Is there a direct link between depression and the occurrence of T2D?
Depression is a common comorbidity of type 2 diabetes. A recent study evaluated cause-and-effect relationships and shared genetics between them
Type 2 diabetes mellitus is a disease characterized by chronic hyperglycemia, while depression is its frequent comorbidity, potentially due to common risk factors. Depression, even at subclinical levels, has been shown to increase the risk of developing type 2 diabetes by 25–60%, while other studies have shown that type 2 diabetes increases the risk of depression by 40–60%.
The causality of observational studies remains unclear due to unmeasured confusion and potential reverse causality. However, this can be partially circumvented with Mendelian randomization (MR), an approach that evaluates a potential causal relationship between phenotypes, using genetic variants as tools, since genes are randomly distributed at birth and are free from mixing.
Previous large-scale genomic association studies (GWAS) of type 2 diabetes and depression have reported 403 and 102 associated genomic loci for these diseases, respectively. However, standard GWAS examines each disease independently, without taking into account the genetic correlation between related phenotypes and their heredity.

The researchers have now looked at the causal relationship between depression and type 2 diabetes by conducting an MRI study using pooled statistics from non-overlapping samples of previous GWAS depression and type 2 diabetes.

The researchers looked at the causal relationship between depression and type 2 diabetes by conducting an MRI study using pooled statistics from non-overlapping samples of previous GWAS depression and type 2 diabetes.

For depression, they compared two assessment approaches: clinically diagnosed major depressive disorder (MDD) and self-reported depressive symptoms.

The researchers said their analyses provide evidence of a causal relationship between previously known epidemiological associations from depression to type 2 diabetes, but not vice versa. These findings are consistent with the pathophysiology of these diseases, where depression begins in adolescence or early adulthood, while type 2 diabetes tends to develop later, and it is known that bad habits among individuals with depression, including smoking, physical inactivity, and increased caloric intake (and therefore excess weight), contribute to the development of type 2 diabetes.
Specifically, our results indicate mediation through body mass index in the causal relationship between depression and type 2 diabetes, further supporting this hypothesis. In addition, antidepressants often cause weight gain, leading to type 2 diabetes, and the systemic inflammatory response associated with increased levels of stress hormones such as cortisol in the context of depression also contributes to insulin resistance.
Although epidemiological studies also show an increased risk of depression in people with type 2 diabetes, researchers have found no evidence of a causal relationship in this regard.
Our assessment of the strength of the tool for MR analysis indicates that the absence of this causal relationship is not simply a matter of statistical power. The likely hypothesis is that the epidemiologically observable association is created due to other factors that are not easy to evaluate in epidemiological studies, such as psychosocial factors related to the management of the treatment of conditioned pain, that is, from regular self-administration of insulin, in this chronic disease of middle age.
Distress, the psychological burden caused by the need to cope with and care for diabetes, has been linked to depression. However, a large international long-term study in 14 countries found that only symptoms of depression, not MDD, were predicted by diabetes-related distress 1 year after diagnosis.
Based on the findings, the researchers concluded that people with depression should be encouraged, as part of routine clinical care, to engage in a positive, healthy lifestyle, namely increased physical activity, adequate sleep, and a healthy diet.
Antidepressants offered to people with depression at risk of developing type 2 diabetes should be those that provide better glycemic control, such as selective serotonin reuptake inhibitors.
The results highlight the importance of effective prevention of type 2 diabetes when depressive symptoms appear. It is also highly recommended to maintain a healthy weight in the context of its impact on depression and the comorbidity of type 2 diabetes