Insulin resistance in patients with depression and its changes in the clinical course of depression: a report on three cases using the minimal model analysis

Depression and diabetes: An experience from Kashmir

BACKGROUND

Diabetes mellitus is a common chronic metabolic disorder characterized by hyperglycemia. Minimal attention has been paid toward the relationship between diabetes and depression in developing countries such as India, despite a number of studies in developed countries, exploring casual pathway between the two highly prevalent conditions. The aim of this study was to estimate the prevalence and severity of depression among patients of diabetes attending the endocrinology department of a tertiary care hospital of Kashmir.

METHODOLOGY

A total of 527 patients having diabetes of ≥6 months with age ranging from 18 years to 60 years were screened for major depressive disorder (MDD) using Diagnostic and Statistical Manual IV-based criteria. Severity of depression was assessed by the Montgomery-Asberg Depression Rating Scale.

RESULTS

Depression was present in 39.65% of patients. Depression was more prevalent in the age group of 29-38 years, in females as compared to males, among literates and government employees. Prevalence of depression among Type 1 diabetic patients was 60%, while as in case of Type 2, it was 37.75%. Depressed patients had higher fasting blood glucose levels as compared to nondepressed diabetic patients.

CONCLUSION

MDD is inordinately high among adult diabetic patients, and majority of the depressive patients have moderate intensity of MDD.

Association between dietary insulin index and load and psychological disorders

The present study was carried out to determine whether the dietary insulin index (DII) and dietary insulin load (DIL) are related to psychological disorders in a cross-sectional study among adults. A total of 3172 Iranian adults (age range of 18–55 years) were included. Data on dietary intakes were collected using a validated dish-based 106-item semi-quantitative FFQ. DII and DIL were calculated using food insulin index values published earlier. To assess depression and anxiety, an Iranian validated version of the Hospital Anxiety and Depression Scale was used. Furthermore, psychological distress was examined using the General Health Questionnaire. Among women, a significant positive association was seen; such that women in the highest quartile of DIL had higher odds of depression than those in the lowest quartile (OR 1·84; 95 % CI 1·14, 2·96). In terms of DII, in the fully adjusted model, women in the top quartile of DII were more likely to be depressed compared with those in the bottom quartile (OR 1·65; 95 % CI 1·05, 2·58). In conclusion, we found a significant positive association between DIL and DII and odds of depression among women, but not in men. However, such findings were not seen for anxiety and psychological distress.

The relationship between atypical depression and insülin resistance in patients with polycystic ovary syndrome and major depression

In this study, we aimed to examine the relationship between atypical depression and insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) and major depression. A total of 176 subjects (69 patients with PCOS, 58 patients with depression, and 49 healthy controls) were included in the study. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Beck Hopelessness Scale (BHS), and the Scale for Suicide Ideation (SSI) were administered. Data concerning their height, weight, fasting a.m. serum levels of insulin, glucose level, and total testosterone level were collected from all participants. The body mass index (BMI) and the Homeostasis Model Assessment Insulin Resistance index (HOMA-IR) were both calculated. 34 (49.3%) of the PCOS patients met the criteria for depression. 26 (76.5%) of them had atypical depression, 8 (23.5%) had non-atypical depression. 27 (46.6%) of the 58 depressed patients had atypical depression. Insulin resistance was higher in the PCOS patients than in the control subjects and the depression patients. There was no association between atypical depression and IR in patients with PCOS and depression. We concluded that there is no relationship between IR and atypical depression.

The effects of aging in the hippocampus and cognitive decline

Aging is a natural process that is associated with cognitive decline as well as functional and social impairments. One structure of particular interest when considering aging and cognitive decline is the hippocampus, a brain region known to play an important role in learning and memory consolidation as well as in affective behaviours and mood regulation, and where both functional and structural plasticity (e.g., neurogenesis) occur well into adulthood. Neurobiological alterations seen in the aging hippocampus including increased oxidative stress and neuroinflammation, altered intracellular signalling and gene expression, as well as reduced neurogenesis and synaptic plasticity, are thought to be associated with age-related cognitive decline. Non-invasive strategies such as caloric restriction, physical exercise, and environmental enrichment have been shown to counteract many of the age-induced alterations in hippocampal signalling, structure, and function. Thus, such approaches may have therapeutic value in counteracting the deleterious effects of aging and protecting the brain against age-associated neurodegenerative processes.

Antidepressant effects on insulin sensitivity and proinflammatory cytokines in the depressed males

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 (S_I), glucose effectiveness (S_G), 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 S_I, S_G, 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.

Shifts in metabolic parameters surrounding glucose homoeostasis resulting from tricyclic antidepressant therapy: implications of insulin resistance?

This study displayed the physiological effects the tricyclic antidepressants amitriptyline or trimipramine have on glucose homoeostasis in male Wistar rats. An insulin secreting cell line (INS-1) was also used to determine effects tricyclic antidepressants have on insulin secretion and insulin displacement. Thirty rats each received a 1 mg kg−1 dose of amitriptyline or trimipramine for a period of 14 weeks; another 14 rats served as the control group. Blood glucose, serum insulin and muscle and liver glycogen levels were determined. Kidney, liver and muscle insulin degradation was measured and compared with insulin degrading enzyme concentrations in the latter two tissues. INS-1 cells were used to determine the effect 1μM amitriptyline has on insulin secretion. Displacement studies for [3H]glibenclamide by amitriptyline or trimipramine were undertaken on INS-1 cells. A significant increase in blood glucose (P < 0.01) was found for both test groups after 6 and 14 weeks of receiving the medication, which may be related to a significant decrease in liver and muscle glycogen levels (P < 0.001). Serum insulin levels remained unchanged, although a significant increase in insulin degradation was observed in the muscle, liver and kidney, which may be related to a significant increase in insulin degrading enzyme (P < 0.001) that was found. A significant increase in insulin secretion was observed for the INS-1 cells treated with amitriptyline, although no significant displacement for the [3H]glibenclamide was evident for amitriptyline or trimipramine. The significant alterations in glucose homoeostasis observed, as well as the significant changes associated with insulin secretion and degradation associated with amitriptyline or trimipramine treatment, imply that prolonged use of these medicines may lead to insulin resistance and full blown diabetes.

Comparisons of glucose-insulin homeostasis following maprotiline and fluoxetine treatment in depressed males

BACKGROUND

To investigate the effects of antidepressants on glucose-insulin homeostasis, we provided homogenous situation and performed standard procedures to assess the interactions of antidepressants and glucose regulation during hospitalization.

METHODS

Twenty-three non-diabetic depressed males were recruited and assigned to two groups based on the antidepressants received (maprotiline n=11, fluoxetine n=12). The severity of depression was evaluated using a 21-item Hamilton depression rating scale (HAM-D). Before and after the 4-week treatment, participants underwent 75-g oral glucose tolerance test (OGTT) and frequently sampled intravenous glucose tolerance test (FSIGT). Insulin sensitivity (SI), glucose effectiveness (SG), acute insulin response (AIR), and disposition index (DI) were estimated using minimal model method.

RESULTS

The HAM-D scores were reduced significantly (P<0.005) after antidepressant treatment. Following maprotiline treatment, the body weight and BMI were significantly increased (P=0.02). Individuals treated with maprotiline displayed a significantly increased AIR (3239+/-682 vs. 4698+/-597 pmol; P=0.04) during the FSIGT.

LIMITATIONS

The sample size was limited. Furthermore, the study was conducted in the early phase of depression-treated course.

CONCLUSIONS

The results suggest that the beta-cell function is hyperbolic in order to offset the insulin resistance following maprotiline treatment. Our findings imply that norepinephrine reuptake inhibitor (NRI) antidepressants might attenuate insulin sensitivity.

History of major depressive disorder and diabetes outcomes in diet- and tablet-treated post-menopausal women: a case control study

AIMS

Little is known about the long-term associations between remitted major depressive disorder (MDD) and clinical diabetes outcomes. This study investigated associations between a remote history of fully remitted MDD and (i) glycaemic control, (ii) diabetes symptoms, and (iii) physical and emotional functioning in post-menopausal women with Type 2 diabetes (T2DM).

METHODS

Forty-four post-menopausal women with diet- or tablet-treated T2DM participated. Twenty-three had never experienced depression and 21 had a history of MDD. All participants had been free of MDD and antidepressant treatment for > or = 1 year.

RESULTS

Compared with their never-depressed counterparts, women with a history of MDD had significantly higher HbA(1c) (7.0 vs. 6.5%), more diabetes symptoms, and worse emotional functioning, after controlling for confounding variables. Differences in HbA(1c) and diabetes symptoms were not accounted for by the higher current subclinical depressive symptoms observed in the previously depressed group. Differences in emotional functioning were accounted for by current subclinical depressive symptoms.

CONCLUSIONS

Most health-care providers overlook fully remitted depression. However, previously depressed patients, who outnumber currently depressed patients, may still have poorer glycaemic control than never-depressed patients.

Major depressive disorder viewed as a dysfunction in astroglial bioenergetics

For many years scientists and physicians have pondered upon the apparent connection between depressive disorder and diabetes mellitus. Several epidemiologic studies confirm that diabetics have increased incidence of depression, and vice versa. In addition: depressive, non-diabetic patients have several insulin- and glucose-metabolism disturbances, probably exerting a compensatory reaction to the malfunction in the depressed brain as these disturbances are normalised in remission. After the discovery of PET-scanning, such studies have shown that patients with depressive disorder have reduced glucose metabolism in frontal parts of the brain. The present hypothesis regards the PET findings as observations of the primary pathophysiology of depression. Furthermore: two studies of post mortem samples from depressed patients show reduced numbers of astroglia. This is in accordance to the mentioned insulin disturbances, as only astroglia, not neurons, have insulin-sensitive glucose metabolism. Hence: the astroglia, not necessarily the neurons, are proposed to be the type of cells in which the disease resides. Most probably depressive disorder is a multitude of diseases, explaining the apparent multitude of symptoms, and the fact that different patients do respond to different drugs. Therefore: one can only formulate the hypothesis by mentioning a common denominator to these specific malfunctions, namely: disturbed glucose metabolism in the depressed brain. The present paper reviews several findings and proposes that attenuated cerebral glucose metabolism in frontal parts of the brain, in the astroglia, is the cause of depressive disorder.

Impact of the selective serotonin reuptake inhibitor citalopram on insulin sensitivity, leptin and basal cortisol secretion in depressed and non-depressed euglycemic women of reproductive age

INTRODUCTION

Major depression in women of reproductive age may be accompanied by multiple endocrine and metabolic disturbances, which, in turn, may affect reproductive functioning. Enhanced cortisol synthesis, impaired leptin production and diminished insulin sensitivity have been reported in some depressed populations. We sought to determine whether an 8-week administration of citalopram would have an effect on these endocrine factors in a group of euglycemic depressed and non-depressed women of reproductive age.

MATERIALS AND METHODS

Fourteen depressed and 18 non-depressed women (diagnosed by structured clinical interview) aged between 18 and 45 years completed an 8-week study. All depressed women were treated with citalopram and non-depressed subjects randomized to citalopram or no treatment in an open label cohort study. An oral glucose tolerance test with insulin levels was performed at baseline and at the end of the 8-week trial. Weight, blood pressure, fasting serum cortisol, fasting serum leptin and Beck Depression Inventory were assessed at baseline, 2, 4 and 8 weeks.

RESULTS

Citalopram significantly improved depressive symptoms and Beck Depression Inventory scores in the depressed cohort. Cortisol production was higher in depressed women but did not diminish with citalopram therapy over 8 weeks. Indices of insulin sensitivity and leptin production were similar between depressed and non-depressed women and did not change despite citalopram therapy.

CONCLUSION

. Insulin sensitivity in moderately depressed women of reproductive age does not differ from that in a similar group of non-depressed women. Insulin sensitivity, cortisol secretion and leptin production do not change significantly in depressed women following an 8-week course of citalopram despite substantial improvement in depression scores.

Comparison of Fluoxetine and Paroxetine in Type II Diabetes Mellitus Patients

BACKGROUND

This study aims to investigate the efficacy of fluoxetine and paroxetine on the levels of depression-anxiety, quality of life, disability, and metabolic control in type II diabetes mellitus (DM) patients.

METHODS

The patients were first applied the Hospital Anxiety-Depression Scale (HADS). After a psychiatric interview with patients who had scores above the cut-off point, those who were diagnosed as having a major depressive disorder according to DSM-IV criteria were applied the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Twenty three patients who scored 16 or above on the HDRS were included in the study and given the Short Form-36 (SF-36), and the Brief Disability Questionnaire (BDQ) and HbA1c levels were measured. Patients were randomized on 20 mg/day fluoxetine or 20 mg/day paroxetine treatment. The patients were evaluated with the same scales at the 2(nd), 4(th), 6(th), and the 12(th) weeks.

RESULTS

Both groups showed a statistically significant decrease in HDRS, HARS, and BDQ scores with comparison to the index assessment. At the end of treatment, though not statistically significant, a decrease was observed in HbA1c values of the fluoxetine-administered group.

CONCLUSIONS

Fluoxetine and paroxetine effectively reduce the severity of major depressive disorder in type II DM patients. There is need for further and longer-lasting monitoring studies with more patients in order to determine whether there is any difference in terms of their effects on glycemic control.

Prevention and treatment of type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska Native children. American Academy of Pediatrics Committee on Native American Child Health

The emergence of type 2 diabetes mellitus in the American Indian/Alaska Native pediatric population presents a new challenge for pediatricians and other health care professionals. This chronic disease requires preventive efforts, early diagnosis, and collaborative care of the patient and family within the context of a medical home.

Depression in women with polycystic ovary syndrome: clinical and biochemical correlates

BACKGROUND

We assessed the prevalence of mood disturbance among women with prospectively documented polycystic ovary syndrome (PCOS).

METHODS

Thirty-two women with PCOS completed the Center for Epidemiological Studies-Depression Rating Scale (CES-D). Clinical and biochemical characteristics were assessed.

RESULTS

Sixteen women had CES-D scores indicative of depression. Depression was associated with greater insulin resistance (P=0.02) and higher body mass index (P=0.05). Women receiving oral contraceptives for the treatment of PCOS were less depressed than patients not receiving treatment (P=0.03).

LIMITATIONS

Possible selection bias, use of a screening tool alone without further diagnostic evaluation of depression, small samples size and lack of direct comparison with an age matched control group, should be considered in interpretation of these results.

CONCLUSION

Findings suggest a high prevalence of depression among women with PCOS, and an association between depression and PCOS markers.

Insulin resistance: a metabolic link between depressive disorder and atherosclerotic vascular diseases

The association of depression with insulin resistance (IR) and athersclerotic vascular diseases has been well documented. This review examines the relevance of IR as a link between depressive disorder and atherosclerotic vascular diseases. Relevant articles collected from Medline database over the period of 1966-2001 were reviewed. Studies have shown that IR is a state-dependent abnormality in depression and depression increases the risk of vascular morbidity and mortality. Given that IR is a central component of cardiovascular risk factors, depression-related IR might play a role in the development and progression of coronary and cerebral atherosclerosis in chronic-resistant depression. Further, IR may contribute to the pathophysiology of depressive disorder. In conclusion IR could account for the linkage between depression and atherosclerotic vascular diseases. More studies are needed to examine the importance of improving insulin sensitivity in the treatment of chronic-resistant depression and prevention of depression-related vascular morbidity and mortality.

Cushing’s disease and melancholia

Striking similarities exist in the endocrinology of Cushing's disease and melancholic depression.Laboratory abnormalities, which have been found in both, include raised urinary,plasma and salivary cortisol, non-suppression of cortisol in the dexamethasone suppression test and adrenocorticotrophin (ACTH) hypersecretion. The hypercortisolism can be so severe in melancholic depression that it is difficult to distinguish from Cushing's disease and has been described as a "pseudo-Cushing's" state. Cerebrospinal fluid corticotrophin-releasing hormone (CRH) levels have been found to be lower in patients with Cushing's disease than in depressed subjects. Dynamic endocrine tests may help to distinguish between the two disorders.An exaggerated response to synacthen has been found in both but a reduced ACTH response to CRH occurs in depression, unlike those with Cushing's disease who show ACTH hyper-responsiveness. Other tests, which may help to distinguish between the two disorders,include the dexamethasone-CRH test, the naloxone test, the insulin-induced hypoglycemia test and the desmopressin stimulation test. Similarities in psychiatric symptoms have been recognised for many years. More recently, the physical complications of melancholic depression have been noted. These include osteoporosis, an increased risk of death from cardiovascular disease, hypertension, a redistribution of fat to intra abdominal sites and insulin resistance. Cushing's disease shares these physical complications and we propose that the common underlying factor is excessive plasma glucocorticoids. The increasing recognition of the physical complications and the increased morbidity and mortality in those who suffer from depression underscores the necessity for early detection and treatment of this illness and screening for undetected physical complications.

Acute effect of different antidepressants on glycemia in diabetic and non-diabetic rats

Diabetic patients have a 20% higher risk of depression than the general population. Treatment with antidepressant drugs can directly interfere with blood glucose levels or may interact with hypoglycemic agents. The treatment of depression in diabetic patients must take into account variations of glycemic levels at different times and a comparison of the available antidepressant agents is important. In the present study we evaluated the interference of antidepressants with blood glucose levels of diabetic and non-diabetic rats. In a first experiment, male adult Wistar rats were fasted for 12 h. Imipramine (5 mg/kg), moclobemide (30 mg/kg), clonazepam (0.25 mg/kg), fluoxetine (20 mg/kg) sertraline (30 mg/kg) or vehicle was administered. After 30 min, fasting glycemia was measured. An oral glucose overload of 1 ml of a 50% glucose solution was given to rats and blood glucose was determined after 30, 60 and 90 min. Imipramine and clonazepam did not change fasting or overload glycemia. Fluoxetine and moclobemide increased blood glucose at different times after the glucose overload. Sertraline neutralized the increase of glycemia induced by oral glucose overload. In the second experiment, non-diabetic and streptozotocin-induced diabetic rats were fasted, and the same procedures were followed for estimation of glucose tolerance 30 min after glucose overload. Again, sertraline neutralized the increase in glycemia after glucose overload both in diabetic and non-diabetic rats. These data raise the question of whether sertraline is the best choice for prolonged use for diabetic individuals, because of its antihyperglycemic effects. Clonazepam would be useful in cases with potential risk of hypoglycemia.