The major depressive disorder in diabetes

Physiopathological processes and their impact on the self-care behavior of the people living with diabetes

Abstract

Diabetes and the major depressive disorder constitute huge challenges to the worldwide health public systems. Indeed, diabetes is a pandemic disease and according to the World Health Organization the major depressive disorder is the first illness producing more years (~15 years) living with disability. The prevalence of the major depressive disorder within the population living with diabetes is 2-3 times more that in the general population. When the person living with diabetes begins to express the depressive symptomatology, both its motivated behavior is turned-off and the decision making capabilities is disrupted, thereby affecting the activities required for the appropriate control of diabetes and its vascular, renal and neuronal complications. Besides, some pathophysiological processes underling the mayor depressive disorder may affect the regulation of the glucose in blood. For instance, the hypercortisolism present in melancholic depression may promote the hepatic glycogenolysis or the brain serotoninergic deficit might affect the perception of satiety during and the insulin release. The role of obesity as a risk factor for diabetes and depression is discussed and from a physiological approach it is proposed that inflammatory cytokines are the molecular messenger linking diabetes with the major depressive disorder. Finally, it is discussed how the major depressive disorder impact the self-care behavior of the person living with diabetes.