Insulin resistance in depression: A large meta-analysis of metabolic parameters and variation

• Published in: Neuroscience and biobehavioral reviews Vol. 139; p. 104758
• Main Authors: Fernandes, Brisa S., Salagre, Estela, Enduru, Nitesh, Grande, Iria, Vieta, Eduard, Zhao, Zhongming
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01-08-2022
• Subjects: Adult; Antidepressive Agents - therapeutic use; Biomarker; Bipolar Disorder - drug therapy; Depression; Depression - drug therapy; Depression - psychology; Humans; Insulin; Insulin Resistance; Major depressive disorder; Meta-analysis; Precision psychiatry; Systematic review; Depression; Systematic review; Biomarker; Major depressive disorder; Precision psychiatry; Meta-analysis
• ISSN: 0149-7634; 1873-7528
• DOI: 10.1016/j.neubiorev.2022.104758

Increased insulin resistance is recognized in psychiatric disorders, such as schizophrenia and bipolar disorder, but its occurrence in depression is less clear. Our aims were to verify if insulin resistance is altered in depression, to test the metabolic subgroup hypothesis of depression and if there are changes with antidepressants. Inclusion criteria were studies including adult subjects with depression and either a control group or follow-up after treatment with antidepressants, and assessing fasting insulin or glucose levels or the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index. Seventy studies with 240,704 participants were included. Both insulin levels and the HOMA-IR index were increased in acute depression. Neither insulin nor the HOMA-IR index were altered during remission. Insulin was increased in atypical, but not typical depression. There was higher variation in insulin in individuals with depression than in controls. Insulin resistance did not change with antidepressant treatment. Insulin resistance is increased in depression during acute episodes. Heterogeneity was high in most of the analyses. Laboratory assessment of insulin resistance might have clinical utility in people with depression for diagnosis of the metabolic subtype and treatment selection, following precision psychiatry standards.
•Is there an association between insulin resistance and depression?•Is there a metabolic subtype of depression?•Insulin resistance was increased in acute depression but not remitted depression.•Variation in insulin levels was larger in the individuals with depression.•Insulin resistance is a state biomarker in acute depression.