Magazine article Clinical Psychiatry News

Comorbid Depression Can Double Dementia Risk: Screening in Type 2 Diabetes for Depression Strongly Advised

Magazine article Clinical Psychiatry News

Comorbid Depression Can Double Dementia Risk: Screening in Type 2 Diabetes for Depression Strongly Advised

Article excerpt

EXPERT ANALYSIS FROM THE ANNUAL MEETING OF THE AMERICAN PSYCHIATRIC ASSOCIATION

HONOLULU--Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the meeting. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington, Seattle.

This dual comorbidity puts patients at increased risk for earlier mortality.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high Cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25: 423-9).

"It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said. …

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