Depression may be both consequence of and risk factor for diabetes

ScienceDaily (Nov. 22, 2010) ? Diabetes appears to be associated with the risk of depression and vice versa, suggesting the relationship between the two works in both directions, according to a report in the November 22 issue of Archives of Internal Medicine.

An estimated 23.5 million U.S. adults -- more than 10 percent -- have diabetes, including 23 percent of those ages 60 and older, according to background information in the article. Major depressive disorder affects about 14.8 million U.S. adults each year. "Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting," the authors write.

An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues assessed the relationship between the two diseases among 65,381 women who were age 50 to 75 in 1996. Participants completed an initial questionnaire about their medical history and health practices, and then follow-up questionnaires every two years through 2006. They were classified as having depression if they reported symptoms of depression, using antidepressant medication or being given a diagnosis of depression by a physician. Women who reported a new diagnosis of diabetes completed a supplementary questionnaire about symptoms, diagnostic tests and treatments.

During the 10-year follow-up, 2,844 women were diagnosed with type 2 diabetes and 7,415 developed depression. Women with depression were about 17 percent more likely to develop diabetes after controlling for other risk factors, such as physical activity and body mass index (BMI). Those who were taking antidepressants had a 25 percent higher risk of developing diabetes than those who did not have depression.

After controlling for other risk factors for mood disorders, women with diabetes were 29 percent more likely to develop depression. Women who took insulin for diabetes had a further increased risk -- 53 percent higher than women without diabetes.

"The findings from this well-characterized cohort of more than 55,000 U.S. women with 10 years' follow-up add to the growing evidence that depression and diabetes are closely related to each other, and this reciprocal association also depends on the severity or treatment of each condition," the authors write. "All the associations were independent of sociodemographic, diet and lifestyle factors."

The results indicate that lifestyle factors such as physical activity and BMI may partially mediate the association between depression and new cases of diabetes, but since the association remained significant after adjusting for these factors, depression may have an effect on risk for diabetes beyond weight and inactivity. In addition, the findings reinforce the idea that diabetes is related to stress, the authors note. "A diagnosis of diabetes may lead to the symptoms of depression for the following reasons: 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," they write.

"Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association," the authors conclude. "Furthermore, depression and diabetes are highly prevalent in the middle-aged and elderly population, particularly in women. Thus, proper lifestyle interventions including adequate weight management and regular physical activity are recommended to lower the risk of both conditions."

This study was supported by a National Institutes of Health grant. Co-author Dr. Ascherio received a grant from the National Alliance for Research on Schizophrenia & Depression. Co-author Dr. Lucas received a postdoctoral fellowship from the Fonds de recherche en sante du Quebec.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Note: If no author is given, the source is cited instead.

View the original article here

Depression may be both consequence of and risk factor for diabetes

ScienceDaily (Nov. 22, 2010) ? Diabetes appears to be associated with the risk of depression and vice versa, suggesting the relationship between the two works in both directions, according to a report in the November 22 issue of Archives of Internal Medicine.

An estimated 23.5 million U.S. adults -- more than 10 percent -- have diabetes, including 23 percent of those ages 60 and older, according to background information in the article. Major depressive disorder affects about 14.8 million U.S. adults each year. "Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting," the authors write.

An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues assessed the relationship between the two diseases among 65,381 women who were age 50 to 75 in 1996. Participants completed an initial questionnaire about their medical history and health practices, and then follow-up questionnaires every two years through 2006. They were classified as having depression if they reported symptoms of depression, using antidepressant medication or being given a diagnosis of depression by a physician. Women who reported a new diagnosis of diabetes completed a supplementary questionnaire about symptoms, diagnostic tests and treatments.

During the 10-year follow-up, 2,844 women were diagnosed with type 2 diabetes and 7,415 developed depression. Women with depression were about 17 percent more likely to develop diabetes after controlling for other risk factors, such as physical activity and body mass index (BMI). Those who were taking antidepressants had a 25 percent higher risk of developing diabetes than those who did not have depression.

After controlling for other risk factors for mood disorders, women with diabetes were 29 percent more likely to develop depression. Women who took insulin for diabetes had a further increased risk -- 53 percent higher than women without diabetes.

"The findings from this well-characterized cohort of more than 55,000 U.S. women with 10 years' follow-up add to the growing evidence that depression and diabetes are closely related to each other, and this reciprocal association also depends on the severity or treatment of each condition," the authors write. "All the associations were independent of sociodemographic, diet and lifestyle factors."

The results indicate that lifestyle factors such as physical activity and BMI may partially mediate the association between depression and new cases of diabetes, but since the association remained significant after adjusting for these factors, depression may have an effect on risk for diabetes beyond weight and inactivity. In addition, the findings reinforce the idea that diabetes is related to stress, the authors note. "A diagnosis of diabetes may lead to the symptoms of depression for the following reasons: 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," they write.

"Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association," the authors conclude. "Furthermore, depression and diabetes are highly prevalent in the middle-aged and elderly population, particularly in women. Thus, proper lifestyle interventions including adequate weight management and regular physical activity are recommended to lower the risk of both conditions."

This study was supported by a National Institutes of Health grant. Co-author Dr. Ascherio received a grant from the National Alliance for Research on Schizophrenia & Depression. Co-author Dr. Lucas received a postdoctoral fellowship from the Fonds de recherche en sante du Quebec.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Note: If no author is given, the source is cited instead.

View the original article here

New Links Seen Between Depression and Diabetes

Study Shows Depression May Raise Risk of Diabetes and Vice Versa

By Denise Mann
WebMD Health News

Reviewed by Laura J. Martin, MD

Nov. 22, 2010 -- Depression and diabetes may be linked, according to new research in the Archives of Internal Medicine.

"People usually think of these as two isolated conditions, but there is growing evidence that they are linked behaviorally and biologically," says study researcher Frank Hu, MD, PhD, MPH, professor of nutrition and epidemiology at the Harvard School of Public Health in Boston. "This data provide strong evidence that we should not consider these two isolated conditions any longer."

About 23.5 million Americans have diabetes, and about 14.8 million Americans have major depressive disorder in a given year, according to statistics in the new report.

Of the 65,381 women aged 50 to 75 in 1996 who were study participants, 2,844 women were newly diagnosed with type 2 diabetes and 7,415 women developed depression in the ensuing 10 years.

Depression increased the risk for diabetes, and diabetes increased the risk for depression, the study shows. Specifically, women who were depressed were 17% more likely to develop diabetes even after the researchers adjusted for other risk factors such as weight and lack of regular exercise.

Those women who were taking antidepressants were 25% more likely to develop diabetes than their counterparts who were not depressed, the study shows.

Women with diabetes were 29% more likely to develop depression after taking into account other depression risk factors, and those women who took insulin for their diabetes were 53% more likely to develop depression during the 10-year study.

While certain factors such as physical activity and body mass index may partially explain the link between depression and diabetes, they do not completely explain the connection, Hu tells WebMD.

The common denominator may be stress, Hu says.

People who are depressed have elevated levels of stress hormones such as cortisol, which can lead to problems with glucose or blood sugar metabolism, increased insulin resistance, and the accumulation of belly fat -- all diabetes risk factors, he says.

But "there is long-term stress and strain associated with diabetes management such as blood sugar control and treatment for complications, and this can lead to decreased quality of life and increased probability of depression," he says.

"Both are very common diseases," says Leonid Poretsky, MD, director of the Friedman Diabetes Institute at Beth Israel Medical Center in New York City. "Diabetes can make depression worse because diabetes is chronic illness with a lot of worries."

"So much of the treatment for diabetes is self-care, and people who are depressed may not take good care of themselves," he says. "They don't exercise as much and may have other issues in terms of watching their diet, checking their blood sugar, and taking medications."

Certain medications used to treat depression can also increase risk for developing diabetes, he says.

"It can be a vicious cycle. Both diseases have to be addressed at the same time," Poretsky says. "If control of diabetes is deteriorating, look for depression as a possible cause of this deterioration."

"This study is interesting, and one of a number of studies that points to a bi-directional link between diabetes and depression," says Jeffrey Gonzalez, PhD, assistant professor of medicine and epidemiology and population health at Albert Einstein College of Medicine in the Bronx, N.Y. "The emotional side of diabetes is an important one to attend to in the treatments of this illness."

"This speaks to the burden associated with diabetes," Gonzalez says. "Changes in diet and lifestyle, having to take injections can lead to increased levels of distress."

Doctors need to do a better job of addressing the emotional side of diabetes, he says. "We know that if you are distressed once you do have diabetes, you are at increased risk for poor self-management, complications, and death."

SOURCES: Pan, A. Archives of Internal Medicine, 2010; vol 170: pp 1884-1891Leonid Poretsky, MD, director, Friedman Diabetes Institute, Beth Israel Medical Center, New York City.Frank Hu, MD, MPH, PhD, professor, nutrition and epidemiology, Harvard School of Public Health, Boston.Jeffrey Gonzalez, PhD, assistant professor of medicine, epidemiology and population health, Albert Einstein College of Medicine, New York.

ⓒ2010 WebMD, LLC. All Rights Reserved.

View the original article here

Diabetes May Cause Depression, Depression Can Cause Diabetes

Editor's Choice
Main Category: Diabetes
Also Included In: Depression;??Psychology / Psychiatry;??Endocrinology
Article Date: 23 Nov 2010 - 15:00 PST window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend ? printer friendly ? opinions ?

The link between depression and diabetes risk works the other way round too; diabetes can cause depression. Put simply, diabetes can cause depression and depression can cause diabetes, researchers from the Harvard School of Public Health wrote in Archives of Internal Medicine.

Over 10% of all US adults have diabetes; for those aged at least 60 years the figure is 23%. About 14.8 million Americans are affected by a major depressive disorder annually.

The authors explained: "Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting."An Pan, Ph.D., and team gathered data on 65,381 adult females aged 50 to 75 to see what the relationship between diabetes and depression might be. The women had to fill in an initial questionnaire with details about health practices and their medical history. Follow-up questionnaires were completed every two years for ten years until the end of 2006.

The investigators classified participants with depression as those diagnosed with the disease by a doctor, and/or taking antidepressants. Those who said they had depression were given another questionnaire to fill in with questions about their depression, including symptoms, treatments and diagnostic tests.

During the whole study period 2,844 females developed type 2 diabetes and 7,415 were identified with depression.

Those with depression had a 17% higher risk of developing diabetes - even after the researchers ruled out certain risk factors, such as BMI (body mass index) and physical activity.

The women on antidepressant medications had a 25% higher risk of developing diabetes compared to those without depression.

The investigators also found that those with diabetes had a 29% higher risk of developing depression compared to women without diabetes. This figure prevailed even after taking into account certain risk factors.

Those taking insulin for their condition had a 53% higher risk compared to the non-diabetic women.

The authors wrote: "The findings from this well-characterized cohort of more than 55,000 U.S. women with 10 years' follow-up add to the growing evidence that depression and diabetes are closely related to each other, and this reciprocal association also depends on the severity or treatment of each condition. All the associations were independent of sociodemographic, diet and lifestyle factors."The researchers say their findings indicate that depression has an impact on diabetes risk beyond inactivity and body weight.

They also believe that their study showed a relationship between stress and diabetes.

The authors noted: "A diagnosis of diabetes may lead to the symptoms of depression for the following reasons: 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."They concluded: "Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association. Furthermore, depression and diabetes are highly prevalent in the middle-aged and elderly population, particularly in women. Thus, proper lifestyle interventions including adequate weight management and regular physical activity are recommended to lower the risk of both conditions.""Bidirectional Association Between Depression and Type 2 Diabetes Mellitus in Women"
An Pan, PhD; Michel Lucas, PhD; Qi Sun, ScD; Rob M. van Dam, PhD; Oscar H. Franco, MD, DSc, PhD; JoAnn E. Manson, MD, DrPH; Walter C. Willett, MD, DrPH; Alberto Ascherio, MD, DrPH; Frank B. Hu, MD, PhD
Arch Intern Med. 2010;170(21):1884-1891. doi:10.1001/archinternmed.2010.356

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Please rate this article:
(Hover over the stars
then click to rate)

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

All opinions are moderated before being added.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

View the original article here

Depression May Be Both Consequence Of And Risk Factor For Diabetes

Main Category: Diabetes
Also Included In: Depression;??Psychology / Psychiatry
Article Date: 23 Nov 2010 - 1:00 PST window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend ? printer friendly ? opinions ?

Diabetes appears to be associated with the risk of depression and vice versa, suggesting the relationship between the two works in both directions, according to a report in the November 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

An estimated 23.5 million U.S. adults-more than 10 percent-have diabetes, including 23 percent of those ages 60 and older, according to background information in the article. Major depressive disorder affects about 14.8 million U.S. adults each year. "Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting," the authors write.

An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues assessed the relationship between the two diseases among 65,381 women who were age 50 to 75 in 1996. Participants completed an initial questionnaire about their medical history and health practices, and then follow-up questionnaires every two years through 2006. They were classified as having depression if they reported symptoms of depression, using antidepressant medication or being given a diagnosis of depression by a physician. Women who reported a new diagnosis of diabetes completed a supplementary questionnaire about symptoms, diagnostic tests and treatments.

During the 10-year follow-up, 2,844 women were diagnosed with type 2 diabetes and 7,415 developed depression. Women with depression were about 17 percent more likely to develop diabetes after controlling for other risk factors, such as physical activity and body mass index (BMI). Those who were taking antidepressants had a 25 percent higher risk of developing diabetes than those who did not have depression.

After controlling for other risk factors for mood disorders, women with diabetes were 29 percent more likely to develop depression. Women who took insulin for diabetes had a further increased risk-53 percent higher than women without diabetes.

"The findings from this well-characterized cohort of more than 55,000 U.S. women with 10 years' follow-up add to the growing evidence that depression and diabetes are closely related to each other, and this reciprocal association also depends on the severity or treatment of each condition," the authors write. "All the associations were independent of sociodemographic, diet and lifestyle factors."

The results indicate that lifestyle factors such as physical activity and BMI may partially mediate the association between depression and new cases of diabetes, but since the association remained significant after adjusting for these factors, depression may have an effect on risk for diabetes beyond weight and inactivity. In addition, the findings reinforce the idea that diabetes is related to stress, the authors note. "A diagnosis of diabetes may lead to the symptoms of depression for the following reasons: 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," they write.

"Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association," the authors conclude. "Furthermore, depression and diabetes are highly prevalent in the middle-aged and elderly population, particularly in women. Thus, proper lifestyle interventions including adequate weight management and regular physical activity are recommended to lower the risk of both conditions."

(Arch Intern Med. 2010;170[21]:1884-1891.)

Source:
Archives of Internal Medicine

Please rate this article:
(Hover over the stars
then click to rate)

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

All opinions are moderated before being added.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

View the original article here

Diabetes, Depression Can Be Two-Way Street

MONDAY, Nov. 22 (HealthDay News) -- Diabetes and depression are conditions that can fuel each other, a new study shows.

The research, conducted at Harvard University, found that study subjects who were depressed had a much higher risk of developing diabetes, and those with diabetes had a significantly higher risk of depression, compared to healthy study participants.

"This study indicates that these two conditions can influence each other and thus become a vicious cycle," said study co-author Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health in Boston. "Thus, primary prevention of diabetes is important for prevention of depression, and vice versa."

In the United States, about 10 percent of the population has diabetes and 6.7 percent of people over the age of 18 experience clinical depression every year, according to the researchers.

Symptoms of clinical depression include anxiety, feelings of hopelessness or guilt, sleeping or eating too much or too little, and loss of interest in life, people and activities.

Diabetes is characterized by high blood sugar and an inability to produce insulin. Symptoms include frequent urination, unusual thirst, blurred vision and numbness in the hands or feet.

About 95 percent of diabetes diagnoses are type 2, and often are precipitated by obesity.

The researchers found that the two can go hand in hand.

The study followed 55,000 female nurses for 10 years, gathering the data through questionnaires. Among the more than 7,400 nurses who became depressed, there was a 17 percent greater risk of developing diabetes. Those who were taking antidepressant medicines were at a 25 percent increased risk.

On the other hand, the more than 2,800 participants who developed diabetes were 29 percent more likely to become depressed, with those taking medications having an even higher risk that increased as treatment became more aggressive.

Tony Z. Tang, adjunct professor in the department of psychology at Northwestern University, said that participants who were taking medications for their conditions fared worse because their illnesses were more severe.

"None of these treatments are cures, unlike antibiotics for infections. So, depressed patients on antidepressants and diabetic patients on insulin still frequently suffer from their main symptoms," said Tang. "These patients fare worse in the long run because they were much worse than the other patients to start with."

Tang cautioned against drawing too many conclusions from the study. He noted that the correlations between diabetes and depression declined markedly when excessive weight and inactivity were controlled for in the study.

"This suggests that much of the observed correlation between depression and diabetes comes from confounding variables," he said. "In layman's terms, being fat and having an unhealthy lifestyle makes people more likely to be depressed, and [also] more likely to have diabetes."

But if research establishes a strong connection between the two illnesses it could advance treatment, Tang added.

"If a substantial causal connection is established between the two disorders, it would be rather novel and it could potentially change how we understand and treat both disorders," Tang said.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said establishing causal relationships is difficult in a study based on questionnaires because self-reports can be inaccurate.

"This is not ideal," he said. "It's difficult to say what is causing what, if one is causing the other. This is very difficult to elucidate."

A large, controlled, randomized study is needed, said Zonszein, who is also a professor of clinical medicine at Albert Einstein College of Medicine, in New York City.

But he praised the research, noting that tracking such as large number of subjects "over a long period of time" strengthened the findings.

Hu, also a professor of medicine at Harvard University, said the study conclusions were valid. When two conditions share the same risk factors (obesity and lack of exercise), "we can still say that the conditions are linked and one is both the cause and consequence of the other condition," he explained.

Depression can affect blood sugar levels and insulin metabolism through increased cortisol, contributing to unhealthy eating habits, weight gain and diabetes, he said.

"On the other hand, management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression," said Hu. The two "are linked not only behaviorally, but biologically."

More information

For more on diabetes, go to U.S. National Library of Medicine .

View the original article here