Can Treating Depression Improve Disease Outcomes?

The separation of the mind and body, a legacy that can be traced from Greek philosophers to Descartes' Meditations to modern western thought, is reflected in the attitudes and practices of western medicine. This partitioning of mental disorders as processes of the mind, separate and distinct from processes of the body, is increasingly subject to challenge. An article in this issue (1) tests the validity of partitioning mental and physical processes by assessing the effect of treatment for depression on diabetic care outcomes.

Depression is a profound source of human suffering worldwide. It is common among patients with chronic pain and frequently develops after the onset of other medical conditions, such as heart attacks, strokes, malignant disease, osteoporosis, heart failure, liver disease, end-stage renal disease, and rheumatologic disorders. We aren't surprised when a person becomes depressed after developing a life-altering, chronic, disabling, or painful medical condition. Some of us are surprised by evidence that depression associated with chronic medical conditions leads to worse outcomes for the chronic illness. For example, patients with depression after myocardial infarction or stroke are more likely to die (2), and depressed, diabetic patients have worse glycemic control (3) and higher rates of diabetic complications (4). Most of us would be startled to learn of emerging evidence that depression may increase the risk for subsequent development of many health conditions, including osteoporosis (5), coronary artery disease (6), diabetes (7), and cerebral vascular disease (8). Although it is only logical to believe that treating depression might improve outcomes for these health conditions, this conjecture is still unproven.

By what mechanism does a process of the mind affect the …