Women suffering from diabetes plus depression have a greater risk of dying, especially from heart disease, a new study suggests.In fact, women with both conditions have a twofold increased risk of death, researchers say. “People with both conditions are at very high risk of death,” said lead researcher Dr. Frank B. Hu, a professor of medicine at Harvard Medical School. “Those are double whammies.” When people are afflicted by both diseases, these conditions can lead to a “vicious cycle,” Hu said. “People with diabetes are more likely to be depressed, because they are under long-term psychosocial stress, which is associated with diabetes complications.”
People with diabetes plus depression are less likely to take care of themselves and effectively manage their diabetes, he added. “That can lead to complications, which increase the risk of mortality.” Hu stressed that it is important to manage both the diabetes and the depression to lower the mortality risk. “It is possible that these two conditions not only influence each other biologically, but also behaviorally,” he said.
Type 2 diabetes plus depression are often related to unhealthy lifestyles, including smoking, poor diet and lack of exercise, according to the researchers. In addition, depression may trigger changes in the nervous system that adversely affect the heart, they said.
The report is published in the January issue of the Archives of General Psychiatry.
Commenting on the study, Dr. Luigi Meneghini, an associate professor of clinical medicine and director of the Eleanor and Joseph Kosow Diabetes Treatment Center at the Diabetes Research Institute of the University of Miami Miller School of Medicine, said the findings were not surprising.
“The study highlights that there is a clear increase in risk to your health and to your life when you have a combination of diabetes and depression,” he said. Meneghini noted there are many diabetics with undiagnosed depression. “I am willing to bet that there are quite a number of patients with diabetes and depression walking around without a clear diagnosis.” Patients and doctors need to be more aware that depression is an issue, Meneghini added.
For the study, Hu’s team collected data on 78,282 women who were aged 54 to 79 in 2000 and who were participants in the Nurses’ Health Study. Over six years of follow-up, 4,654 women died, including 979 who died of cardiovascular disease, the investigators found. Women who had diabetes had about a 35 percent increased risk of dying, and those with depression had about a 44 percent increased risk, compared with women with neither condition, the researchers calculated. Those with both conditions had about twice the risk of dying, the study authors found.
When Hu’s team looked only at deaths from heart disease, they found that women with diabetes had a 67 percent increased risk of dying and those with depression had a 37 percent increased risk of death. But women who had both diabetes and depression had a 2.7-fold increased risk of dying from heart disease, the researchers noted.
In the United States, some 15 million people suffer from depression and 23.5 million have diabetes, the researchers say. Up to one-fourth of people with diabetes also experience depression, which is nearly twice as many as among people who don’t have diabetes, they added. “The combination of diabetes and depression needs to be addressed,” Meneghini concluded. He added that patients need to tell their doctors if they are feeling depressed, and doctors also need to be on the lookout for signs of depression in their diabetic patients.
SOURCES: HealthDay News; Frank B. Hu, M.D., Ph.D., professor, medicine, Harvard Medical School, Boston; Luigi Meneghini, M.D., associate professor, clinical medicine and director, Eleanor and Joseph Kosow Diabetes Treatment Center, Diabetes Research Institute, University of Miami Miller School of Medicine; January 2011, Archives of General Psychiatry
Treating obese women's depression may help them lose weight, a new study suggests. Although researchers couldn't determine which condition may cause the other, obesity and depression frequently strike together. Obese women who saw their depression lessened in a treatment program also lost more weight than women whose depression didn't improve or worsened, researchers said.
“I expect that the relationship between depression and physical activity goes in both directions,” said study researcher Dr. Gregory Simon, a senior investigator and psychiatrist at Group Health Research Institute in Seattle. “Increased physical activity leads to improvement in depression, and improvement in depression leads to increased physical activity.” “You can't prove which came first.”
The researchers evaluated 203 women, ages 40 to 65, who had an average body mass index of 38.3 at the study's start, and found that obesity increased a woman's risk of depression by 50 percent to 150 percent.
Participants were then split into two groups: one focused only on helping the women lose weight, and the other also treating the women's depression. The researchers held 26 group treatment sessions over 12 months, and checked in on the women six, 12 and 24 months after the study began.
Of those whose depression had loosened its grip — as measured by a small drop on a test called the Hopkins Symptom Checklist depression score — 38 percent had lost at least 5 percent of their body weight. Of those whose depression scores stayed the same or increased, 21 percent lost that much weight.
While the study's purpose wasn't to make recommendations about exercise, Simon said, it's advisable for people suffering from depression to seek more opportunities for physical activity. “There certainly is evidence that exercise alone is an effective treatment for depression, whether you're overweight or obese or not, or even if you're a normal weight,” he said.
The study was unusual because it focused on the sometimes-overlooked link between depression and obesity, without focusing solely on the role of weight loss, said Robert E. Thayer, a psychology professor at California State University in Long Beach who has researched how people regulate their moods with food and exercise.
“These findings suggest that, like other negative moods that motivate eating as a kind of self-medication, depression is no exception,” said Thayer, who was not involved with the study. “It's a useful addition to the scientific literature.”
Simon said future studies could focus on learning which antidepressants — many of which can bring on weight gain as a side effect — contribute most to that situation. “Losing weight can certainly have a positive effect on people's moods,” he said.
The research was published in the November/December issue of the journal General Hospital Psychiatry.
A baseline questionnaire about medical history and health practices was completed and then repeated every 2 years through 2006. Self-reported symptoms of depression, use of antidepressant medication, and physician-diagnosed depression were used as measures of depression. Depressed mood was assessed using the 5-item Mental Health Index, with a score of 52 or less indicating severe depression.
Those who reported a diagnosis of type 2 diabetes mellitus had the diagnosis confirmed by means of a supplementary questionnaire validated by medical record review.
During the 10-year follow-up, 2844 women were diagnosed as having type 2 diabetes and 7415 developed depression.
The relative risk of developing type 2 diabetes among women who were depressed was 1.17 (95% confidence interval [CI], 1.05 – 1.30). Study participants using antidepressants had a relative risk of 1.25 (95% CI, 1.10 – 1.41).
After controlling for all covariates, the investigators found women with diabetes had a relative risk of 1.29 (95% CI, 1.18 – 1.40) of developing clinical depression.
In addition, the relative risk for depression in diabetic subjects taking no diabetic medication, oral hypoglycemic agents, and insulin was 1.25 (95% CI, 1.09 – 1.42), 1.24 (95% CI, 1.09 – 1.41), and 1.53 (95% CI, 1.26 – 1.85), respectively.
The results also showed that compared with their nondiabetic counterparts, women with diabetes were more likely to have a higher body mass index and less likely to be physically active, a finding that suggests these 2 risk factors could be “major mediating factors.”
Nevertheless, they note the association remained significant after controlling for body mass index and lifestyle factors, which suggests “depression has effects on incident diabetes independent of adiposity and inactivity.”
The finding that women taking antidepressant medications were at higher risk of developing type 2 diabetes compared with those with severe depressive symptoms or physician-diagnosed depression has at least 2 possible explanations — antidepressant medications may be a marker of more severe, chronic, or recurrent depression or the medications themselves may increase diabetes risk.
“Although antidepressant medication use might be a marker of severe depression, its specific association with elevated risk of diabetes warrants further scrutiny,” they write.
In addition, the study authors note that these findings reinforce the hypothesis that diabetes may be related to stress: “Depression may result from the biochemical changes directly caused by diabetes or its treatment, or from the stresses and strains associated with living with diabetes and its often debilitating consequences.”
“This large, well-established cohort study provides evidence that the association between depression and diabetes is bidirectional and this association is partially explained by, but independent of, other known risk factors such as adiposity and lifestyle variables. Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association,” the investigators conclude.
The study was funded by the National Institutes of Health and the National Alliance for Research on Schizophrenia and Depression. The study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2010;170:1884-1891.
The study involved participants in the Chicago Health and Aging Project, a longitudinal study of risk factors for Alzheimer's disease involving a population of older adults on Chicago's south side. At three year intervals, the entire population completed a brief self-report measure of depressive symptoms and clinical evaluations for Alzheimer's disease.
Initial analyses focused on a group of 357 individuals who developed Alzheimer's disease during the course of the study. The study found a barely perceptible increase in depressive symptoms, a rate of 0.04 symptoms per year, during six to seven years of observation before the diagnosis of Alzheimer's disease and no change during two to three years of observation after the diagnosis.
Because dementia may reduce the accuracy of self-report, in a subgroup of 340 participants, researchers conducted additional analyses of change in depressive symptoms by interviewing family, friends and other who were close to the study participants. Neither Alzheimer's disease nor its precursor, mild cognitive impairment, was associated with change in depressive symptoms during a mean of three years of observation.
The results were consistent across all demographics. There was no evidence that sex, age, education or race modified the trajectory of depressive symptoms before or after Alzheimer's disease was diagnosed.
“Here is this terrible disease that robs people of who they are and their ability to function and yet it doesn't make them depressed,” said Wilson. “Alzheimer's may disrupt the ability to have prolonged bouts of negative emotions, in much the same way it disrupts many other activities.”
The study authors suggest additional studies of patients with Alzheimer's disease for longer periods to determine if depressive symptoms may eventually decrease as the disease becomes more severe.
In addition, researchers at Rush continue to look at why depression increases the risk of Alzheimer's disease.
The study was supported by funding from the National Institutes of Health (NIH)/ National Institute on Aging (NIA). Co-authors include G.M. Hoganson, BS; K.B. Rajan, PhD; L.L. Barnes, PhD; C.F. Mendes de Leon, PhD; and D.A. Evans, MD.
The team set out to examine levels of depression and anxiety between adults with celiac disease following a gluten-free diet and in control subjects drawn from the general population.
For their study, the team used the Hospital Anxiety and Depression Scale to measure levels of anxiety, depression, and likely anxiety or depressive disorder, in 441 adult patients with celiac disease recruited by the German Celiac Society. They then conducted the same assessments on 235 comparable patients with inflammatory bowel disease (IBD), either in remission or with slight disease activity. They did the same for the cross-sample control group of 441 adults from the general population.
The team used regression analysis to test possible demographic and disease-related predictors of anxiety and depression in celiac disease. Demographic predictors included age, sex, social class, and family status. Disease-related predictors included Latency to diagnosis, duration of GFD, compliance with GFD, thyroid disease.
The team found that female gender (P = 0.01) was the main predictor (R(2) = 0.07) of anxiety levels in patients with celiac disease. Female patients had a higher risk for a probable anxiety disorder (OR = 3.6, 95% CI: 1.3-9.4, P = 0.01) Patients who lived alone (OR = 0.5, 95% CI: 0.2-0.9, P = 0.05) enjoyed a lower risk of anxiety disorder. None of the demographic and medical variables for which the team screened predicted either depression levels or risk for a probable depressive disorders.
Patients with celiac disease showed anxiety levels of 6.6 +/- 3.4, and those with IBD, anxiety levels of 6.9 +/- 3.7, both higher than the general population's level of 4.6 +/- 3.3 – (both P < 0.001). Depression levels were similar for people with celiac disease (4.2 +/- 3.4), IBD (4.6 +/- 3.4) and the general population (4.2 +/- 3.8) (P = 0.3). Rates of likely anxiety disorders in people with celiac disease were 16.8%, and 14.0% for IBD, both higher than the rates of 5.7% in the general population (P < 0.001). All three groups showed similar rates of probable depressive disorder (P = 0.1).
Their results provide strong indications that adult women with celiac disease on a gluten-free diet suffer higher rates of anxiety than persons of the general population. They encourage clinicians to provide anxiety screens for adult women with celiac disease on a gluten-free diet.
According to UCSF Professor Michael German, MD, who is also the senior author of the paper, tryptophan hydroxylase (Tph1), the enzyme that produces serotonin from tryptophan increased by as much 1000-fold during the early pregnancy. The researchers found that inhibition of serotonin synthesis by restricting the intake of tryptophan in pregnant mice blocked beta cell proliferation and resulted in the development of glucose intolerance and gestational diabetes in the mice.
The research indicates that anything that affects the production of serotonin, such as drugs, diet or genetic inheritance may affect the risk of developing gestational diabetes and possibly the long-term risk of developing type 2 diabetes.
Serotonin has been widely studied as a neurotransmitter in the brain for its effects on appetite and mood, especially depression. Since it also influences the insulin production, this could explain why some patients with gestational diabetes experience depression. This would also explain the effect of some classes of psychiatric medications on diabetes.
The study will be published in the upcoming issue of “Nature Medicine” and was published online on June 27, 2010.
The study, to be published in the journal Pain, found that particular areas of the brain were less active as meditators anticipated pain, as induced by a laser device. Those with longer meditation experience (up to 35 years) showed the least anticipation of the laser pain.
Dr Brown, who is based in the University's School of Translational Medicine, found that people who meditate also showed unusual activity during anticipation of pain in part of the prefrontal cortex, a brain region known to be involved in controlling attention and thought processes when potential threats are perceived.
He said: “The results of the study confirm how we suspected meditation might affect the brain. Meditation trains the brain to be more present-focused and therefore to spend less time anticipating future negative events. This may be why meditation is effective at reducing the recurrence of depression, which makes chronic pain considerably worse.”
Dr Brown said the findings should encourage further research into how the brain is changed by meditation practice. He said: “Although we found that meditators anticipate pain less and find pain less unpleasant, it's not clear precisely how meditation changes brain function over time to produce these effects.
“However, the importance of developing new treatments for chronic pain is clear: 40% of people who suffer from chronic pain report inadequate management of their pain problem.”
In the UK, more than 10 million adults consult their GP each year with arthritis and related conditions. The estimated annual direct cost of these conditions to health and social services is £5.7 billion.
Study co-author Professor Anthony Jones said: “One might argue that if a therapy works, then why should we care how it works? But it may be surprising to learn that the mechanisms of action of many current therapies are largely unknown, a fact that hinders the development of new treatments. Understanding how meditation works would help improve this method of treatment and help in the development of new therapies.
“There may also be some types of patient with chronic pain who benefit more from meditation-based therapies than others. If we can find out the mechanism of action of meditation for reducing pain, we may be able to screen patients in the future for deficiencies in that mechanism, allowing us to target the treatment to those people.