Melancholic Depression and Abdominal Fat Distribution: A Mini-Review

Abstract

Fat is stored around the abdomen in both subcutaneous and intra abdominal (visceral) sites. Visceral fat is associated in its own right with a set of metabolic abnormalities, including non insulin dependent diabetes, hypertension and dyslipidaemias. States of marked hypercortisolaemia, for example Cushing's syndrome, lead to the preferential accumulation of visceral fat. Since melancholic depression is known to be associated with elevated plasma Cortisol levels, this review explores whether depressed patients are prone to excess visceral fat storage, with the subsequent risk of developing the associated metabolic disturbances. Though the literature is limited, there is evidence that intra abdominal fat is increased in major depression. There is also evidence that depression is associated with increased risk of death from cardiovascular disease. Is visceral fat and its association with metabolic abnormalities the link between depression and physical illness?

Mood, food, and obesity

“…Under physiologic acute stress, the HPA axis is activated, and glucocorticoids are released. This leads to a major restoration of energy balance by increasing insulin, increasing motivation for palatable food (Piazza and Le Moal, 1997; Dallman et al, 2006; Dallman, 2010), and mobilizing stored energy toward central stores that leads to obesity (Mann and Thakore, 1999). Thus, obesity and mood disorder are linked via the HPA axis.…”

Metabolic disturbances connecting obesity and depression

“…GCs exert pleiotropic effects on metabolic, endocrine, immune and behavioral functions. Under normal physiological conditions of acute stress, the HPA axis is activated to release GCs which have an adaptive value to restore energy balance by increasing insulin, motivation for palatable food (Piazza and Le Moal, 1997; Dallman et al, 2006; Dallman, 2010) and mobilizing stored energy and directing it to central stores (Mann and Thakore, 1999). The critical actions of GCs on adipose tissue deposition were demonstrated by early studies showing that adrenalectomy prevents obesity in Zucker rats and this is reversed by replacement of corticosterone (Freedman et al, 1985; Castonguay et al, 1986).…”

Mind and body: how the health of the body impacts on neuropsychiatry

“…Elevated heart rate has been associated with depression in multiple studies (Forbes and Chaney, 1980; Carney et al, 1993, 2000; Lechin et al, 1995), and is a strong predictor of multiple parameters of cardiovascular disease, including myocardial ischaemia, arrhythmias, hypertension, and cardiac failure (Dyer et al, 1980; Kannel et al, 1987; Palatini and Julius, 1997). Depression is associated with an increased risk of mortality in patients with cardiovascular disease (Mann and Thakore, 1999), and this increased risk is strongly linked with hypercortisolaemia (Jokinen and Nordstrom, 2009). In healthy subjects, cortisol and ACTH response to the Dex/CRH test were negatively associated with central adiposity and blood pressure and positively associated with HDL cholesterol, strong risk factors for cardiovascular disease (Tyrka et al, 2012).…”