Depression and Diabetic Peripheral Neuropathy: Birds of a Feather, But When do They Flock Together?

Abstract

The association between diabetes and depression is well recognised. Similarly, diabetic peripheral neuropathy (DPN) is a frequent complication of diabetes. Given the high prevalence of these conditions individually, it is hardly surprising they frequently interact, conferring additional morbidity and a higher mortality risk. Despite this, the specific clinical characteristics that underpin co-morbid depression and DPN remain unclear. Additionally, there is insufficient insight into causal pathways and temporal trends. High-quality epidemiological data is limited, but they suggest that these conditions may share certain common risk factors, although there are also distinct differences such as gender. Improved insights into the risk factors for the co-existence of DPN and depression may help towards improved screening for and treatment of these conditions.

A higher incidence of diabetic peripheral neuropathy may be associated with decreased sleep and increased depression in older adults

“…Given the high prevalence of depression and DPN in diabetes, it is hardly surprising that these two conditions are related. In two meta-analyses, depression was independently associated with DPN (32,33). In addition, antidepressants are used effectively to treat depression (34).…”

Anxiety and/or depression: which symptoms contribute to adverse clinical outcomes after amputation?

“…mortality in the univariate model, when the model was adjusted for the four longitudinal assessments of depression symptoms (T0, T1, T2 and T3), and after controlling for sex, age, ability to walk, duration of diabetes, type of foot, previous and index amputation level and number of complications, depression symptoms were no longer associated with mortality, suggesting the existence of a potential indirect effect of depression symptoms on mortality. Several studies have focused on depression as a predictor of mortality in patients with DM, in patients with a history of ulcers and in patients with the first ulcer, being considered a risk factor for ulceration, but also for delayed healing (Al-Smadi & Gharaibeh, 2019;Ismail et al, 2007;Iversen et al, 2009;Katon et al, 2005;Nowakowska et al, 2019;Shrestha et al, 2019;Vas & Papanas, 2020;Vedhara et al, 2010;Winkley et al, 2012). However, in the only study the authors are aware of which addressed the symptoms of depression as a predictor of mortality after a LEA (addressing amputation from all causes), found no significant relationship between depression and mortality (Singh & Prasad, 2016).…”

“…In addition, depression has been identified as a significant predictor of reduced life expectancy in patients with DM (Katon et al, 2005;Nowakowska et al, 2019), in patients with a history of ulcers (Ismail et al, 2007;Shrestha et al, 2019) and patientswith their first foot ulcer (Al-Smadi & Gharaibeh, 2019;Ismail et al, 2007;Iversen et al, 2009;Katon et al, 2005;Winkley et al, 2012). Depression is also a risk factor for ulceration (Ismail et al, 2007;Vas & Papanas, 2020) and for a delay in ulcer healing (Shrestha et al, 2019;Vedhara et al, 2010). However, there is a bidirectional relationship between depression and diabetes.…”

Diabetic Peripheral Neuropathy and Depression: Dancing with Wolves? - Mini-Review and Commentary on Alghafri et al. "Screening for depressive symptoms amongst patients with diabetic peripheral neuropathy"

“…However, they also share certain clinical characteristics, in particular older age, frailty, neuropathic pain, and diabetes complications. While this constellation may be considered the equivalent of “birds of the same feather flocking together” [ 33 ], its clinical impact can be as fierce as a wolf pack. In everyday practice, subjects with LOPS should be evaluated for depression early, with the aim of avoiding resultant impoverishment in the quality of life [ 17 , 25 , 27 , 34 ].…”