Korean J Fam Med. 2014;35:109-110

http://dx.doi.org/10.4082/kjfm.2014.35.3.109

The Interrelationship between Diabetes and Depression

Editorial

Young Gyu Cho Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

Both diabetes and depression are highly prevalent health

from previous research. However, the authors report that

problems that have a negative impact on various aspects of health,

there is a lack of prior research on the treatment of depression

quality of life, and mortality. It has been well documented that

in individuals with diabetes. Gill et al. 7) investigated the

depression is more common among people with diabetes than

prescription of antidepressant medications for patients with

among the general population. Although the exact nature of

medical comorbidities including diabetes in the primary care

the relationship between diabetes and depression is not fully

setting using electronic health record data. They found that

understood, the bidirectional relationship of these two diseases

primary care physicians prescribed antidepressant medication

has been suggested.1) A meta-analysis by Mezuk et al.2) showed

less aggressively for patients with multiple comorbidities,

that depression is associated with a 60% increased risk of type 2

although there was no significant difference in the antidepressant

diabetes and type 2 diabetes is associated with 15% increased risk

medication prescription for diabetes alone. Patients with medical

of depression. Depression is associated with biochemical changes

comorbidities may be already taking multiple medications

including increased activity of counter-regulatory hormones,

for management of comorbid medical diseases so additional

altered glucose transport function, and increased production

medications may increase their burden in relation to potential

of proinflammatory cytokines, which contribute to insulin

side effects and cost. Low rates of depression treatment in patients

resistance, beta islet cell dysfunction, and ultimately diabetes.

with diabetes may be related to a concern about the adverse

Depression is also associated with unhealthy behaviors including

metabolic effects of antidepressant medication.8)

smoking, physical inactivity, and hypercaloric diets, which are risk

However, Sung et al.’s study is a cross-sectional design which

factors for the development of diabetes. In patients with diabetes,

does not prove causality. Although they described that diabetes

the psychosocial burden of having a chronic illness may result in

is associated with an increased risk of depressive symptoms,

3,4)

development of depression.

Comorbid depression in patients

the direction of relationship between diabetes and depressive

with diabetes is related to poor glycemic control, higher severity of

symptoms was unclear. One limitation of this study was that

diabetic complications, increased risk of cardiovascular diseases,

depressive symptoms were assessed by the Patient Health

5)

higher functional disability, and higher all-cause mortality. 6)

In the present issue, Sung et al. investigated the relationship

Questionnaire-2 with low specificity, not by a formal depression diagnostic interview.

between diabetes and depressive symptoms among Korean women

The comorbidity of diabetes and depression is associated

using a nationally representative data of Korean. They obtained

with significantly higher morbidity, disability, and mortality

the data from the fifth Korea National Health and Nutrition

beyond those due to either diabetes or depression alone.9) Sung

Examination survey 2010–2011, which consisted of 6,572 Korean

et al.6)’s study suggests that diabetes and depression frequently

women aged 30 years and over. They found that diabetes has a

exist together and there is a possibility that depression treatment

relationship with depressive symptoms but that patients with

is suboptimal in patients with diabetes. Therefore, it should be

diabetes were less likely to be treated for their depression.

emphasized that the coordinated care system which optimizes

The result that women with diabetes have a higher likelihood of having depressive symptoms is consistent with findings

Korean J Fam Med

diagnosis and treatment of depression in patients with diabetes is necessary.

Vol. 35, No. 3 May 2014

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Young Gyu Cho: The Interrelationship between Diabetes and Depression

CONFLICT OF INTEREST

5. Rustad JK, Musselman DL, Nemeroff CB. The relationship of depression and diabetes: pathophysiological and treatment

No potential conflict of interest relevant to this article was reported.

implications. Psychoneuroendocrinology 2011;36:1276-86. 6. Sung HN, Chae HS, Kim ES, Kim JS. Diabetes and depressive symptoms in Korean women: the Fifth Korean National

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Health and Nutrition Examination Survey (2010-2011). Korean J Fam Med 2014;35:127-35. 7. Gill JM, Klinkman MS, Chen YX. Antidepressant medication

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