Can Depression Be Classified Into Different Subtypes Based on Cardiometabolic Risk Factors?

What you need to know

• Researchers identified a distinct “cardiometabolic depression” subtype characterized by high rates of obesity, high blood pressure, and blood sugar abnormalities.
• People with cardiometabolic depression tended to have more severe depression symptoms, lower cognitive functioning, and were more likely to be taking antidepressants compared to those with non-cardiometabolic depression.
• The existence of this subtype suggests depression patients may benefit from screening for cardiometabolic risk factors and tailored treatment approaches.

Depression and cardiometabolic health: A two-way street

Depression and cardiometabolic health problems like obesity, high blood pressure, and diabetes often go hand in hand. But the relationship between depression and these physical health issues is complex. Does depression increase the risk of developing cardiometabolic problems? Or do cardiometabolic issues contribute to depression? The answer appears to be both.

Previous research has found that people with depression are more likely to develop conditions like obesity, high blood pressure, and diabetes. At the same time, having these cardiometabolic risk factors seems to increase a person’s chances of experiencing depression. This two-way relationship suggests that for some people, depression and cardiometabolic health may be closely intertwined.

Identifying a cardiometabolic depression subtype

To explore this connection further, researchers from Maastricht University in the Netherlands set out to determine if they could identify a distinct subtype of depression characterized by cardiometabolic risk factors. They analyzed data from 248 adults with major depressive disorder who were part of a larger population study.

The researchers looked at five key cardiometabolic risk factors:

1. Central obesity (excess fat around the waistline)
2. High blood pressure
3. High triglycerides (a type of fat in the blood)
4. Low HDL cholesterol (the “good” cholesterol)
5. High blood sugar

Using a statistical technique called latent class analysis, they found that the participants clustered into two distinct groups:

1. A “cardiometabolic depression” subtype (58% of participants)
2. A “non-cardiometabolic depression” subtype (42% of participants)

People in the cardiometabolic depression group had much higher rates of obesity, high blood pressure, and blood sugar abnormalities compared to the non-cardiometabolic group. They were also more likely to have high triglycerides and low HDL cholesterol, though the difference was less pronounced for these factors.

Characteristics of cardiometabolic depression

The researchers then compared the two groups to see how they differed in terms of demographics and clinical characteristics. Some key findings emerged:

Demographics: People with cardiometabolic depression were more likely to be male and have lower levels of education compared to those with non-cardiometabolic depression.

Depression severity: The cardiometabolic group had more severe depression symptoms overall, as measured by a standard questionnaire.

Symptom differences: Interestingly, the cardiometabolic group reported less depressed mood but more loss of energy compared to the non-cardiometabolic group. This suggests the two subtypes may have somewhat different symptom profiles.

Medication use: People with cardiometabolic depression were more likely to be taking antidepressant medication.

Cognitive functioning: The cardiometabolic group performed worse on tests of memory, information processing speed, and executive function (skills like planning and decision-making).

Physical activity: Those with cardiometabolic depression reported less physical activity compared to the non-cardiometabolic group.

Brain volume: In a subset of participants who underwent brain scans, the cardiometabolic group had lower white matter volume in the brain. White matter acts as the brain’s communication network, connecting different regions.

Implications for depression treatment

The identification of this cardiometabolic depression subtype has important implications for how we understand and treat depression. Some key takeaways include:

Screening: The findings suggest it may be beneficial to screen depression patients for cardiometabolic risk factors, especially men and those with lower education levels. Identifying these risk factors early could help prevent future health complications.

Tailored treatment: People with cardiometabolic depression may benefit from a more holistic treatment approach that addresses both mental and physical health. This could include lifestyle interventions to improve diet and increase physical activity alongside traditional depression treatments.

Medication considerations: Since the cardiometabolic group was more likely to be taking antidepressants, doctors may need to carefully consider medication choices. Some antidepressants can have negative effects on weight and metabolic health.

Cognitive support: Given the lower cognitive functioning seen in the cardiometabolic group, these patients may benefit from additional support for memory and thinking skills as part of their treatment plan.

Limitations and future directions

It’s important to note some limitations of this study. The research was observational, meaning it can’t prove that cardiometabolic factors directly cause a specific type of depression or vice versa. Additionally, the study only looked at people at one point in time, so it can’t show how the relationship between depression and cardiometabolic health might change over time.

Future research could explore whether treating cardiometabolic risk factors in depression patients leads to better mental health outcomes. It would also be valuable to study whether this cardiometabolic subtype responds differently to various depression treatments compared to other subtypes.

Conclusions

• This study provides evidence for a distinct “cardiometabolic depression” subtype characterized by high rates of obesity, high blood pressure, and blood sugar abnormalities.
• People with cardiometabolic depression may have unique clinical characteristics, including more severe symptoms and lower cognitive functioning.
• Recognizing this subtype could lead to more personalized and effective depression treatments that address both mental and physical health.
• More research is needed to fully understand the relationship between depression and cardiometabolic health and how best to treat patients with this profile.