[Metabolic syndrome and depression]

Abstract

The metabolic syndrome is defined as a constellation of metabolic abnormalities, including glucose intolerance, obesity, dyslipidaemia, and hypertension. It is associated with an elevated risk for cardiovascular disease and type 2 diabetes. Over the past 20 years, a worldwide increase of the metabolic syndrome has taken place. In the USA, 21% to 39% of the general population suffer from metabolic syndrome; in Europe prevalence rates are lower. At the same time, depressive disorders, which are associated with a 1.5 to 2.5 fold risk for cardiovascular events, are increasing. The combination of metabolic syndrome and depression multiplies the risk for severe complications: Due to behavioural, physiological, genetic, and treatment-induced factors, depression stimulates the development of a metabolic syndrome. In reverse, the metabolic syndrome favours development and maintenance of the metabolic syndrome. Consequently, in patients suffering from metabolic syndrome and depression, both disorders must be treated simultaneously. The treatment plan includes weight reduction, physical activity, psychoeducation, family interventions, the patient's subjective explanatory and treatment models, cognitive techniques, and problem solving techniques. Weight, blood pressure, fastening glucose, haemoglobin A1c, and lipids must be controlled in order to monitor treatment progress. Additional drug treatment can be appropriate for hypertension, dyslipidaemia, hyperglycaemia, and depression. Under these conditions, sustained improvements of individual well-being, psychosocial risk-factors, functional limitations, glycemic control, hypertension, and obesity are possible.