Insulin resistance as a marker for the immune-metabolic subtype of depression

Annelies Brouwer*, Daniël H. van Raalte, Femke Lamers, Femke Rutters, Petra J.M. Elders, Eus J.W. Van Someren, Frank J. Snoek, Aartjan T.F. Beekman, Marijke A. Bremmer

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

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Objective: Insulin resistance (IR), a marker of metabolic dysregulation and pro-inflammatory state, moderates the antidepressant treatment effect in patients with type 2 diabetes (T2D) and is therefore a potential marker for personalized treatment. Based on data from a light therapy trial (NTR4942), we aimed to evaluate whether 1) depression symptoms differ according to the level of IR, and 2) improvement of specific depression symptoms drive the positive effects of light therapy in those with higher IR. Methods: This secondary analysis in 59 individuals with depression and T2D explored differences in depressive symptom profile (30-item Inventory of Depressive Symptomatology (IDS)) at baseline and in response to light therapy (versus placebo), between lower and higher IR individuals, using Likelihood Ratio tests and Linear-by-linear association. IR was measured using the gold standard, a hyperinsulinemic-euglycaemic clamp. Results: At baseline, higher IR individuals reported more symptoms of irritability (p=0.024) anhedonia (no interest in people and activities: p=0.011; absence of pleasure and enjoyment: p=0.021), fatigue (fatigue: p=0.036; physical fatigue: p=0.035) and hypersomnia (p=0.029) relative to persons with lower IR, who reported more insomnia (nightly awakening: p=0.041; early morning awakening: p=0.012). Light therapy led to an improvement across IDS symptoms in higher IR individuals, while in lower IR individuals, light therapy improved early morning awakening (p=0.005) and interest in people and activities (p=0.015), but worsened mood (feeling sad: p=0.001; feeling irritable: p=0.002; interpersonal sensitivity: p=0.014). Conclusions: Results add to the hypothesis of an immune-metabolic subtype of depression, and suggest that IR might be a promising focus for precision medicine.

Original languageEnglish
Pages (from-to)1371-1376
Number of pages6
JournalJournal of Affective Disorders
Early online date1 Sept 2021
Publication statusPublished - 1 Dec 2021

Bibliographical note

Funding Information:
This study was supported by a European Foundation for the Study of Diabetes (EFSD)/Lilly Mental Health award 2012.

Publisher Copyright:
© 2021


  • Depression
  • Diabetes
  • Insulin resistance
  • Light therapy
  • Subtype


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