The Role of Anxiety in Metabolic Syndrome

Results

Psychological Factors, Diabetes & MS

Depression and anxiety have been independently associated with an increased risk of both diabetes mellitus and cardiovascular disease, but the extent to which this risk may be explained by health behaviors, socioeconomic status and biological mediators is still unknown.^[16] A study conducted with 2997 men and women supported the hypothesis that depression may increase the risk for diabetes and suggested that the relationship between negative mood states and metabolic variables could extend to the whole population, not only to people diagnosed with either depression or diabetes.^[17]

Type 2 diabetes is also closely related to abdominal obesity and is generally associated with other cardiometabolic risk factors, resulting in a high incidence of cardiovascular complications.^[18] Most authors consider the links between cardiovascular disease, diabetes and psychiatric disorders bidirectional because patients with anxiety and depression are known to present an elevated cardiovascular risk and patients with Type 2 diabetes and cardiometabolic diseases suffer more frequently from psychiatric problems.^[19] However, results from a prospective population-based study (n = 37,291) showed that diabetes could not be considered a predictor of depression or anxiety. Conversely, the presence of these psychological disorders, and particularly the presence of comorbidity between depression and anxiety, have emerged as significant risk factors for onset of Type 2 diabetes independent of other established risk factors for diabetes, such as lifestyle, socioeconomic condition and markers of MS.^[20]

In addition to poor glycemic control, hypothalamic–pituitary–adrenal (HPA) axis dysfunction, impaired stress responses and elevated basal levels of glucocorticoids are also hallmark features of experimental models of Type 1 and Type 2 diabetes. Glucocorticoids regulate many functions of the central nervous system, such as the activity and direction of intermediary metabolism, the maintenance of a proper cardiovascular tone and the activity and quality of the immune and inflammatory reaction. Common behavioral and/or somatic complex disorders, such as anxiety, depression, insomnia, chronic pain and fatigue syndromes, obesity, the MS, essential hypertension, diabetes Type 2, atherosclerosis with its cardiovascular sequelae, and osteoporosis, as well as autoimmune inflammatory and allergic disorders, all appear to have a glucocorticoid-regulated component.^[21,22]

Conversley, Licht and colleagues found that increases in sympathetic and decreases in parasympathetic activity rather than changes in HPA axis activity are associated with metabolic abnormalities, suggesting autonomic nervous system activity is more strongly associated with MS, than HPA axis activity.^[23] Stress and glucocorticoids contribute to the neurological complications observed in diabetes patients and many of the hyperglycemia-mediated changes in the brain are similar to those observed in depressive and chronically stressed patients; common mechanisms may be involved in the development of the neurological complications related to anxiety, depression and diabetes.^[22]

Table 1. Current evidence on the association of anxiety and depression and metabolic syndrome.
Study (year)	Sample	Outcome	Ref.
Cohen et al. (2010)	1024 stable CAD outpatients	Higher levels of depression were significantly associated with increased prevalence of MS	[16]
Holt et al. (2009)	2997 subjects	Depression increases risk for diabetes	[17]
Engum (2007)	37291 subjects	Diabetes could not be considered a predictor of depression or anxiety. The presence of depression and anxiety represented a significant risk for onset of Type 2 diabetes	[20]
Takeuchi et al. (2009)	1183 men	MS can predict the development of depression	[24]
Hildrum et al. (2009)	9571 subjects	No association of anxiety and depression with MS	[25]
Raikkonen et al. (2002)	425 women	Psychological risk factors, particularly anger, predicted the development of MS	[26]
Dunbar et al. (2008)	1690 subjects	Participants with MS with or without diabetes presented higher scores on depression scales than individuals without MS. No association was found with psychological distress or anxiety	[28]
Petrlova et al. (2004)	116 subjects	In MS patients, depression was approximately four-times more prevalent than in the general population	[29]
Bonnet et al. (2009)	840 hypertensive subjects with MS	In hypertensive subjects with MS, depressive symptoms were independently associated with unhealthy lifestyles	[30]
Skilton et al. (2007)	1598 subjects	MS was related to an increased prevalence of depression but not anxiety	[31]
Toker et al. (2008)	2355 men and 1525 women	Depression among women, but not men, was associated with a twofold increased risk of MS and elevated glucose levels	[32]
Nishnia et al. (2011)	1613 subjects	Depression was associated with MS and glucose abnormality in men	[33]
Vogelzangs et al. (2007)	2917 elderly patients	An association between depressive and MS symptoms was found in white but not in black participants. Anxiety symptoms were significantly associated with MS in men, but not in women	[34]
Herva et al. (2006)	5698 subjects	No clear association of MS with depression or anxiety	[45]
van Reedt Dortland et al. (2010)	1217 anxious and depressive patients	MS was associated with severity of depression and with tricyclic antidepressant use, but not with anxiety	[47]
Carroll et al. (2009)	4256 men	Generalized anxiety disorder, but not major depressive disorder, was associated with MS	[50]

Table 1. Current evidence on the association of anxiety and depression and metabolic syndrome.

Study (year)

Sample

Outcome

Ref.

Cohen et al. (2010)

1024 stable CAD outpatients

Higher levels of depression were significantly associated with increased prevalence of MS

[16]

Holt et al. (2009)

2997 subjects

Depression increases risk for diabetes

[17]

Engum (2007)

37291 subjects

Diabetes could not be considered a predictor of depression or anxiety. The presence of depression and anxiety represented a significant risk for onset of Type 2 diabetes

[20]

Takeuchi et al. (2009)

1183 men

MS can predict the development of depression

[24]

Hildrum et al. (2009)

9571 subjects

No association of anxiety and depression with MS

[25]

Raikkonen et al. (2002)

425 women

Psychological risk factors, particularly anger, predicted the development of MS

[26]

Dunbar et al. (2008)

1690 subjects

Participants with MS with or without diabetes presented higher scores on depression scales than individuals without MS. No association was found with psychological distress or anxiety

[28]

Petrlova et al. (2004)

116 subjects

In MS patients, depression was approximately four-times more prevalent than in the general population

[29]

Bonnet et al. (2009)

840 hypertensive subjects with MS

In hypertensive subjects with MS, depressive symptoms were independently associated with unhealthy lifestyles

[30]

Skilton et al. (2007)

1598 subjects

MS was related to an increased prevalence of depression but not anxiety

[31]

Toker et al. (2008)

2355 men and 1525 women

Depression among women, but not men, was associated with a twofold increased risk of MS and elevated glucose levels

[32]

Nishnia et al. (2011)

1613 subjects

Depression was associated with MS and glucose abnormality in men

[33]

Vogelzangs et al. (2007)

2917 elderly patients

An association between depressive and MS symptoms was found in white but not in black participants. Anxiety symptoms were significantly associated with MS in men, but not in women

[34]

Herva et al. (2006)

5698 subjects

No clear association of MS with depression or anxiety

[45]

van Reedt Dortland et al. (2010)

1217 anxious and depressive patients

MS was associated with severity of depression and with tricyclic antidepressant use, but not with anxiety

[47]

Carroll et al. (2009)

4256 men

Generalized anxiety disorder, but not major depressive disorder, was associated with MS

[50]

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

The Role of Anxiety in Metabolic Syndrome

Results

Psychological Factors, Diabetes & MS

Tables

References

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar

Key Issues

Comments

Email This

Feedback