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Disturbed Glucose Disposal in Patients With Major Depression; Application of the Glucose Clamp Technique

From the Departments of Psychiatry (U.S., W.G., S.R., M.P., T.M., S.W., J.H., E.F., K.G.K., K.M.O., F.H.) and Internal Medicine (A.P.), Luebeck University Medical School, Luebeck, Germany.

Address correspondence and reprint requests to Ulrich Schweiger, Department of Psychiatry, University of Luebeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. E-mail: ulrich.schweiger{at}psychiatrie.uk-sh.de

Objective: To assess the whole-body glucose disposal in patients with both typical and atypical depression and to characterize the neuroendocrine responses during a hyper-, eu-, hypoglycemic stepwise clamp experiment in patients with both subtypes of major depression. Depressive disorders and alterations in glucose metabolism are closely associated. The glucose clamp technique is considered to be the "gold standard" for the assessment of whole-body glucose disposal.

Methods: We studied 19 patients with typical major depressive disorder (MDD), 7 patients with atypical major depression, and 30 men and women of a healthy comparator group using a stepwise glucose clamp procedure. Glucose disposal rates were assessed and concentrations of hormones involved in glucose allocation were measured.

Results: Glucose disposal rates were lower by 19% in patients with typical MDD and 30% in patients with atypical MDD than in the group of healthy controls (3.2 ± 0.8 and 2.8 ± 0.7 versus 4.0 ± 1.0 mmol h^–1 kg^–1). C-peptide concentrations were 26% higher in patients with atypical MDD and similar in patients with typical MDD and healthy controls. Vascular endothelial growth factor concentrations were 30% higher in typical MDD and similar in atypical MDD and the control group.

Conclusions: Whole-body glucose disposal is reduced in patients with typical and atypical depression. The observed neuroendocrine responses suggest a hyperactive allocation system in typical depression and a hypoactive allocation system in atypical depression.

Key Words: depressive disorder • insulin • glucose clamp technique • cortisol • norepinephrine • vascular endothelial growth factor

Abbreviations: ACTH = adrenocorticotropic hormone; ANOVA = analysis of variance; BMI = body mass index; CV = coefficient of variation; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, version IV; GH = growth hormone; GLUT1 = glucose transporter Type 1; GLUT4 = glucose transporter Type 4; HDL = high-density lipoproteins; HPA = hypothalamic-pituitary-adrenal; MDD = major depressive disorder; SCID = Structured Clinical Interview for DSM-IV; VEGF = vascular endothelial growth factor.

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				Disturbances of Glucose Metabolism in Depression Journal Watch Psychiatry, April 7, 2008; 2008(407): 3 - 3. [Full Text]