Depression and Diabetes. Wayne Katon, Mario Maj and Norman Sartorius (Eds.). Chichester, England: Wiley-Blackwell, August 2010. 180 pp. Price: $50.48. ISBN: 9780470688380.
Reviewed by Rick Doray, Jul 18, 2011
Although there are shelves and shelves of books dealing with diabetes, and shelves and shelves of books dealing with depression, this is one of only a few books that deal specifically with the relationship, origins and complications of co-occurring depression and diabetes. Published less than a year ago, the focus of Depression and Diabetes is relevantly timed. The latest figures on diabetes released by the World Health Organization are not good. 285 million people worldwide, 6.6% of the population, have type 2 diabetes. Last year, diabetes accounted for 4 million deaths globally (World Diabetes Association, 2011). The World Diabetes Association declared that numbers have reached pandemic levels (Hu, 2011). The number of people with diabetes may climb as high as 400 million by the year 2030, which is almost a hundred million more than the entire population of the United States.
Though it is well known that depression and diabetes can exist as comorbid conditions, current research in diabetes reveals that there are links to depression that have been hitherto unexplored. Clinicians and researchers have begun to find surprising bidirectional relationships. These relationships are raising new questions about the development and advancement of diabetes. Do we know as much as we thought we did about diabetes? What can the depression-diabetes link tell us about the pathogenic origin of diabetes and what makes certain individuals predisposed to acquiring the disease? Moreover, can this research help medicine find better diabetic treatments or even a cure?
Depression and Diabetes sets out to explore these questions with a broad overview of what is known, and what science hopes to find out, in the exploration of the interaction between these common disorders. And the book does so admiringly well. Depression and Diabetes has six chapters, each with a different focus on the issues regarding comorbid diabetes mellitus and depression, written by known experts. Chapter topics cover epidemiology, pathogenic origins, health costs, treatment, clinical management, and socio-cultural aspects of health management.
The editors are well known psychiatrists among their peers. Dr. Wayne Katon is a professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine in Seattle. Dr. Mario Maj is the Department of Psychiatry Chair at the University of Naples in Italy. Dr. Norman Sartorius has an impressive curriculum vita which includes being the former Director, World Health Organization’s Mental Health Group, former President of the World Psychiatric Association (WPA) and several professorships at Johns Hopkins School of Public Health, the University of Prague and Zagreb, among others.
Depression and Diabetes is directed at the clinical medicine community and, to a lesser degree, the professional mental health community in general. This is not surprising since it is a publication of Wiley-Blackwell and the World Psychiatric Association and is one in a series of books dealing with depression and its comorbid conditions. The others in the series deal with depression and co-occurring heart disease and cancer. The writing is consistent with the credentials of the authors. They write at a post-graduate level and not for the general public. The reading level is fairly complex and medical terminology is used extensively. Even though I have a background involving medical terminology, I found myself googling medically related vocabulary terms more than once. The average nonprofessional might get lost in the “doc-talk” which permeates the book, but the material can be conquered with a little patience and perseverance.
Chapter 1 deals with the epidemiology of the depression-diabetes link. The authors provide an excellent overview of how diabetes has traditionally been seen as a risk factor for depression. But here, the authors present new research showing that the reverse is also true. Depression can act as a risk factor for developing type 2 diabetes. The chapter covers recent data showing the prevalence of increased complications and higher mortality rates for patients with comorbid severe depression and diabetes.
The best chapter is written by Dr. Khalida Ismail, “Unraveling the Pathogenesis of the Depression-Diabetes Link.” Dr. Ismail gives an excellent overview of the various theoretical mechanisms that may explain the depression-diabetes link. This is no small task given the competing possible explanations and the way they intertwine with each other. Ismail gives an explanation of each “link” theory model, including: The psychological, insulin resistance, hypothalamic-pituitary-adrenal axis, autonomic nervous system, genetics, and birth weight and childhood trauma.
The autonomic nervous system theory was the most interesting to me. This theory builds upon the “macrophage theory of depression.” Essentially, the body’s immune system causes macrophages (white blood cells) and nervous system glial cells to release pro-inflammatory cytokines into the bloodstream during times of stress. These cytokines have been associated with pancreatic β-cell apoptosis (cell death), insulin resistance and coronary artery disease. The pro-inflammatory cytokines stimulate the sympathetic nervous system, increasing cortisol production. This, in turn, causes the body to increase production of visceral fat. As a person becomes more obese, pro-cytokine production in the body increases at the newly formed adipose tissue. With the increased number of fat cells, more cytokines are released into the system than in previous cycles. As stress continues, there is a feedback loop through the nervous system, releasing more cytokines and stimulating more cortisol production. Not only does this produce more pancreatic β-cell death, eventually resulting in diabetes, but the cytokines begin interfering with the chemistry of the brain. This can produce behavioral changes, including depressive conditions.
One topic that received less than full attention concerned the clinical treatment of depression-diabetes as covered in chapter 5. Though Hellman and Ciechanowski provided a case for coordination of care and the benefits of depression treatment in diabetic clinics, they did not specify exactly what that plan of care might entail. This omission may be due to the fact that medicine is just now catching on to the realization of a depression-diabetes link outside of the traditional psychological model. Unfortunately, after Ismail’s excellent chapter on the models of disease development it would have been nice to see an equally comprehensive coverage of the models of disease treatment. It would be my recommendation that future additions include a chapter outlining new models of treatment.
As this is a new and previously unexplored territory for medicine, the possibility of a widening scope of knowledge with further research is encouraging. The challenge for medicine is to adapt current models of treatment to incorporate what we are learning about the pathogenesis of the depression-diabetes link. Depression and Diabetes is an excellent early entry into the professional literature on this topic. I recommend this book to anyone who has a personal investment in diabetic care and to all primary care and family physicians who routinely diagnose and treat diabetic patients. I expect that several more books covering newly discovered facets of this topic, as well as further volumes from the World Psychiatric Association, will be forthcoming.
References
Hu, F. (2011, July 9). Diet and exercise for new-onset type 2 diabetes? The Lancet, 378 , pp. 101-102.
World Diabetes Association. (2011, May 5). Diabetes Facts. Retrieved July 6, 2011, from http://www.worlddiabetesfoundation.org/composite-35.htm
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