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Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables

  • D. Vancampfort (a1) (a2), C. U. Correll (a3) (a4), M. Wampers (a1), P. Sienaert (a1), A. J. Mitchell (a5) (a6), A. De Herdt (a2), M. Probst (a1) (a2), T. W. Scheewe (a7) and M. De Hert (a1)
  • DOI:
  • Published online: 21 November 2013

Individuals with depression have an elevated risk of cardiovascular disease (CVD) and metabolic syndrome (MetS) is an important risk factor for CVD. We aimed to clarify the prevalence and correlates of MetS in persons with robustly defined major depressive disorder (MDD).


We searched Medline, PsycINFO, EMBASE and CINAHL up until June 2013 for studies reporting MetS prevalences in individuals with MDD. Medical subject headings ‘metabolic’ OR ‘diabetes’ or ‘cardiovascular’ or ‘blood pressure’ or ‘glucose’ or ‘lipid’ AND ‘depression’ OR ‘depressive’ were used in the title, abstract or index term fields. Manual searches were conducted using reference lists from identified articles.


The initial electronic database search resulted in 91 valid hits. From candidate publications following exclusions, our search generated 18 studies with interview-defined depression (n = 5531, 38.9% male, mean age = 45.5 years). The overall proportion with MetS was 30.5% [95% confidence interval (CI) 26.3–35.1] using any standardized MetS criteria. Compared with age- and gender-matched control groups, individuals with MDD had a higher MetS prevalence [odds ratio (OR) 1.54, 95% CI 1.21–1.97, p = 0.001]. They also had a higher risk for hyperglycemia (OR 1.33, 95% CI 1.03–1.73, p = 0.03) and hypertriglyceridemia (OR 1.17, 95% CI 1.04–1.30, p = 0.008). Antipsychotic use (p < 0.05) significantly explained higher MetS prevalence estimates in MDD. Differences in MetS prevalences were not moderated by age, gender, geographical area, smoking, antidepressant use, presence of psychiatric co-morbidity, and median year of data collection.


The present findings strongly indicate that persons with MDD are a high-risk group for MetS and related cardiovascular morbidity and mortality. MetS risk may be highest in those prescribed antipsychotics.

Corresponding author
*Address for correspondence: Dr D. Vancampfort, University Psychiatric Centre KU Leuven, Campus Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium. (Email:
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KG Alberti , RH Eckel , SM Grundy , PZ Zimmet , JI Cleeman , KA Donato , JC Fruchart , WP James , CM Loria , SC Smith Jr. (2009). A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 16401645.

KG Alberti , P Zimmet , P Shaw (2006). The metabolic syndrome – a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabetes Medicine 23, 469480.

E Atlantis , Z Shi , BJ Penninx , GA Wittert , A Taylor , OP Almeida (2012). Chronic medical conditions mediate the association between depression and cardiovascular disease mortality. Social Psychiatry and Psychiatric Epidemiology 47, 615625.

J Barth , M Schumacher , C Herrmann-Lingen (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine 66, 802813.

O Bayturan , EM Tuzcu , A Lavoie , T Hu , K Wolski , P Schoenhagen , S Kapadia , SE Nissen , SJ Nicholls (2010). The metabolic syndrome, its component risk factors, and progression of coronary atherosclerosis. Archives of Internal Medicine 170, 478484.

CB Begg , M Mazumdar (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 10881101.

AD Brown , DA Barton , GW Lambert (2009). Cardiovascular abnormalities in patients with major depressive disorder: autonomic mechanisms and implications for treatment. CNS Drugs 23, 583602.

CU Correll , T Lencz , AK Malhotra (2011). Antipsychotic drugs and obesity. Trends in Molecular Medicine 17, 97107.

JR Davidson (2010). Major depressive disorder treatment guidelines in America and Europe. Journal of Clinical Psychiatry 71 (Suppl. E1), e04.

M De Hert , D Cohen , J Bobes , M Cetkovich-Bakmas , S Leucht , DM Ndetei , HJ Möller , S Gautam , J Detraux , CU Correll (2011 a). Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, and recommendations at the system and individual levels. World Psychiatry 10, 138151.

M De Hert , CU Correll , J Bobes , M Cetkovich-Bakmas , D Cohen , I Asai , J Detraux , S Gautam , HJ Möller , DM Ndetei , JW Newcomer , R Uwakwe , S Leucht (2011 b). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10, 5277.

M De Hert , J Dekker , D Wood , K Kahl , R Holt , H Möller (2009). Cardiovascular disease and diabetes is people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry 24, 412424.

M De Hert , J Detraux , R van Winkel , W Yu , CU Correll (2011 c). Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nature Reviews. Endocrinology 8, 114126.

MDe Hert , DVancampfort , CCorrell , VMercken , JPeuskens , KSweers , Rvan Winkel , AJMitchell (2011 d). Guidelines for screening and monitoring of cardiometabolic risk in schizophrenia: systematic evaluation. British Journal of Psychiatry 199, 99105.

S Duvall , R Tweedie (2000). A non-parametric ‘trim and fill’ method for assessing publication bias in meta-analysis. Journal of the American Statistical Association 95, 8998.

M Egger , SG Davey , M Schneider , C Minder (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.

Expert Panel (2001). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). Journal of the American Medical Association 285, 24862497.

A Farahani , CU Correll (2012). Are antipsychotics or antidepressants needed for psychotic depression? A systematic review and meta-analysis of trials comparing antidepressant or antipsychotic monotherapy with combination treatment. Journal of Clinical Psychiatry 73, 486496.

ES Ford , WH Giles , WH Dietz (2002). Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. Journal of the American Medical Association 287, 356359.

A Galassi , K Reynolds , J He (2006). Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. American Journal of Medicine 119, 812819.

AS Gami , BJ Witt , DE Howard , PJ Erwin , LA Gami , VK Somers , VM Montori (2007). Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. Journal of the American College of Cardiology 49, 403414.

G Gartlehner , RA Hansen , LC Morgan , K Thaler , L Lux , M Van Noord , U Mager , P Thieda , BN Gaynes , T Wilkins , M Strobelberger , S Lloyd , U Reichenpfader , KN Lohr (2011). Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Annals of Internal Medicine 155, 772785.

SM Grundy , JI Cleeman , RS Daniels , KA Donato , RH Eckel , BA Franklin , DJ Gordon , RM Krauss , PJ Savage , SC Smith Jr., JA Spertus , F Costa (2005). Diagnosis and management of the metabolic syndrome: an American Heart/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112, 27352752.

LV Hedges , I Olkin (1985). Statistical Models for Meta-Analysis. Academic Press: New York.

JM Hennings , L Schaaf , S Fulda (2012). Glucose metabolism and antidepressant medication. Current Pharmaceutical Design 18, 59005919.

LCHwang , CHBai , CJChen (2006). Prevalence of obesity and metabolic syndrome in Taiwan. Journal of the Formosan Medical Association 105, 626635.

MJ Knol , HJ Derijks , MI Geerlings , ER Heerdink , PC Souverein , KJ Gorter , DE Grobbee , AC Egberts (2008). Influence of antidepressants on glycaemic control in patients with diabetes mellitus. Pharmacoepidemiology and Drug Safety 17, 577586.

F Lamers , N Vogelzangs , KR Merikangas , P de Jonge , AT Beekman , BW Penninx (2013). Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Molecular Psychiatry 18, 692699.

O Lord , D Malone , AJ Mitchell (2010). Receipt of preventive medical care and medical screening for patients with mental illness: a comparative analysis. General Hospital Psychiatry 32, 519543.

FS Luppino , LM de Wit , PF Bouvy , T Stijnen , P Cuijpers , BWJH Penninx , FG Zitman (2010). Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry 67, 220229.

L Maayan , J Vakhrusheva , CU Correll (2010). Effectiveness of medications used to reduce antipsychotic-related weight gain and metabolic abnormalities: a systematic review and meta-analysis. Neuropsychopharmacology 35, 15201530.

P Manu , CU Correll , R van Winkel , M Wampers , M De Hert (2012). Prediabetes in patients treated with antipsychotic drugs. Journal of Clinical Psychiatry 73, 460466.

P Manu , CU Correll , M Wampers , R van Winkel , W Yu , A Mitchell , M De Hert (2013). Prediabetic increase in hemoglobin A1c compared with impaired fasting glucose in patients receiving antipsychotic drugs. European Neuropsychopharmacology 23, 205211.

RS McIntyre , KY Park , CW Law , F Sultan , A Adams , MT Lourenco , AK Lo , JK Soczynska , H Woldeyohannes , M Alsuwaidan , J Yoon , SH Kennedy (2010). The association between conventional antidepressants and the metabolic syndrome: a review of the evidence and clinical implications. CNS Drugs 24, 741753.

RS McIntyre , NL Rasgon , DE Kemp , HT Nguyen , CW Law , VH Taylor , HO Woldeyohannes , MT Alsuwaidan , JK Soczynska , B Kim , MT Lourenco , LS Kahn , BI Goldstein (2009). Metabolic syndrome and major depressive disorder: co-occurrence and pathophysiologic overlap. Currents Diabetes Reports 9, 5159.

RS McIntyre , JK Soczynska , JZ Konarski , SH Kennedy (2006). The effect of antidepressants on glucose homeostasis and insulin sensitivity: synthesis and mechanisms. Expert Opinion on Drug Safety 5, 157168.

RS McIntyre , JK Soczynska , JZ Konarski , HO Woldeyohannes , CW Law , A Miranda , D Fulgosi , SH Kennedy (2007). Should depressive syndromes be reclassified as ‘metabolic syndrome type II’? Annals of Clinical Psychiatry 19, 257264.

L Meng , D Chen , Y Yang , Y Zheng , R Hui (2012). Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. Journal of Hypertension 30, 842851.

AJ Mitchell , D Malone , CC Doebbeling (2009). Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies. British Journal of Psychiatry 194, 491499.

AJ Mitchell , D Vancampfort , A De Herdt , W Yu , M De Hert (2013 a). Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Schizophrenia Bulletin 39, 295305.

AJ Mitchell , D Vancampfort , K Sweers , R van Winkel , W Yu , M De Hert (2013 b). Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders – a systematic review and meta-analysis. Schizophrenia Bulletin 39, 306318.

D Moher , A Liberati , J Tetzlaff , DG Altman ; PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 6, e1000097.

R Mojtabai (2013). Antidepressant use and glycemic control. Psychopharmacologia 227, 467477.

S Mottillo , KB Filion , J Genest , L Joseph , L Pilote , P Poirier , S Rinfret , EL Schiffrin , MJ Eisenberg (2010). The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. Journal of the American College of Cardiology 56, 11131132.

A Nicholson , H Kuper , H Hemingway (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal 27, 27632774.

A Niranjan , A Corujo , RC Ziegelstein , E Nwulia (2012). Depression and heart disease in US adults. General Hospital Psychiatry 34, 254261.

BJ North , DA Sinclair (2012). The intersection between aging and cardiovascular disease. Circulation Research 110, 10971108.

A Pan , N Keum , OI Okereke , Q Sun , M Kivimaki , RR Rubin , FB Hu (2012). Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care 35, 11711180.

A Pan , Q Sun , OI Okereke , KM Rexrode , FB Hu (2011). Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. Journal of the American Medical Association 306, 12411249.

SB Patten , JVA Williams , DH Lavorato , MA Eliasziw (2009). Longitudinal community study of major depression and physical activity. General Hospital Psychiatry 31, 571575.

GC Patton , JB Carlin , C Coffey , R Wolfe , M Hibbert , G Bowes (1998). Depression, anxiety, and smoking initiation: a prospective study over 3 years. American Journal of Public Health 88, 15181522.

BW Penninx , AT Beekman , A Honig , DJ Deeg , RA Schoevers , JT van Eijk , W van Tilburg (2001). Depression and cardiac mortality: results from a community-based longitudinal study. Archives of General Psychiatry 58, 221227.

R Rugulies (2002). Depression as a predictor for coronary heart disease. A review and meta-analysis. American Journal of Preventive Medicine 23, 5161.

MSmith , DHopkins , RCPeveler , RIHolt , MWoodward , KIsmail (2008). First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis. British Journal of Psychiatry 192, 406411.

W Swardfager , N Herrmann , S Marzolini , M Saleem , SB Farber , A Kiss , KL Lanctôt (2011). Major depressive disorder predicts completion, adherence, and outcomes in cardiac rehabilitation: a prospective cohort study of 195 patients with coronary artery disease. Journal of Clinical Psychiatry 72, 11811188.

T Tillin , N Forouhi , DG Johnston , PM McKeigue , N Chaturvedi , IF Godsland (2005). Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study. Diabetologia 48, 649656.

V Valkanova , KP Ebmeier (2013). Vascular risk factors and depression in later life: a systematic review and meta-analysis. Biological Psychiatry 73, 406413.

D Vancampfort , K Vansteelandt , CU Correll , AJ Mitchell , A De Herdt , P Sienaert , M Probst , M De Hert (2013). Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators. American Journal of Psychiatry 170, 265274.

K Van der Kooy , H van Hout , H Marwijk , H Marten , C Stehouwer , A Beekman (2007). Depression and the risk for cardiovascular diseases: systematic review and meta analysis. International Journal of Geriatric Psychiatry 22, 613626.

W Whang , LD Kubzansky , I Kawachi , KM Rexrode , CH Kroenke , RJ Glynn , H Garan , CM Albert (2009). Depression and risk of sudden cardiac death and coronary heart disease in women. Journal of the American College of Cardiology 53, 950958.

MA Whooley , P de Jonge , E Vittinghoff , C Otte , R Moos , RM Carney , S Ali , S Dowray , B Na , MD Feldman , NB Schiller , WS Browner (2008). Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. Journal of the American Medical Association 300, 23792388.

LR Wulsin , BM Singal (2003). Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosomatic Medicine 65, 201210.

LR Wulsin , GE Vaillant , VE Wells (1999). A systematic review of the mortality of depression. Psychosomatic Medicine 61, 617.

RC Ziegelstein , JA Fauerbach , SS Stevens , J Romanelli , DP Richter , DE Bush (2000). Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Archives of Internal Medicine 160, 18181823.

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