated symptoms mark a time of increased risk for chronic disease, most notably cardiovascular disease. The diabetes epidemic, combined with recent epidemiologic studies linking sex hormone profiles with incident diabetes risk, have recently raised the possibility that the menopause may increase diabetes risk as well. This report reviews studies of menopause and diabetes risk, as well as the potential mechanisms through which menopause might affect traditional and more novel diabetes risk factors. Diabetes risk appears to be more strongly linked with factors associated with chronological aging and sex hormones rather than changes in menopausal status per se. Strategies to reduce diabetes risk, namely lifestyle changes, hormone therapy and other pharmacologic interventions are also discussed vis à vis midlife women and menopause.
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Affiliation(s)
- Catherine Kim
- 300 North Ingalls Building, Room 7C13, Mailstop 5429, Ann Arbor, MI 48109-45429, USA, Tel.: +1 734 936 4787, Fax: +1 734 936 8944,
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207
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Kuo SY, Pi-Hua PH, Chuang LM, Chen WJ. The Taipei Adolescent Twin/Sibling Family Study II: Depression, Insulin Resistance, and Hormonal Factors. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.9.6.895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIn this ongoing longitudinal study of adolescent twins/sibling pairs and their parents in Taipei, we aimed to investigate the genetic and environmental influences on adolescent behavioral development, metabolic risk factors, and the associations between the two. Special focus is on anxious depression, metabolic profile, and hormonal factors such as cortisol and leptin. The first wave of assessment was completed during the period of 2002 to 2005 and included 192 twin pairs, 6 triplets, 56 sibling pairs and their first-degree relatives (484 parents and 142 siblings). We are currently in the process of a second wave assessment as follow-up. Dimensional psychological assessments using self-report questionnaires, as well as categorical assessments based on semistructured clinical interviews, were performed. All subjects received a 2-hour oral glucose tolerance test at the examination site. The metabolic phenotypes including body mass index, blood pressure, levels of glucose, insulin, and lipid profile as well as related hormonal levels were measured. Zygosity was determined using DNA, except for a few twins whose DNA was not available. Such a combination of detailed psychological assessments and metabolic function tests is expected to help shed light on the interrelation of psychological well-being and metabolic functioning.
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208
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The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Soc Psychiatry Psychiatr Epidemiol 2012; 47:175-84. [PMID: 21184214 DOI: 10.1007/s00127-010-0330-z] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the link between multimorbidity, type of chronic physical health problems and depressive symptoms METHOD The study was a cross-sectional postal survey conducted in 30 General Practices in Victoria, Australia as part of the diamond longitudinal study. Participants included 7,620 primary care attendees; 66% were females; age range from 18 to 76 years (mean = 51 years SD = 14); 81% were born in Australia; 64% were married and 67% lived in an urban area. The main outcome measures include the Centre for Epidemiologic Studies Depression Scale (CES-D) and a study-specific self-report check list of 12 common chronic physical health problems. RESULTS The prevalence of probable depression increased with increasing number of chronic physical conditions (1 condition: 23%; 2 conditions: 27%; 3 conditions: 30%; 4 conditions: 31%; 5 or more conditions: 41%). Only 16% of those with no listed physical conditions recorded CES-D scores of 16 or above. Across the listed physical conditions the prevalence of 'probable depression' ranged from 24% for hypertension; 35% for emphysema; 35% for dermatitis to 36% for stroke. The dose-response relationship is reduced when functional limitations and self-rated health are taken into account, suggesting that these factors mediate the relationship. CONCLUSIONS A clear dose-response relationship exists between the number of chronic physical problems and depressive symptoms. The relationship between multimorbidity and depression appears to be mediated via self-perceived health related quality of life. Primary care practitioners will identify more cases of depression if they focus on those with more than one chronic health problem, no matter what the problems may be, being especially aware in the group who rate their health as poor/fair.
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209
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Abstract
Diabetes with comorbid depression increases healthcare use, expenditures, and risk for complications. This study investigated current practice patterns for diabetic management as measured by HbA1C (A1C). Results indicated significant increases in Patient Health Questionnaire (PHQ)-9 and HbA1C scores among patients with diabetes who take antidepressant drugs.
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Affiliation(s)
- Anna M Acee
- Long Island University, School of Nursing, Brooklyn, NY, USA
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210
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Depression and type 2 diabetes: Inflammatory mechanisms of a psychoneuroendocrine co-morbidity. Neurosci Biobehav Rev 2012; 36:658-76. [DOI: 10.1016/j.neubiorev.2011.10.001] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 10/01/2011] [Accepted: 10/05/2011] [Indexed: 01/28/2023]
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211
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Davydow DS, Hough CL, Russo JE, Von Korff M, Ludman E, Lin EHB, Ciechanowski P, Young B, Oliver M, Katon WJ. The association between intensive care unit admission and subsequent depression in patients with diabetes. Int J Geriatr Psychiatry 2012; 27:22-30. [PMID: 21308790 PMCID: PMC3810068 DOI: 10.1002/gps.2684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 12/07/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine whether intensive care unit (ICU) admission is independently associated with increased risk of major depression in patients with diabetes. METHODS This prospective cohort study included 3596 patients with diabetes enrolled in the Pathways Epidemiologic Follow-Up Study, of whom 193 had at least one ICU admission over a 3-year period. We controlled for baseline depressive symptoms, demographics, and clinical characteristics. We examined associations between ICU admission and subsequent major depression using logistic regression. RESULTS There were 2624 eligible patients who survived to complete follow-up; 98 had at least one ICU admission. Follow-up assessments occurred at a mean of 16.4 months post-ICU for those who had an ICU admission. At baseline, patients who had an ICU admission tended to be depressed, older, had greater medical comorbidity, and had more diabetic complications. At follow-up, the point prevalence of probable major depression among patients who had an ICU admission was 14% versus 6% among patients without an ICU admission. After multivariate adjustment, ICU admission was independently associated with subsequent probable major depression (Odds Ratio 2.07, 95% confidence interval (1.06-4.06)). Additionally, baseline probable major depression was significantly associated with post-ICU probable major depression. CONCLUSIONS ICU admission in patients with diabetes is independently associated with subsequent probable major depression. Additional research is needed to identify at-risk patients and potentially modifiable ICU exposures in order to inform future interventional studies with the goal of decreasing the burden of comorbid depression in older patients with diabetes who survive critical illnesses.
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Affiliation(s)
- Dimitry S. Davydow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Catherine L. Hough
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Joan E. Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Evette Ludman
- The Group Health Cooperative Research Institute, Seattle, WA, USA
| | | | - Paul Ciechanowski
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Bessie Young
- Department of Medicine, University of Washington, Seattle, WA, USA,The Epidemiologic Research and Information Center, VA Puget Sound Health Care Center, Seattle, WA, USA
| | - Malia Oliver
- The Group Health Cooperative Research Institute, Seattle, WA, USA
| | - Wayne J. Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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212
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Anaforoğlu I, Ramazanoğulları I, Algün E, Kutanis R. Depression, anxiety and quality of life of family caregivers of patients with type 2 diabetes. Med Princ Pract 2012; 21:360-5. [PMID: 22188726 DOI: 10.1159/000334622] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 10/24/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It was our aim to investigate the quality of life (QOL) among family caregivers of patients with type 2 diabetes mellitus. SUBJECTS AND METHODS The Short Form-36 QOL scale, Beck Depression Inventory and State-Trait Anxiety Inventory Form were used to evaluate the presence and degree of depression and anxiety and their association with sociodemographic features of 50 family caregivers of diabetic patients compared to 54 controls. RESULTS The groups were similar in terms of age, sex, health insurance, educational status and marital and financial status. Beck Depression Inventory scores were significantly higher in family caregivers (p = 0.001) than in controls. Depression as a categorical variable was significantly more frequent among family caregivers of diabetic patients than among controls (p < 0.001). The social function component of the QOL of controls was better than that of family caregivers (p < 0.005). There was no difference between groups in terms of anxiety. CONCLUSION Family caregivers of diabetic patients appeared to be more prone to depression and tended to have a poorer QOL.
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Affiliation(s)
- Inan Anaforoğlu
- Department of Endocrinology and Metabolism, Trabzon Numune Education and Research Hospital, Trabzon, Turkey.
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213
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Lange-Asschenfeldt C, Lederbogen F. [Antidepressant therapy in coronary artery disease]. DER NERVENARZT 2011; 82:657-64; quiz 665-6. [PMID: 21109992 DOI: 10.1007/s00115-010-3181-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Depression is considered an independent risk factor for coronary artery disease (CAD) and other vascular conditions. Moreover, comorbid depressive disorder in CAD patients carries an increased risk of cardiac events and mortality. Among survivors of acute myocardial infarction, up to 20% meet diagnostic criteria for major depression, the presence of which carries a fivefold increased risk of cardiac death within 6 months. Heart patients with depressive comorbidity require particular care for both adequate treatment of their affective disorder and reduction of their cardiac risk. Antidepressant treatment must follow established guidelines; special care is needed to avoid cardiac side effects. In this review, we discuss the pathophysiological and prognostic significance of comorbid depression in CAD and weigh risks and benefits of available treatment options - particularly different drug classes and psychotherapy - in light of recent study results.
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Affiliation(s)
- C Lange-Asschenfeldt
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum, Heinrich-Heine-Universität, Bergische Landstraße 2, 40629, Düsseldorf.
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214
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Rustad JK, Musselman DL, Nemeroff CB. The relationship of depression and diabetes: pathophysiological and treatment implications. Psychoneuroendocrinology 2011; 36:1276-86. [PMID: 21474250 DOI: 10.1016/j.psyneuen.2011.03.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 02/25/2011] [Accepted: 03/08/2011] [Indexed: 12/15/2022]
Abstract
Diabetes is a highly prevalent, chronic disease that requires ongoing, multi-specialty medical care combined with patient self-management, family support, and education to prevent or delay end-organ morbidity and mortality. There is clearly an increased prevalence of major depressive disorder, a relatively common and costly central nervous system syndrome, in diabetic patients. During the past two decades, multiple studies reveal that not only are depressive symptoms a risk factor for the development of type 2 diabetes, but they have also been shown to contribute to hyperglycemia, diabetic complications, functional disability and all-cause mortality among diabetic patients. This article reviews studies examining the relationship between depression and diabetes, neurochemical underpinnings of the two disorders, and the diagnosis and treatment of depression associated with diabetes. We examine the validity of rating scales used to diagnose depression in diabetic patients and review the literature on psychotherapeutic and psychopharmacologic management for these patients. The challenges of optimal depression screening and treatment in primary care settings of diabetic patients are currently under close scrutiny, especially regarding their potential impact related to improvements in diabetes-related outcomes and decreased health care costs, be it "depression" or "diabetes" relevant. Much of the current literature regarding the intertwined nature of diabetes and depression is cross-sectional in nature. Future research should focus on longitudinal, prospective studies to determine causal factors. What is clear from the research reviewed in this article is that depression and diabetes should be treated together rather than as isolated diseases. The mind/body dualism is a false dichotomy and a truly team-based approach is necessary to address both issues of depression and diabetes. Collaborative care and the "patient-centered medical home" have emerged as potentially effective interventions to improve quality of care and patient outcomes in patients with depression and medical illnesses such as diabetes.
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Affiliation(s)
- James K Rustad
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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215
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Binkofski F, Loebig M, Jauch-Chara K, Bergmann S, Melchert UH, Scholand-Engler HG, Schweiger U, Pellerin L, Oltmanns KM. Brain energy consumption induced by electrical stimulation promotes systemic glucose uptake. Biol Psychiatry 2011; 70:690-5. [PMID: 21703596 DOI: 10.1016/j.biopsych.2011.05.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 05/06/2011] [Accepted: 05/06/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Controlled transcranial stimulation of the brain is part of clinical treatment strategies in neuropsychiatric diseases such as depression, stroke, or Parkinson's disease. Manipulating brain activity by transcranial stimulation, however, inevitably influences other control centers of various neuronal and neurohormonal feedback loops and therefore may concomitantly affect systemic metabolic regulation. Because hypothalamic adenosine triphosphate-sensitive potassium channels, which function as local energy sensors, are centrally involved in the regulation of glucose homeostasis, we tested whether transcranial direct current stimulation (tDCS) causes an excitation-induced transient neuronal energy depletion and thus influences systemic glucose homeostasis and related neuroendocrine mediators. METHODS In a crossover design testing 15 healthy male volunteers, we increased neuronal excitation by anodal tDCS versus sham and examined cerebral energy consumption with ³¹phosphorus magnetic resonance spectroscopy. Systemic glucose uptake was determined by euglycemic-hyperinsulinemic glucose clamp, and neurohormonal measurements comprised the parameters of the stress systems. RESULTS We found that anodic tDCS-induced neuronal excitation causes an energetic depletion, as quantified by ³¹phosphorus magnetic resonance spectroscopy. Moreover, tDCS-induced cerebral energy consumption promotes systemic glucose tolerance in a standardized euglycemic-hyperinsulinemic glucose clamp procedure and reduces neurohormonal stress axes activity. CONCLUSIONS Our data demonstrate that transcranial brain stimulation not only evokes alterations in local neuronal processes but also clearly influences downstream metabolic systems regulated by the brain. The beneficial effects of tDCS on metabolic features may thus qualify brain stimulation as a promising nonpharmacologic therapy option for drug-induced or comorbid metabolic disturbances in various neuropsychiatric diseases.
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216
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Baune BT, Thome J. Translational research approach to biological and modifiable risk factors of psychosis and affective disorders. World J Biol Psychiatry 2011; 12 Suppl 1:28-34. [PMID: 21905992 DOI: 10.3109/15622975.2011.603223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES This review summarizes the literature on (molecular-) biological, medical, environmental and modifiable risk factors for psychosis and mood disorders with the view of their suitability for translational research and mental health practice from preventative and clinical treatment perspectives. METHODS This review summarized literature on biological, medical, environmental and modifiable risk factors for psychosis and mood disorders evaluating their potential for translational research and clinical practice. RESULTS Based on the concept of the gene - environment interaction in the development of mental disorders, we highlight the numerous risk factors reported to contribute to an increased susceptibility to schizophrenia and mood disorders of young adults to late-life. Special emphasis is placed onto the discussion on the requirement of translational and interdisciplinary research approaches integrating basic and clinical neuroscience approaches that may have important implications for future studies and clinical practice. CONCLUSIONS Interdisciplinary research approaches integrating developmental neuroscience and policy makers are encouraged in order to achieve effective prevention and intervention programs addressing environmental, behavioural, biological factors relevant to psychiatric disorders during young ages, adulthood and aging.
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Affiliation(s)
- B T Baune
- Discipline of Psychiatry, University of Adelaide, School of Medicine, Adelaide, Australia.
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217
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Davydow DS, Russo JE, Ludman E, Ciechanowski P, Lin EHB, Von Korff M, Oliver M, Katon WJ. The association of comorbid depression with intensive care unit admission in patients with diabetes: a prospective cohort study. PSYCHOSOMATICS 2011; 52:117-26. [PMID: 21397103 DOI: 10.1016/j.psym.2010.12.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 09/22/2010] [Accepted: 09/27/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is unknown if comorbid depression in patients with diabetes mellitus increases the risk of intensive care unit (ICU) admission. OBJECTIVE This study examined whether comorbid depression in patients with diabetes increased risk of ICU admission, coronary care unit (CCU) admission, and general medical-surgical unit hospitalization, as well as total days hospitalized, after controlling for demographics, clinical characteristics, and health risk behaviors. METHOD This prospective cohort study included 3,596 patients with diabetes enrolled in the Pathways Epidemiologic Follow-Up Study. We assessed baseline depression with the Patient Health Questionnaire-9. We controlled for baseline demographics, smoking, BMI, exercise, hemoglobin A(1c), medical comorbidities, diabetes complications, type 1 diabetes, diabetes duration, and insulin treatment. We assessed time to any ICU, CCU, and/or general medical-surgical unit admission using Cox proportional-hazards regression. We used Poisson regression with robust standard errors to examine associations between depression and total days hospitalized. RESULTS Unadjusted analyses revealed that baseline probable major depression was associated with increased risk of ICU admission [hazard ratio (HR) 1.94, 95% confidence interval (95% CI)(1.34-2.81)], but was not associated with CCU or general medical-surgical unit admission. Fully adjusted analyses revealed probable major depression remained associated with increased risk of ICU admission [HR 2.23, 95% CI(1.45-3.45)]. Probable major depression was also associated with more total days hospitalized (Incremental Relative Risk 1.64, 95%CI(1.26-2.12)). CONCLUSIONS Patients with diabetes and comorbid depression have a greater risk of ICU admission. Improving depression treatment in patients with diabetes could potentially prevent hospitalizations for critical illnesses and lower healthcare costs.
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Affiliation(s)
- Dimitry S Davydow
- Dept. of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, Seattle, WA 98195, USA.
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Markowitz SM, Gonzalez JS, Wilkinson JL, Safren SA. A review of treating depression in diabetes: emerging findings. PSYCHOSOMATICS 2011; 52:1-18. [PMID: 21300190 DOI: 10.1016/j.psym.2010.11.007] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 07/07/2009] [Accepted: 07/08/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depression in patients with diabetes is associated with poorer adherence and worse health outcomes, however treating depression may help improve these outcomes. OBJECTIVE The present systematic review identified published papers to evaluate treatments for depression in patients with diabetes. RESULTS Seventeen studies that met criteria were identified, indicating that psychosocial interventions, particularly cognitive-behavior therapy, anti-depressant medications, and collaborative care are effective in the treatment of depression in patients with diabetes. CONCLUSION Evidence for the efficacy of these interventions in improving glycemic control was mixed. No study targeted adherence to treatment or health behaviors in addition to depression, which may be necessary to maximize improvement in diabetes outcomes such as glycemic control.
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Affiliation(s)
- Sarah M Markowitz
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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The metabolic syndrome and mind-body therapies: a systematic review. J Nutr Metab 2011; 2011:276419. [PMID: 21773016 PMCID: PMC3136147 DOI: 10.1155/2011/276419] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 03/18/2011] [Indexed: 11/18/2022] Open
Abstract
The metabolic syndrome, affecting a substantial and increasing percentage of the worldwide population, is comprised of a cluster of symptoms associated with increased risk of type 2 diabetes, cardiovascular disease, and other chronic conditions. Mind-body modalities based on Eastern philosophy, such as yoga, tai chi, qigong, and meditation, have become increasingly popular worldwide. These complementary therapies have many reported benefits for improving symptoms and physiological measures associated with the metabolic syndrome. However, clinical trial data concerning the effectiveness of these practices on the syndrome as a whole have not been evaluated using a systematic and synthesizing approach. A systematic review was conducted to critically evaluate the data from clinical trials examining the efficacy of mind-body therapies as supportive care modalities for management of the metabolic syndrome. Three clinical trials addressing the use of mind-body therapies for management of the metabolic syndrome were identified. Findings from the studies reviewed support the potential clinical effectiveness of mind-body practices in improving indices of the metabolic syndrome.
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Gomes JEM, Ruiz T, Corrente JE. Sintomas depressivos e déficit cognitivo na população de 60 anos e mais em um município de médio porte do interior paulista*. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2011. [DOI: 10.5712/rbmfc6(19)90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: a população mundial está envelhecendo e o Brasil segue essa tendência, o que demanda uma reorganização da sociedade para o cuidado desses idosos. Observa-se, nesta tendência, um aumento do número de casos de depressão e demência, além da vinculação destas com outras doenças crônico-degenerativas. Objetivo: estimar a prevalência dos sintomas depressivos e déficits cognitivos em uma população de 60 anos e mais, moradora de um município de médio porte do interior do estado de São Paulo, e sua associação com outras doenças crônico-degenerativas mais prevalentes. Métodos: estudo transversal, com 364 idosos, utilizando: instrumentos sociodemográficos e de morbidade; o Mini Exame do Estado Mental (MEEM), a Escala de Yesavage, a Escala de Atividades de Vida Diária e a Escala de Atividades Instrumentais de Vida Diária (AIVD). Foram realizadas: análises estatísticas de frequências dos escores dos instrumentos; apresentação da sumarização das variáveis e as possíveis associações entre depressão/demência, aplicando-se o teste do X2 seguido do ajuste de um modelo de regressão logística para dados ordinais. Resultados: a suspeita de depressão foi encontrada em 44% (160) e o déficit cognitivo foi identificado em 38,7% (141) dos idosos. Aproximadamente 75% dos idosos, com suspeita de depressão ou déficit cognitivo, eram portadores de pelo menos mais uma patologia crônica. Foi possível estabelecer associações estatisticamente significativas entre: suspeita de depressão e AIVD (p<0,0001; OR=7,59; IC=3,361-7,139) e déficit cognitivo e AIVD (p=0,0007; OR=3,967; IC=1,788-8,799). Não foram encontradas associações entre idade, situação conjugal, escolaridade, inserção no mercado de trabalho, aposentadoria ou renda. Conclusão: idosos de ambos os sexos estão vulneráveis a doenças como depressão e demência. Por outro lado, sintomas depressivos e déficit cognitivo foram associados ao escore dos idosos comprometidos, segundo as AIVD.*Parte da Dissertação de Mestrado apresentada à Faculdade de Medicina de Botucatu para a obtenção do Título de Mestre em Saúde Pública.
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Russo AJ. Analysis of plasma zinc and copper concentration, and perceived symptoms, in individuals with depression, post zinc and anti-oxidant therapy. Nutr Metab Insights 2011; 4:19-27. [PMID: 23946658 PMCID: PMC3738484 DOI: 10.4137/nmi.s6760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIM To assess plasma Zn and Cu levels in individuals with depression. SUBJECTS AND METHODS Plasma from 73 clinically depressed individuals, 38 individuals with anxiety and 16 controls were tested for plasma Zn and Cu concentration using inductively-coupled plasma-mass spectrometry. RESULTS Depressed individuals, with and without secondary anxiety, had decreased plasma Zn and elevated plasma Cu compared to controls. Zn normalized (increased to the level of normal controls) but Cu increased in individuals with depression (with and without secondary anxiety), after Zn therapy, whereas both plasma Zn increased and Cu levels decreased in anxiety, with and without secondary depression, after Zn therapy. Individuals with depression,with and without secondary anxiety, had significantly higher symptom severity when compared to neurotypical controls. Symptom severity in individuals with anxiety (both with and without secondary depression) significantly decreased after Zn therapy, whereas symptoms remained the same in individuals with primary depression. DISCUSSION These data show an association between Zn and Cu plasma levels and clinically depressed individuals, and suggest that high Cu levels are associated with high symptom severity.
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Affiliation(s)
- A J Russo
- Health Research Institute/Pfeiffer Treatment Center, 4575 Weaver Parkway, Warrenville, Illinois 60555, USA
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222
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Depression and treatment nonadherence in type 2 diabetes: Assessment issues and an integrative treatment approach. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00000798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractResearch has found that depression is more common among individuals with diabetes and is associated with worse diabetes outcomes including treatment nonadherence, worse glycemic control, higher risk of diabetes complications, greater functional impairment, and increased risk of mortality. These patterns of association have led to an increase in research investigating the relationship between diabetes and depression. There remain important questions about the relationship between depression and diabetes and an unmet need for treatment approaches that are successful in ameliorating depression and improving diabetes outcomes. The current commentary discusses several conceptual issues related to the measurement of depression in diabetes, argues for the importance of health behavior and treatment adherence in approaching the problem of depression in diabetes, and provides an example of a treatment approach that incorporates the treatment of depression with strategies aimed at improving treatment adherence in order to maximize effects on diabetes outcomes.
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Jacobs GE, Hulskotte EGJ, van Gerven JMA, Zuurman L, de Kam ML, Elassaiss-Schaap J, Ruigt G, van Pelt J, Peeters BWMM, Peeters PAM, Burggraaf J. Desmopressin as a pharmacological tool in vasopressinergic hypothalamus-pituitary-adrenal axis modulation: neuroendocrine, cardiovascular and coagulatory effects. J Psychopharmacol 2011; 25:353-60. [PMID: 20142306 DOI: 10.1177/0269881109358203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arginine-vasopressin (AVP) is a physiological co-activator of the hypothalamus-pituitary-adrenal (HPA) axis, together with corticotrophin releasing hormone (CRH). A synthetic analogue of AVP, desmopressin (dDAVP), is often used as a pharmacological tool to assess co-activation in health and disease. The relation between dDAVP's neuroendocrine, cardiovascular, pro-coagulatory, anti-diuretic and non-specific stress effects has not been studied. A randomized, double-blind, placebo-controlled, three-way crossover study was performed in 12 healthy male and female volunteers (6 : 6). dDAVP was administered intravenously as a 10 μg bolus (over 1 min) or a 30 μg incremental infusion (over 60 min). Neuroendocrine, cardiovascular, pro-coagulatory, anti-diuretic effects and adverse events (AEs) were recorded, and autonomic nervous system (ANS) activation evaluated. The incremental infusion reached 1.8-fold higher dDAVP concentrations than the bolus. Neuroendocrine effects were similar for the 10 μg dDAVP bolus and the 30 μg incremental infusion, while cardiovascular and coagulatory effects were greater with the 30 µg dose. Osmolality and ANS activity remained uninfluenced. AEs corresponded to dDAVP's side-effect profile. In conclusion, the neuroendocrine effects of a 10 μg dDAVP bolus administered over 1 min are similar to those of a 30 μg incremental infusion administered over one hour, despite higher dDAVP concentrations after the infusion. Cardiovascular and coagulatory effects showed clear dose-related responses. A 10 μg dDAVP bolus is considered a safe vasopressinergic function test at which no confounding effects of systemic or autonomic stress were seen.
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Affiliation(s)
- G E Jacobs
- Centre for Human Drug Research, Leiden, The Netherlands
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225
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Kucyi A, Alsuwaidan MT, Liauw SS, McIntyre RS. Aerobic physical exercise as a possible treatment for neurocognitive dysfunction in bipolar disorder. Postgrad Med 2011; 122:107-16. [PMID: 21084787 DOI: 10.3810/pgm.2010.11.2228] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neurocognitive dysfunction associated with bipolar disorder (BD) is pervasive, persistent across illness phases, and is demonstrated to predispose and portend psychosocial impairment. Moreover, no approved therapies for various phases of BD have been shown to reliably improve any dimension of neurocognitive performance. In this article, we emphasize that aerobic physical exercise is a viable neurocognitive-enhancing adjunctive treatment for patients with BD. The overarching aim of this review is to emphasize that aerobic physical exercise is a viable neurocognitive-enhancing adjunctive treatment for patients with BD. METHODS We conducted PubMed and Google Scholar searches of all English-language articles published between January 1966 and February 2010 using the search terms bipolar disorder, major depressive disorder, depression, exercise, and physical activity cross-referenced with each other and the following terms: cognition, executive function, learning, memory, attention, emotion, and behavior. Articles selected for review were based on adequacy of sample size, use of standardized experimental procedures, validated assessment measures, and overall quality. RESULTS Available studies have documented an array of persisting neurocognitive deficits across disparate bipolar populations. Abnormalities in verbal working memory are highly replicated; deficits in executive function, learning, attention, and processing speed are also a consistent abnormality. The effect sizes of neurocognitive deficits in BD are intermediate between those reported in schizophrenia and major depressive disorder. Several original reports and reviews have documented the neurocognitive-enhancing effects of aerobic exercise in the general population as well as across diverse medical populations and ages. Proposed mechanisms involve nonexclusive effects on neurogenesis, neurotrophism, immunoinflammatory systems, insulin sensitivity, and neurotransmitter systems. Each of these effector systems are implicated in both normal and abnormal neurocognitive processes in BD. CONCLUSION Available evidence provides a rationale for empirically evaluating the neurocognitive benefits of aerobic exercise in BD.
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Affiliation(s)
- Aaron Kucyi
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
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226
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Reagan LP. Diabetes as a chronic metabolic stressor: causes, consequences and clinical complications. Exp Neurol 2011; 233:68-78. [PMID: 21320489 DOI: 10.1016/j.expneurol.2011.02.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/04/2011] [Accepted: 02/06/2011] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus is an endocrine disorder resulting from inadequate insulin release and/or reduced insulin sensitivity. The complications of diabetes are well characterized in peripheral tissues, but there is a growing appreciation that the complications of diabetes extend to the central nervous system (CNS). One of the potential neurological complications of diabetes is cognitive deficits. Interestingly, the structural, electrophysiological, neurochemical and anatomical underpinnings responsible for cognitive deficits in diabetes are strikingly similar to those observed in animals subjected to chronic stress, as well as in patients with stress-related psychiatric illnesses such as major depressive disorder. Since diabetes is a chronic metabolic stressor, this has led to the suggestion that common mechanistic mediators are responsible for neuroplasticity deficits in both diabetes and depression. Moreover, these common mechanistic mediators may be responsible for the increase in the risk of depressive illness in diabetes patients. In view of these observations, the aims of this review are (1) to describe the neuroplasticity deficits observed in diabetic rodents and patients; (2) to summarize the similarities in the clinical and preclinical studies of depression and diabetes; and (3) to highlight the diabetes-induced neuroplasticity deficits in those brain regions that have been implicated as important pathological centers in depressive illness, namely, the hippocampus, the amygdala and the prefrontal cortex.
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Affiliation(s)
- Lawrence P Reagan
- Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208, USA.
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Abstract
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.
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Grande I, Kunz M, Potter W, Balanzá-Martínez V, Vieta E, Kapczinski F. Should bipolar disorder be considered a systemic illness? ACTA ACUST UNITED AC 2011. [DOI: 10.2217/npy.10.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Baseline depression predicts malnutrition in head and neck cancer patients undergoing radiotherapy. Support Care Cancer 2011; 20:335-42. [DOI: 10.1007/s00520-011-1087-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
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Cabassa LJ, Blanco C, Lopez-Castroman J, Lin KH, Lui SM, Lewis-Fernández R. Racial and ethnic differences in diabetes mellitus among people with and without psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Gen Hosp Psychiatry 2011; 33:107-15. [PMID: 21596203 PMCID: PMC3099036 DOI: 10.1016/j.genhosppsych.2010.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 11/24/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study examined racial/ethnic differences in the prevalence of diabetes mellitus in a nationally representative sample of adults with and without common psychiatric disorders. METHOD Data were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34,653). Logistic regression models adjusting for sociodemographic variables and diabetes risk factors were used to examine racial/ethnic differences in 12-month prevalence rates of diabetes by psychiatric status. RESULTS Among people without psychiatric disorders, African Americans, Hispanics and American Indians/Alaska Natives, but not Asians/Pacific Islanders, had significantly higher rates of diabetes than non-Hispanic whites even after adjusting for sociodemographic variables and diabetes risk factors. In the presence of psychiatric disorders, these health disparities persisted for African Americans and Hispanics, but not for American Indians/Alaska Natives. No significant interactions between race/ethnicity and psychiatric disorders in the odds of diabetes were found across any group. CONCLUSION Policies and services that support culturally appropriate prevention and treatment strategies are needed to reduce racial/ethnic disparities in diabetes among people with and without psychiatric disabilities.
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Affiliation(s)
- Leopoldo J. Cabassa
- New York State Psychiatric Institute, New York, NY, 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
,Corresponding author: New York State Psychiatric Institute, 1051 Riverside Dr. Rm 1715, Unit 11, New York, NY 10032, USA, Tel: +1 212 543 5311; Fax: +1 212 543 5416.
| | - Carlos Blanco
- New York State Psychiatric Institute, New York, NY, 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | | | - Keng-Han Lin
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | | | - Roberto Lewis-Fernández
- New York State Psychiatric Institute, New York, NY, 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
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231
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Prisciandaro JJ, Gebregziabher M, Grubaugh AL, Gilbert GE, Echols C, Egede LE. Impact of psychiatric comorbidity on mortality in veterans with type 2 diabetes. Diabetes Technol Ther 2011; 13:73-8. [PMID: 21175275 PMCID: PMC3025763 DOI: 10.1089/dia.2010.0092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND particular psychiatric disorders, such as depression, have a significant and negative effect on diabetes outcomes. However, we know very little about the impact of other psychiatric disorders, and of the effect of multiple psychiatric comorbidities, on the clinical course of diabetes. As such, the present study examined the impact of a wide range of psychiatric comorbidities on all-cause mortality in individuals with type 2 diabetes. METHODS retrospective follow-up was conducted of 15,065 veterans with type 2 diabetes enrolled in hospital care between 1997 and 2006. Clinical diagnoses from patient records were used to construct four psychiatric disorder scales: internalizing (i.e., depression and anxiety); externalizing (i.e., alcohol and drug abuse); psychotic; and bipolar. Longitudinal relationships were examined between these scales and mortality using Cox regression. RESULTS only externalizing disorders were significantly associated with mortality: hazard ratio = 1.22 (95% confidence interval = 1.02-1.47). In other words, each additional diagnosed externalizing disorder increased an individual's chance of dying over the follow-up period by 22%. This association remained significant when demographics and medical comorbidities were statistically controlled, but was rendered nonsignificant when medication adherence was introduced to the regression model. CONCLUSIONS the results provide evidence that among individuals with diabetes, alcohol and drug abuse/dependence have a significant impact on mortality. This increased risk of mortality may have been due to the association between psychiatric disorders and adherence to antidiabetes medications observed in the present study. Individuals with co-occurring diabetes and alcohol or drug abuse should be targeted for intensive interventions given their acute increased risk of mortality.
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Affiliation(s)
- James J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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232
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Fydrich T, Ülsmann D. Komorbidität chronischer somatischer Erkrankung und psychischer Störungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:108-19. [DOI: 10.1007/s00103-010-1189-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sieu N, Katon W, Lin EH, Russo J, Ludman E, Ciechanowski P. Depression and incident diabetic retinopathy: a prospective cohort study. Gen Hosp Psychiatry 2011; 33:429-35. [PMID: 21762993 PMCID: PMC3175259 DOI: 10.1016/j.genhosppsych.2011.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 05/26/2011] [Accepted: 05/28/2011] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study examined whether depression is associated with a higher incidence of diabetic retinopathy among adults with type 2 diabetes after controlling for sociodemographic factors, health risk behaviors and clinical characteristics. METHOD This study included 2359 patients enrolled in Pathways Epidemiologic Follow-Up Study, a prospective cohort study investigating the impact of depression in primary care patients with type 2 diabetes. The predictor of interest was baseline severity of depressive symptoms assessed with the Patient Health Questionnaire-9 (PHQ-9). The outcome was incident diabetic retinopathy. Risk of diabetic retinopathy was assessed using logistic regression, and time to incident diabetic retinopathy was examined using Cox proportional hazard models. RESULTS Over a 5-year follow-up period, severity of depression was associated with an increased risk of incident retinopathy [odds ratio =1.026; 95% confidence interval (CI) 1.002-1.051] as well as time to incident retinopathy (hazard ratio=1.025; 95% CI 1.009-1.041). The risk of incident diabetic retinopathy was estimated to increase by up to 15% for every significant increase in depressive symptoms severity (5-point increase on the PHQ-9 score). CONCLUSION Diabetic patients with comorbid depression have a significantly higher risk of developing diabetic retinopathy. Improving depression treatment in patients with diabetes could contribute to diabetic retinopathy prevention.
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Affiliation(s)
- Nida Sieu
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | | | - Joan Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Evette Ludman
- Group Health Research Institute, Group Health, Seattle, Washington
| | - Paul Ciechanowski
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Fasting Blood Glucose and Depressive Mood among Patients with Mental Illness in a Medicaid Managed Care Program. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:862708. [PMID: 21738870 PMCID: PMC3124031 DOI: 10.1155/2011/862708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/21/2011] [Accepted: 04/04/2011] [Indexed: 12/31/2022]
Abstract
Objective. This study explores the relationship between depressive symptoms, as measured by the PHQ-9 depression screen and blood glucose levels among patients with diabetes enrolled in Gold Choice, a Medicaid managed care program for individuals with mental illness and/or substance abuse. Methods. The PHQ-9 was mailed to 454 Gold Choice members and a questionnaire was mailed to their physicians requesting current HbA1c% and fasting blood glucose (FBG) levels. The pearson product-moment correlation was used to describe the association between PHQ-9 scores and FBG levels. Results. The PHQ-9 response rate was 55% (N = 249). Laboratory results were received for 141 patients. The correlation between FBG and PHQ-9 scores was modest but statistically significant: r = 0.21 , P = 0.015. Conclusion. A statistically significant association was found between FBG and PHQ-9 depression scores. This finding supports current recommendations that physicians be alert to depressive symptoms among patients with diabetes or impaired glucose metabolism.
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Longitudinale Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes sowie deren Auswirkung auf die Mortalität von Hausarztpatienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 54:98-107. [DOI: 10.1007/s00103-010-1181-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Mood disorders and obesity: understanding inflammation as a pathophysiological nexus. Neuromolecular Med 2010; 13:93-116. [PMID: 21165712 DOI: 10.1007/s12017-010-8140-8] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 11/19/2010] [Indexed: 02/06/2023]
Abstract
The aim of this review is to evaluate the evidentiary base supporting the hypothesis that the increased hazard for obesity in mood disorder populations (and vice versa) is a consequence of shared pathophysiological pathways. We conducted a PubMed search of all English-language articles with the following search terms: obesity, inflammation, hypothalamic-pituitary-adrenal axis, insulin, cognition, CNS, and neurotransmitters, cross-referenced with major depressive disorder and bipolar disorder. The frequent co-occurrence of mood disorders and obesity may be characterized by interconnected pathophysiology. Both conditions are marked by structural and functional abnormalities in multiple cortical and subcortical brain regions that subserve cognitive and/or affective processing. Abnormalities in several interacting biological networks (e.g. immuno-inflammatory, insulin signaling, and counterregulatory hormones) contribute to the co-occurence of mood disorders and obesity. Unequivocal evidence now indicates that obesity and mood disorders are chronic low-grade pro-inflammatory states that result in a gradual accumulation of allostatic load. Abnormalities in key effector proteins of the pro-inflammatory cascade include, but are not limited to, cytokines/adipokines such as adiponectin, leptin, and resistin as well as tumor necrosis factor alpha and interleukin-6. Taken together, the bidirectional relationship between obesity and mood disorders may represent an exophenotypic manifestation of aberrant neural and inflammatory networks. The clinical implications of these observations are that, practitioners should screen individuals with obesity for the presence of clinically significant depressive symptoms (and vice versa). This clinical recommendation is amplified in individuals presenting with biochemical indicators of insulin resistance and other concurrent conditions associated with abnormal inflammatory signaling (e.g. cardiovascular disease).
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237
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Qiuhua Shen, 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. Biol Res Nurs 2010; 13:175-81. [PMID: 21044969 DOI: 10.1177/1099800410384501] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The association between depression and insulin resistance has been evaluated in previous studies with conflicting results. This study aimed to explore the relationship between major depressive disorder (MDD) and insulin resistance among nondiabetic young adult men and women in the United States. METHOD Analyses of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002, were conducted. The nationally representative sample consisted of 279 men and 358 women aged 20-39 years. MDD was determined by the WHO Composite International Diagnostic Interview (CIDI). Insulin resistance was measured by the homeostasis model assessment for insulin resistance. RESULTS Of 637 subjects, 16 men and 18 women had MDD (weighted percentage = 6.6%, SE = 1.2). Using logistic regression, no significant association was found between MDD and insulin resistance among the nondiabetic young adults in bivariate analysis (β = -0.01, OR = 0.99, 95% CI = [0.38, 2.57], p = .98). A significant interaction effect between gender and MDD was observed. For men, MDD was negatively associated with insulin resistance after adjusting for age, race/ethnicity, waist circumference, smoking status, systolic blood pressure and triglyceride level (β = -2.12, OR = 0.12, 95% CI = [0.02, 0.62], p = .01). No significant association between MDD and insulin resistance among women was found (β = 0.61, OR = 1.84, 95% CI = [0.47, 7.14], p = .38). CONCLUSIONS Overall findings suggest there is no significant association between MDD and insulin resistance among nondiabetic young adults aged 20-39 years. However, gender differences in this relationship were noted.
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Affiliation(s)
- Qiuhua Shen
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA.
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Crucitti A, Zhang Q, Nilsson M, Brecht S, Yang CR, Wernicke J. Duloxetine treatment and glycemic controls in patients with diagnoses other than diabetic peripheral neuropathic pain: a meta-analysis. Curr Med Res Opin 2010; 26:2579-88. [PMID: 20874076 DOI: 10.1185/03007991003769241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Mood disorders are often associated with poor glycemic control, and antidepressant treatments for mood and pain disorders can alter plasma glucose levels in patients with diabetes. A previous meta-analysis from three studies showed that duloxetine modestly increased fasting plasma glucose (FPG) and HbA(1c) levels in patients with diabetic peripheral neuropathic pain (DPNP). This meta-analysis examined whether there were any short- and long-term effects of duloxetine (20-120 mg/day) on glycemic control in patients with diagnoses other than DPNP. RESEARCH DESIGN AND METHODS Short-term data (9-27 weeks): seven studies of duloxetine in general anxiety disorder, fibromyalgia, and chronic lower back pain (CLBP). Long-term data: 41-week, uncontrolled extension of the short-term CLBP study and 52-week study in patients with recurrence of major depressive disorder. MAIN OUTCOME MEASURES Baseline-to-endpoint changes in FPG and HbA(1c) levels. RESULTS In short-term studies, patients were randomly assigned to placebo (n = 1098) or duloxetine (n = 1563). Mean baseline-to-endpoint changes in FPG and HbA(1c) did not significantly differ in duloxetine-treated patients compared with placebo-treated patients. In the 41-week study (n = 181), duloxetine-treated patients experienced a small but significant within-group baseline-to-endpoint increase in HbA(1c) (mean change = 0.1%; p < 0.001). This result was in contrast to absence of effect on mean baseline-to-endpoint within-group changes in FPG (p = 0.326) in that study, and to absence of between-treatment changes in FPG (p = 0.744) and HbA(1c) (p = 0.180) in the 52-week placebo-controlled study. CONCLUSION Duloxetine treatment did not significantly alter FPG and HbA(1c) levels compared with placebo treatment in the short-term studies. A small but statistically significant within-group increase in HbA(1c) was found in the 41-week study, but not in between-treatment group differences in the 52-week study. Neither of the long-term studies showed significant changes in the FPG levels. The small, non-reproducible HbA(1c) increase in one study of patients without DPNP may have resulted from patients with unrecognized diabetes in these trials.
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Quetiapine XR: current status for the treatment of major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1165-73. [PMID: 20307622 DOI: 10.1016/j.pnpbp.2010.03.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/22/2010] [Accepted: 03/15/2010] [Indexed: 11/21/2022]
Abstract
Quetiapine fumarate extended release (XR) has been approved for treatment of schizophrenia and bipolar disorder. Quetiapine may have antidepressant effects through effects on 5-HT(2A) receptor, 5-HT(1A) receptor, dopamine receptor, glutamate receptor and norepinephrine transporter. Recently, 7 large-scale randomized, double-blind, placebo (2-studies with active comparator)-controlled clinical trials have demonstrated that quetiapine XR has clinically meaningful efficacy as monotherapy and adjunct therapy to antidepressants for the treatment of adult patients with major depressive disorder (MDD). In such clinical trials, quetiapine XR was generally well tolerated, although weight gain and changes in metabolic parameters, consistent with the known profile of quetiapine, were observed in some patients. As of December 2009, the United States Food and Drug Administration has approved quetiapine XR for the adjunct treatment of MDD. From the data of currently available clinical trials, this review provides an overview of the data and clinical implications for quetiapine XR in the treatment of MDD to enhance clinicians understanding of the use of quetiapine XR in the treatment of MDD.
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Huang CY, Chi SC, Sousa VD, Wang CP, Pan KC. Depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Southern Taiwan. J Clin Nurs 2010; 20:1293-302. [PMID: 21492275 DOI: 10.1111/j.1365-2702.2010.03451.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To examine the relationships between depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Taiwan. BACKGROUND Research suggests associations between depression, metabolic syndrome and quality of life. Despite this fact, few studies have investigated these relationships among Taiwanese. DESIGN A cross-sectional descriptive correlational design was used to conduct this study. METHODS A convenience sample of 140 adults participated in the study. Data were analysed with descriptive statistics, Pearson's correlations, hierarchical regression and t-tests. RESULTS Almost a half of the subjects (46.5%) had metabolic syndrome. The most common combination of metabolic syndrome criteria was elevated blood glucose, central obesity and high blood pressure (23.7%). A greater number of individuals had coronary artery disease (72.9%), type 2 diabetes (35%) and/or depression (21.4%). Type 2 diabetes and depression were significant predictors of overall quality of life (β = -0.16, p < 0.01 and β = -0.63, p < 0.001, respectively). In addition, there were significant differences between individuals with and without type 2 diabetes and/or depression regarding overall quality of life scores; t (138) = 3.50, p < 0.01); and t (138) = 7.80, p < 0.001), respectively. CONCLUSIONS Coronary artery disease, type 2 diabetes and depression were common among our sample of individuals with metabolic syndrome. Those with diabetes and/or depression had worse quality of life than those without those diseases. RELEVANCE TO CLINICAL PRACTICE Nurses need to be prepared to assess and intervene in preventing or treating depression among patients with chronic diseases, especially those with coronary artery disease, type 2 diabetes and metabolic syndrome. When individuals are treated for depression, they are more likely to engage in self-management of their diseases, which will prevent complications and improve their quality of life.
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Affiliation(s)
- Chiung-Yu Huang
- I-Shou University, Yanchao Hsiang, Kaohsiung County, Taiwan.
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Shomaker LB, Tanofsky-Kraff M, Young-Hyman D, Han JC, Yanoff LB, Brady SM, Yanovski SZ, Yanovski JA. Psychological symptoms and insulin sensitivity in adolescents. Pediatr Diabetes 2010; 11:417-23. [PMID: 19912553 PMCID: PMC2942090 DOI: 10.1111/j.1399-5448.2009.00606.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Symptoms of psychological distress have been linked to low insulin sensitivity in adults; however, little is known about this relationship in pediatric samples. We therefore examined symptoms of depression and anxiety in relation to insulin sensitivity in adolescents. METHODS Participants were 136 non-treatment-seeking, healthy adolescents (53.2% female) of all weight strata (BMI-z = 1.08 +/- 1.08) between the ages of 12 and 18 years (M = 15.16,SD = 1.55). Adolescents completed questionnaire measures assessing depression and anxiety symptoms. Fasting blood samples for serum insulin and plasma glucose were obtained to estimate insulin sensitivity with the quantitative insulin sensitivity check index. Fat mass and fat-free mass were measured with air displacement plethysmography or dual-energy X-ray absorptiometry. RESULTS Depressive symptoms were associated with higher fasting insulin and decreased insulin sensitivity even after controlling for fat mass, fat-free mass, height, age, pubertal status, race, and sex (p < 0.01). CONCLUSIONS As has been described for adults, depressive symptoms are associated with low insulin sensitivity among healthy adolescents. Further experimental and prospective studies are required to determine the directionality of this link.
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Affiliation(s)
- Lauren B. Shomaker
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Rd, Bethesda, MD, 20814
| | - Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Rd, Bethesda, MD, 20814
| | - Deborah Young-Hyman
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| | - Joan C. Han
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| | - Lisa B. Yanoff
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| | - Sheila M. Brady
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
| | - Susan Z. Yanovski
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103,Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, DHHS
| | - Jack A. Yanovski
- Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Service (DHHS), 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103
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Bobo WV, Shelton RC. Efficacy, safety and tolerability of Symbyax for acute-phase management of treatment-resistant depression. Expert Rev Neurother 2010; 10:651-70. [PMID: 20420487 DOI: 10.1586/ern.10.44] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Treatment resistance is frequently encountered during the long-term care of patients with major depression. A number of 'next step' therapeutic options exist in such cases, including switching to an alternative antidepressant, combining antidepressants from different pharmacological classes, adding evidence-supported psychotherapies to ongoing antidepressant treatment and augmentation with a nonantidepressant drug. Augmenting antidepressants with atypical antipsychotic drugs has generated considerable clinical interest. Three atypical antipsychotics (aripiprazole, quetiapine and olanzapine) have received regulatory approval for adjunctive use with antidepressants for treatment-resistant major depression (TRD) in adults. Symbyax (olanzapine-fluoxetine combination or OFC), the combination of olanzapine and the selective serotonin-reuptake inhibitor fluoxetine, is also approved for this indication. The short-term effectiveness of OFC for TRD is supported by results of five published randomized, controlled, acute-phase studies of generally similar design. In each study, OFC was associated with rapid reduction in depressive symptoms. In two studies, significantly greater improvement in depressive symptoms occurred in OFC-treated patients at study end point compared with those who received antidepressant monotherapy. These effects appeared to be strongest in cases where antidepressant failure was established during the current depressive episode. Although OFC was well-tolerated, increases in body weight and prolactin concentration were greater with OFC than antidepressant monotherapy, and were similar to olanzapine monotherapy. Increases in random total cholesterol levels were greatest for OFC, and were significantly greater than those of olanzapine and antidepressant monotherapy. The long-term efficacy and tolerability of OFC for TRD has not been investigated, and the comparative effectiveness of OFC versus other next-step options is unknown. As such, the exact place of OFC among the available therapeutic options for TRD is not fully understood at this time.
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Affiliation(s)
- William V Bobo
- Department of Psychiatry, Vanderbilt University School of Medicine, South Suite 2200, Village at Vanderbilt, Nashville, TN 37212, USA.
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243
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Moreira RO, Amâncio APRL, Brum HR, Vasconcelos DL, Nascimento GF. [Depressive symptoms and quality of life in type 2 diabetic patients with diabetic distal polyneuropathy]. ACTA ACUST UNITED AC 2010; 53:1103-11. [PMID: 20126868 DOI: 10.1590/s0004-27302009000900007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 08/25/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the impact of depressive symptoms and neuropathic pain in the quality of life (QL) of diabetic patients with diabetic distal polyneuropathy (DDP). METHODS Two hundred and four patients with type 2 diabetes mellitus were evaluated. The diagnosis of DDP was achieved using the Neuropathy Disability Score and Neuropathy Symptom Score questionnaires. The severity of neuropathic pain was assessed by means of a Visual Analogue Scale (VAS); the severity of depression, by means of the Beck Depression Inventory (BDI); and QL was assessed by means of the World Health Organization Quality of Life Instrument-bref (WHOQOLbref). RESULTS Patients with DDP presented significant higher scores in BDI (12.6 +/- 7.2 versus 9.9 +/- 7.3; p = 0.018) and in VAS (5.0 +/- 2.4 versus 2.6 +/- 2.9; p < 0.001). They also presented significant lower scores in the physical (52.8 +/- 15.5 versus 59.2 +/- 17.0; p = 0.027) and environmental domains (56.6 +/- 12.3 versus 59.6 +/- 13.6; p = 0,045). CONCLUSIONS Diabetic patients with DDP presented a worse QL in the physical and environmental domains of the WHOQOL-bref, probably due to more depressive symptoms and the severity of pain.
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Affiliation(s)
- Rodrigo O Moreira
- Faculdade de Medicina, Universidade Presidente Antônio Carlos, Juiz de Fora, MG, Brasil.
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Russo AJ. Decreased Serum Hepatocyte Growth Factor (HGF) in Individuals with Depression Correlates with Severity of Disease. Biomark Insights 2010; 5:63-7. [PMID: 20703323 PMCID: PMC2918354 DOI: 10.4137/bmi.s5183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To assess serum Hepatocyte Growth Factor (HGF) levels in individuals with depression and to test the hypothesis that there is a relationship between severity of depression and HGF concentration. SUBJECTS AND METHODS Serum from 26 clinically depressed individuals and 19 controls were tested for serum HGF using ELISAs. Correlation was established between HGF concentration and disease severity. RESULTS Depressed individuals had significantly lower serum levels of HGF compared to controls (P < 0.0001). HGF concentration correlated with overall depressive behavior (P = 0.03) and specifically depression (P = 0.02), but not anxiety (P = 0.36). DISCUSSION These results suggest an association between HGF serum levels and clinically depressed individuals and demonstrate a correlation between severity of depression and HGF levels. Further studies of the predictive strength of HGF as a biomarker for depression may be warranted.
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Affiliation(s)
- A J Russo
- Research Director, Health Research Institute/Pfeiffer Treatment Center, Warrenville, Illinois 60555, USA
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246
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van der Feltz-Cornelis CM, Nuyen J, Stoop C, Chan J, Jacobson AM, Katon W, Snoek F, Sartorius N. 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. [PMID: 20633742 DOI: 10.1016/j.genhosppsych.2010.03.011] [Citation(s) in RCA: 211] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown. OBJECTIVE This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes. DATA SOURCES PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants, interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment by psychotherapy, pharmacotherapy or collaborative care of depression in persons with Type 1 and Type 2 diabetes mellitus. STUDY APPRAISAL risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis. RESULTS Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective in terms of reduction of depressive symptoms: -0.512; 95% CI -0.633 to -0.390. The combined effect of all interventions on clinical impact is moderate, -0.370; 95% CI -0.470 to -0.271; it is large for psychotherapeutic interventions that are often combined with diabetes self management: -0.581; 95% CI -0.770 to -0.391, n=310 and moderate for pharmacological treatment: -0.467; 95% CI -0.665 to -0.270, n=281. Delivery of collaborative care, which provided a stepped care intervention with a choice of starting with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect size of -0.292; 95% CI -0.429 to -0.155, n=1133; indicating the effect size that can be attained on a population scale. Pharmacotherapy and collaborative care aimed at and succeeded in the reduction of depressive symptoms but, apart from sertraline, had no effect on glycemic control. LIMITATIONS amongst others, the number of RCTs is small. CONCLUSION The treatment of depression in people with diabetes is a necessary step, but improvement of the general medical condition including glycemic control is likely to require simultaneous attention to both conditions. Further research is needed.
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Affiliation(s)
- Christina M van der Feltz-Cornelis
- Research Program for Diagnosis and Treatment of Mental Disorder, Trimbos Instituut/Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Russo A. Increased Serum Cu/Zn SOD in Individuals with Clinical Depression Normalizes After Zinc and Anti-oxidant Therapy. Nutr Metab Insights 2010; 3:37-42. [PMID: 23966790 PMCID: PMC3736885 DOI: 10.4137/nmi.s5044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM To assess serum Cu/Zn SOD (Superoxide Dismutase) concentration in individuals with clinical depression. SUBJECTS AND METHODS Serum from 36 individuals diagnosed with clinical depression and 18 healthy controls were tested for Cu/Zn SOD serum concentration using ELISAs. RESULTS Serum Cu/Zn SOD levels of depressed individuals (both with and without secondary anxiety) were significantly higher than age and gender similar controls. We also found that, post anti-oxidant therapy, Cu/Zn SOD levels normalized to the level of normal healthy controls. DISCUSSION These results suggest an association between Cu/Zn SOD serum levels and clinical depression.
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Affiliation(s)
- A.J. Russo
- Research Director, Health Research Institute/Pfeiffer Treatment Center, 4575 Weaver Parkway, Warrenville, Illinois 60555
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248
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Antidepressant effects on insulin sensitivity and proinflammatory cytokines in the depressed males. Mediators Inflamm 2010; 2010:573594. [PMID: 20490354 PMCID: PMC2872762 DOI: 10.1155/2010/573594] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 12/28/2009] [Accepted: 03/11/2010] [Indexed: 12/03/2022] Open
Abstract
Growing evidence suggests that mood disorder is associated with insulin resistance and inflammation. Thus the effects of antidepressants on insulin sensitivity and proinflammatory responses will be a crucial issue for depression treatment. In this study, we enrolled 43 non-diabetic young depressed males and adapted standard testing procedures to assess glucose metabolism during 4-week hospitalization. Before and after the 4-week antidepressant treatment, participants underwent oral glucose tolerance test (OGTT) and frequently sampled intravenous glucose tolerance test (FSIGT). Insulin sensitivity (SI), glucose effectiveness (SG), acute insulin response, and disposition index (DI) were estimated using the minimal model method. The plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and adiponectin were measured. The Hamilton depression rating scale (HAM-D) total scores were reduced significantly during the course of treatment. There were no significant changes in the parameters of SI, SG, and DI. Compared to drug naïve status, the level of plasma IL-6 was significantly elevated (0.77 to 1.30 pg/ml; P = .001) after antidepressant therapy. However, the concentrations of CRP, TNF-α, and adiponectin showed no differences during the course of treatment. The results suggest that antidepressants may promote stimulatory effect on the IL-6 production in the early stage of antidepressant treatment.
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249
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Cherrington A, Wallston KA, Rothman RL. Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. J Behav Med 2010; 33:81-9. [PMID: 20128112 DOI: 10.1007/s10865-009-9233-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Depression and low self-efficacy are both associated with worse glycemic control in adults with diabetes, but the relationship between these variables is poorly understood. We conducted a cross-sectional study examining associations between depressive symptoms, self-efficacy, and glycemic control among men (n = 64) and women (n = 98) with type 2 diabetes to see if self-efficacy mediates the relationship between depression and glycemic control. Correlational and mediational analyses examined the relationship between these three variables for the sample as a whole and separately by sex. A significant association between depressive symptoms and glycemic control was found for men (0.34, P < 0.01) but not for women (0.05, P = 0.59). Path analysis suggested that, among men, self-efficacy mediates the relationship between depressive symptoms and glycemic control. We conclude that men with depressive symptoms and type 2 diabetes may need tailored interventions that improve their self-efficacy in order to achieve glycemic control.
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Affiliation(s)
- Andrea Cherrington
- Department of Medicine, Division of General Internal Medicine, University of Alabama School of Medicine, 725 Faculty Office Tower, 1530 3rd Avenue South, Birmingham, AL 35294-3407, USA.
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Demakakos P, Pierce MB, Hardy R. Depressive symptoms and risk of type 2 diabetes in a national sample of middle-aged and older adults: the English longitudinal study of aging. Diabetes Care 2010; 33:792-7. [PMID: 20086253 PMCID: PMC2845029 DOI: 10.2337/dc09-1663] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association between baseline elevated depressive symptoms and incident type 2 diabetes in a national sample of people aged > or =50 years. RESEARCH DESIGN AND METHODS The sample consisted of 6,111 individuals free from self-reported doctor-diagnosed diabetes at baseline in 2002-2003. The eight-item Center for Epidemiological Studies-Depression (CES-D) scale was the measurement of depressive symptoms. Cox proportional hazards regression models were used to assess whether baseline elevated (> or =4) depressive symptoms were associated with a higher risk of type 2 diabetes over 45.8 months of follow-up. RESULTS The hazard ratio (HR) for diabetes was 1.62 (95% CI 1.15-2.29) in a model adjusted for age, sex, marital status, education, total net household wealth, cardiovascular and psychiatric and other noncardiovascular comorbidities, BMI, and health behaviors for participants with elevated CES-D symptoms compared with those without. Complementary analysis performed for a subsample (n = 5,090) showed that additional adjustment of this model for use of antidepressants did not explain the association (HR 1.58, 95% CI 1.09-2.29). CONCLUSIONS Elevated depressive symptoms were associated with a higher risk of developing type 2 diabetes after accounting for sociodemographic, lifestyle, and clinical factors in a national sample of people aged > or =50 years.
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Affiliation(s)
- Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK.
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