Prevalence and characteristics of depressive disorders in type 1 diabetes.

BACKGROUND: Persons with diabetes and depression have increased risk of complications and increased mortality. We aimed to investigate the prevalence, clinical characteristics and impact with regard to glycosylated haemoglobin (HbA1c) of depressive disorders in persons with type 1 diabetes at an outpatient specialist diabetes clinic. FINDINGS: A total of 51 persons with type 1 diabetes were diagnosed according to Mini International Neuropsychiatric Interview (M.I.N.I) with regard to dysthymia and previous or ongoing depressive episodes during spring 2005. HbA1c was measured at the day of the interview, and self-reported information on family history of depressive disorders was obtained. Eight persons (16%; 95% CI: 7%, 29%) were in the midst of a major depressive episode, 4 of these also reported a previous episode of depression. Seven of the 8 persons with an ongoing major depressive episode met the criteria for melancholia. Three persons (6%) met the criteria for dysthymia, and 6 persons (12%) had previous episode(s) of depression, without being currently depressed. The 17 (33%; 95% CI: 21%, 48%) persons with ongoing and/or previous depressive disorder had increased HbA1c (8.5%; 95% CI: 7.6%, 9.4%) compared to those without depressive disorders (7.9%; 95% CI: 7.5%, 8.3%), although the difference did not reach statistical significance. CONCLUSIONS: Persons with type 1 diabetes had a high prevalence of depressive disorders, mainly depressive episodes that also met the criteria for melancholia, a subtype often considered a more serious and "biologic" form of depression. We were not able to demonstrate that persons with depressive disorders had poorer regulated diabetes compared to those without depressive disorders.

Does diabetes have a protective effect on migraine?

BACKGROUND: Diabetes is associated with an increased risk of several other chronic diseases. In contrast, a previous study found an inverse relation between diabetes and migraine, whereas another large population-based study showed that the prevalence of migraine among patients with diabetes varied strongly depending on age. We aimed to investigate how the prevalence of medically treated migraine in patients with diabetes varied depending on diabetic drug treatment, sex, and age in the complete Norwegian population. METHODS: Data on all persons in Norway being prescribed medication for diabetes (n =124,649) or migraine (n = 81,225) in 2006 were obtained from the National Register of Prescriptions and analyzed in a cross-sectional design. RESULTS: Persons using diabetic drugs had an overall reduced prevalence of medically treated migraine when compared with the nondiabetic population (odds ratio [OR] = 0.72 [95% confidence interval = 0.68-0.75]). The OR was strongly associated with age. Although young persons receiving oral diabetic medication had, in fact, an increased prevalence of medically treated migraine, the prevalence declined with increasing age to about the same reduced prevalence (OR = 0.4-0.6) for all types of diabetes treatment in patients 60 to 69 years of age. The prevalence was equally decreased between men and women. CONCLUSIONS: The results suggest a markedly reduced prevalence of migraine among older patients with diabetes, when compared with the general population. One may speculate that the seemingly protective effect of diabetes on migraine could be a result of neuropathy.

Comorbidity of migraine with ADHD.

OBJECTIVE: The purpose of this study was to investigate how often drugs used to treat migraine and ADHD are prescribed to the same patients to assess, indirectly, the comorbidity of these disorders. METHOD: We used data from the Norwegian prescription database for 2006, including the total Norwegian population (N = 4,640,219). RESULTS: Antimigraine drugs were prescribed to 81,225 persons (1.75% of the total population), anti-ADHD drugs to 18,481 persons (0.40%), and 284 persons were prescribed both types of drugs. There was a positive and significant association between prescription of antimigraine and anti-ADHD drugs for all age groups between 20 and 50 for both genders, with odds ratios ranging from 1.76 to 2.81. CONCLUSION: The prescription patterns for these drugs in adult patients indicate a comorbidity between migraine and ADHD.

Are migraine and bipolar disorders comorbid phenomena?: findings from a pharmacoepidemiological study using the Norwegian Prescription Database.

OBJECTIVES: Clinical, epidemiological, and, recently, genome-wide linkage and genome-wide association studies suggest migraine and bipolar disorder are comorbid phenomena. The objective of this study was to determine whether there is also evidence that this comorbidity exists by virtue of there being a positive relationship between the prescription of medications used to treat migraine and mood-stabilizing agents using the National Norwegian Prescription Database. METHODS: Data allowing ascertainment of the concurrence of prescriptions for migraine and mood-stabilizing agents were gleaned from the Norwegian Prescription Database for calendar year 2006, covering the total population (N = 4,640,219). Results were obtained using logistic regression analyses and were expressed by odds ratios (ORs). RESULTS: A total of 81,225 persons (1.8% of the population) received medications for migraine and 19,517 (0.45%) received a mood-stabilizing agent for a bipolar disorder; 843 persons received both types of medications. The OR expressing the relationship between the concurrent use of both categories of medications was 2.55 (95% confidence interval [CI], 2.38-2.73, P < 0.001, z score = 26.44), significant for all mood stabilizers (lithium: OR = 1.82 [95% CI, 1.58-2.10], P < 0.001, z score = 8.31; carbamazepine: OR = 2.48 [95% CI, 2.01-3.06], P < 0.001, z score = 8.42; valproic acid: OR = 2.26 [95% CI, 1.89-2.70], P < 0.001, z score = 8.96; and lamotrigine: OR = 3.50 [95% CI, 3.14-3.90], P < 0.001, z score = 22.68). The association was significantly higher for men (OR = 3.16 [95% CI, 2.74-3.66], P < 0.001, z score = 15.53) than for women (OR = 2.21 [95% CI, 2.04-2.39], P < 0.001, z score = 19.61) and was most pronounced in younger age groups and for lamotrigine. CONCLUSIONS: There was a strong positive association between the prescription of medications used to treat migraine and mood-stabilizing agents. This is compatible with the hypothesis that migraine and bipolar disorders are associated with one another.

A pharmaco-epidemiological study of migraine and antidepressant medications: complete one year data from the Norwegian population.

BACKGROUND: Migraine, depression and anxiety disorders have been associated with one another in several epidemiological studies. However, it is not known if or how these associations are reflected in the concurrent use of medications for migraine and depressive/anxiety disorders in the general population. The purpose of the present study was to identify groups of patients particularly likely to receive clinical treatment for both conditions. METHODS: Data from the Norwegian Prescription Database for 2006 were analysed for the purpose of ascertaining concurrence of prescriptions for migraine and depression/anxiety disorders. Data were subjected to analysis testing deviation from unity for the OR performed by a chi-square test. RESULTS: In the total Norwegian population (N=4,640,219) migraine drugs were prescribed to 81,225 persons (1.8% of the population), antidepressant drugs to 257,700 persons (5.6% of the population), and 11,269 persons were prescribed both types of drugs. The prescription of antidepressants was significantly increased in patients receiving a prescription for a medication used to treat migraine (OR=2.82 (95% CI=2.76-2.88); chi-square p<0.001), and this association was stronger for men than for women. Teenage women carried the highest risk for this co-morbid constellation (OR=3.89 CI=3.17-4.77); chi-square p<0.001). CONCLUSION: This study revealed a strong positive association between the prescription of migraine and antidepressant medications, and this association was generally most pronounced in men. However, teenage girls carried the highest risk of receiving both kinds of prescriptions, suggesting particular attentiveness is required in the clinical management of these patients.

Comorbidity of asthma with ADHD.

OBJECTIVE: To assess how frequently drugs used to treat asthma and ADHD are prescribed to the same patients. METHOD: The authors used data from the Norwegian Prescription Database for 2006, including the total Norwegian population (n = 4,640,219). RESULTS: Anti-asthma drugs were prescribed to 350,894 persons (7.56 % of the population), anti-ADHD drugs to 18,481 persons (0.40 %), and both to 1,730 persons. There was a 65% increased overall risk (OR = 1.65) of being prescribed one of the drugs given a prescription of the other. Women had a markedly higher risk than men. When data for each age group (10 years interval) and each gender were analyzed separately, the strongest associations were found for women between 20 and 49 years of age and men between 30 and 49 years of age. CONCLUSION: These prescription patterns suggested a marked comorbidity between asthma and ADHD.

Major depressive disorder viewed as a dysfunction in astroglial bioenergetics.

For many years scientists and physicians have pondered upon the apparent connection between depressive disorder and diabetes mellitus. Several epidemiologic studies confirm that diabetics have increased incidence of depression, and vice versa. In addition: depressive, non-diabetic patients have several insulin- and glucose-metabolism disturbances, probably exerting a compensatory reaction to the malfunction in the depressed brain as these disturbances are normalised in remission. After the discovery of PET-scanning, such studies have shown that patients with depressive disorder have reduced glucose metabolism in frontal parts of the brain. The present hypothesis regards the PET findings as observations of the primary pathophysiology of depression. Furthermore: two studies of post mortem samples from depressed patients show reduced numbers of astroglia. This is in accordance to the mentioned insulin disturbances, as only astroglia, not neurons, have insulin-sensitive glucose metabolism. Hence: the astroglia, not necessarily the neurons, are proposed to be the type of cells in which the disease resides. Most probably depressive disorder is a multitude of diseases, explaining the apparent multitude of symptoms, and the fact that different patients do respond to different drugs. Therefore: one can only formulate the hypothesis by mentioning a common denominator to these specific malfunctions, namely: disturbed glucose metabolism in the depressed brain. The present paper reviews several findings and proposes that attenuated cerebral glucose metabolism in frontal parts of the brain, in the astroglia, is the cause of depressive disorder.