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Depression and Comorbid Health Conditions

Comorbid Health Conditions

Not surprisingly, depression shares a bidirectional relationship with other chronic health conditions (Katon, 2011). Depression is associated with behaviors and physiology that increase the likelihood of developing chronic disease, and these factors may also account for depression complicating the management of chronic illnesses. Further, the negative impact to health associated with chronic disease may lead to depression (Katon, 2011). Patients with serious illnesses may experience decreased quality of life, increased physical disability, and increased chance of mortality due to depression. Further, patients with ‘physical’ illness are at an increased risk for depression, especially with the presence of environmental or biological risk factors (Kang et al., 2015). 

Chronic painHeart Disease

Forty percent of people with coronary heart disease also have depression (Dickens, 2015). In the U.S., coronary heart disease is the most frequently identified type of heart disease (Centers for Disease Control and Prevention, 2019). The shared relationship between depression and heart disease has been explained through a variety of pathways, including chronic inflammation, dysfunction in the autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis, as well as platelet and serotonin pathway dysfunction (Sher et al., 2010). In general, patients with heart disease and depression demonstrate poorer adherence to medication, take longer to return to normal levels of activity socially and at work, and have worse quality of life (Nair et al., 2012). Environmental factors also play a role in that limited social support and depression independently predicted poor outcomes for patients with heart disease (Compare et al., 2013). Research that has examined whether depression treatment improves outcomes for patients with heart disease is limited (Carney & Freedland, 2016). While more research is needed, some evidence suggests managing depressive symptoms may improve prognosis and decrease the probability of adverse cardiovascular events (Carney & Freedland, 2016; May et al, 2017).   

Chronic Pain

Interestingly, chronic pain, depression, and heart disease all demonstrate shared genetic linkage, and the relationship among these diseases remained significant after adjustment for environmental factors (van Hecke et al., 2017). Patients with chronic pain can be difficult to treat in healthcare settings. These patients frequently demonstrate strong resistance towards changing behaviors contributing to their poor quality of life, and treatment gains are likely to be difficult to realize. Depressed patients with comorbid chronic pain were more likely to have recently attempted suicide, and also demonstrated less improvement from antidepressant treatment compared to depressed patients without chronic pain (Roughan, 2021). People with depression and chronic pain may have a dampened reaction to endogenous opioids, which may explain their increased likelihood of long term opioid use (Sullivan, 2018). Cognitive behavior therapy, medication, and alternative treatments such as ketamine have demonstrated effectiveness in managing patients with both depression and chronic pain (IsHak, 2018). 

Obesity

A number of etiological pathways have been proposed to explain the bidirectional relationship between obesity and depression, many of which involve systems with integral roles in maintaining homeostasis in the body (Milaneschi et al., 2018). Inflammation  plays a critical role in both diseases (e.g., Chaves Filho, 2018 et al.; Patist et al., 2018). However, a review of population-based studies found differences in the strength of the relationship that was dependent on whether depression or obesity served as the predictor variable. The presence of obesity predicted depression 80% of the time, much more strongly than depression predicted obesity, at 53% of the time, a relationship that was moderated by the participant’s sex (Faith et al., 2011). The research appears to be inconclusive in regards to the strength and directionality of the relationship between depression and obesity. For example, another study reported contradictory results, finding that the risk for a person with depression developing obesity was 58%, versus 55% risk of an obese person developing depression (Luppino et al., 2010). Additional research is needed to further clarify the nature of this particular relationship as well as identify any additional moderating factors.

Diabetes

The coexistence of diabetes alongside depression carries stiff consequences for patients. A review of existing research found that comorbid depression and diabetes correlated with decreased metabolic control, treatment adherence, productivity, and quality of life, as well as increased complications, healthcare utilization, disability, and mortality risk (Egede & Ellis, 2010). In one study frequency of occurrence of comorbidity was approximately 200% greater than chance prediction, and each resulted in poorer outcomes than would be predicted by the other condition alone (Holt et al., 2014). Research suggests a moderating effect of both specific type of diabetes and sex. Depression occurred with 300% greater frequency in people with type 1 diabetes and nearly 200% greater frequency in people with type 2 diabetes. Further, women both with and without diabetes were more likely to have a depression diagnosis (Roy & Lloyd, 2012). Similar to other disorders, diabetes and depression share inflammation as well as HPA axis and sympathetic nervous system dysfunction (Champaneri et al., 2010).

References

Carney, R. M., & Freedland, K. E. (2017). Depression and coronary heart disease. Nature Reviews Cardiology, 14(3), 145–155. https://doi.org/10.1038/nrcardio.2016.181

Centers for Disease Control and Prevention. (2019). Coronary artery disease (CAD). https://www.cdc.gov/heartdisease/coronary_ad.htm

Champaneri, S., Wand, G. S., Malhotra, S. S., Casagrande, S. S., & Golden, S. H. (2010). Biological basis of depression in adults with diabetes. Current Diabetes Reports, 10(6), 396–405. https://doi.org/10.1007/s11892-010-0148-9

 

Chaves Filho, A., Lima, C., Vasconcelos, S., de Lucena, D. F., Maes, M., & Macedo, D. (2018). IDO chronic immune activation and tryptophan metabolic pathway: A potential pathophysiological link between depression and obesity. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 80(Pt C), 234–249. https://doi.org/10.1016/j.pnpbp.2017.04.035

 

Compare, A., Zarbo, C., Manzoni, G. M., Castelnuovo, G., Baldassari, E., Bonardi, A., Callus, E., & Romagnoni, C. (2013). Social support, depression, and heart disease: a ten year literature review. Frontiers in Psychology, 4, 384. https://doi.org/10.3389/fpsyg.2013.00384

Dickens, C. (2015). Depression in people with coronary heart disease: Prognostic significance and mechanisms. Current Cardiology Reports, 17(83). https://doi.org/10.1007/s11886-015-0640-6

 

Egede, L. E., & Ellis, C. (2010). Diabetes and depression: global perspectives. Diabetes Research and Clinical Practice, 87(3), 302–312. https://doi.org/10.1016/j.diabres.2010.01.024

Faith, M. S., Butryn, M., Wadden, T. A., Fabricatore, A., Nguyen, A. M., & Heymsfield, S. B. (2011). Evidence for prospective associations among depression and obesity in population-based studies. Obesity Reviews, 12(5), e438–e453. https://doi.org/10.1111/j.1467-789X.2010.00843.x

 

Holt, R. I., de Groot, M., & Golden, S. H. (2014). Diabetes and depression. Current Diabetes Reports, 14(6), 491. https://doi.org/10.1007/s11892-014-0491-3

IsHak, W. W., Wen, R. Y., Naghdechi, L., Vanle, B., Dang, J., Knosp, M., Dascal, J., Marcia, L., Gohar, Y., Eskander, L., Yadegar, J., Hanna, S., Sadek, A., Aguilar-Hernandez, L., Danovitch, I., & Louy, C. (2018). Pain and depression: A systematic review. Harvard Review of Psychiatry, 26(6), 352–363. https://doi.org/10.1097/HRP.0000000000000198

 

Kang, H. J., Kim, S. Y., Bae, K. Y., Kim, S. W., Shin, I. S., Yoon, J. S., & Kim, J. M. (2015). Comorbidity of depression with physical disorders: research and clinical implications. Chonnam Medical Journal, 51(1), 8–18. https://doi.org/10.4068/cmj.2015.51.1.8

Katon W. J. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience, 13(1), 7–23. https://doi.org/10.31887/DCNS.2011.13.1/wkaton

Luppino, F. S., de Wit, L. M., Bouvy, P. F., Stijnen, T., Cuijpers, P., Penninx, B. W., & Zitman, F. G. (2010). Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry, 67(3), 220–229. https://doi.org/10.1001/archgenpsychiatry.2010.2

 

May, H. T., Bair, T. L., Reiss-Brennan, B., Knight, S., Anderson, J. L., Horne, B. D., Brunisholz, K. D., & Muhlestein, J. B. (2017). The association of antidepressant and statin use with death and incident cardiovascular disease varies by depression severity. Psychology, Health & Medicine, 22(8), 919–931. https://doi.org/10.1080/13548506.2017.1281975


Milaneschi, Y., Simmons, W. K., van Rossum, E., & Penninx, B. W. (2019). Depression and obesity: Evidence of shared biological mechanisms. Molecular Psychiatry, 24(1), 18–33. https://doi.org/10.1038/s41380-018-0017-5

 

Nair, N., Farmer, C., Gongora, E., & Dehmer, G. J. (2012). Commonality between depression and heart failure. The American Journal of Cardiology, 109(5), 768-772. https://doi.org/10.1016/j.amjcard.2011.10.039

Patist, C. M., Stapelberg, N., Du Toit, E. F., & Headrick, J. P. (2018). The brain-adipocyte-gut network: Linking obesity and depression subtypes. Cognitive, Affective & Behavioral Neuroscience, 18(6), 1121–1144. https://doi.org/10.3758/s13415-018-0626-0

 

Roughan, W. H., Campos, A. I., García-Marín, L. M., Cuéllar-Partida, G., Lupton, M. K., Hickie, I. B., Medland, S. E., Wray, N. R., Byrne, E. M., Ngo, T. T., Martin, N. G., & Rentería, M. E. (2021). Comorbid chronic pain and depression: Shared risk factors and differential antidepressant effectiveness. Frontiers in Psychiatry, 12, 643609. https://doi.org/10.3389/fpsyt.2021.643609

Roy, T., & Lloyd, C. E. (2012). Epidemiology of depression and diabetes: A systematic review. Journal of Affective Disorders, 142(Suppl.), S8–S21. https://doi.org/10.1016/S0165-0327(12)70004-6

 

Sher, Y., Lolak, S., & Maldonado, J. R. (2010). The impact of depression in heart disease. Current Psychiatry Reports, 12(3), 255–264. https://doi.org/10.1007/s11920-010-0116-8

Sullivan M. D. (2018). Depression effects on long-term prescription opioid use, abuse, and addiction. The Clinical Journal of Pain, 34(9), 878–884. https://doi.org/10.1097/AJP.0000000000000603

 

van Hecke, O., Hocking, L. J., Torrance, N., Campbell, A., Padmanabhan, S., Porteous, D. J., McIntosh, A. M., Burri, A. V., Tanaka, H., Williams, F. M., & Smith, B. H. (2017). Chronic pain, depression and cardiovascular disease linked through a shared genetic predisposition: Analysis of a family-based cohort and twin study. PloS One, 12(2), e0170653. https://doi.org/10.1371/journal.pone.0170653

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