A New Perspective on Depression: Should We Be Concerned About Hypersomnia and Overeating Depression? Research Reports Suggest "Precision Psychiatry" is Approaching

Depression is not Monolithic——Diabetes and Heart Risks Differ by "Symptom Type"

Depression is often thought of as a mental issue, but it affects the entire body just as much as any physical illness. Recent findings have increasingly shown that individuals with depression are more prone to diabetes and cardiovascular diseases (such as heart attacks and strokes).
A report introduced by the French medical news site Santé log at the ECNP (European College of Neuropsychopharmacology) further examines this relationship. Instead of placing depression into a single category,it suggests that the "destination" of future complications may differ based on the way symptoms manifest (type).santelog.com

What is "Cardiometabolic": The Intersection of Sugar and Blood Vessels

The "cardiometabolic diseases" discussed in the article broadly refer to a group of illnesses involving "metabolism (blood sugar, lipids, weight, etc.)" and "heart and blood vessels." The report primarily focuses on

• Type 2 Diabetes (T2D)

• Cardiovascular Diseases (CVD: such as heart attacks and strokes)
  , analyzing a composite outcome of both (CMD).

This area is crucial because while symptoms progress quietly, once they manifest, they significantly limit daily life and can hinder recovery from depression. Treating depression and preventing cardiometabolic issues separately can lead to a vicious cycle.

Key Points of the Study: "Two Types" and "Separate Exits" Revealed in a 7-Year Follow-Up

The research team followed participants of the NEO Study (a large cohort in the Netherlands) for about seven years, comparing depressive symptoms and subsequent disease onset in adults without diabetes or cardiovascular diseases at the start. During the follow-up, about8%of the participants developed diseases in the cardiometabolic area. However, the "content" varied by the type of depression.santelog.com

Type A: Melancholic

This type is characterized by early morning awakening, worsening mood in the morning, decreased appetite (sometimes with weight loss), intense guilt, and psychomotor retardation/agitation.

Type B: Atypical/Energy-Related

This type is marked by severe fatigue, hypersomnia, increased appetite (sometimes with weight gain), and a feeling of heaviness in the limbs (leaden paralysis), with noticeable "energy drop + changes in eating and sleeping patterns."

The conclusion is summarized as follows:

• Atypical/Energy-Related: The risk of developing type 2 diabetes is approximately2.7 times

• Melancholic: The risk of cardiovascular diseases such as heart attacks and strokes is approximately1.5 times

• It was shown that each type is significantly less likely to increase the risk of the "other" disease, indicating a "segregation." santelog.com
  
  

How Were the Types Created?——An Implementation Method Called "Item Summation" from Questionnaires

According to the ECNP abstract, the Inventory of Depressive Symptomatology (IDS) questionnaire was used to evaluate depression,

• AES (Atypical/Energy-Related)= Summation of five items such as "increased sleepiness, increased appetite, increased weight, decreased energy, leaden paralysis"

• Melancholic= Summation of eight items such as "early morning awakening, morning worsening, decreased appetite, decreased weight, excessive guilt, psychomotor retardation/agitation"
  to create profiles.

The advantage of this method is that it is relatively easy to "reproduce" in clinical settings. Instead of focusing on diagnostic labels, carefully identifying current symptoms and considering "which side they lean towards" can lead to better monitoring of physical complications.

Digging Deeper: "Numbers" and "Biological Signatures" Indicated in the Abstract

The abstract states that the analysis involved6,561 participants(52% women), with an average age of 55.8 years and a median follow-up of 6.7 years. CMD was developed in 498 participants, type 2 diabetes in 296, and cardiovascular disease in 281.

Furthermore, in the group with severe depressive mood, the overall risk of CMD was reported asHR 1.65, confirming the broad framework that "depression raises overall cardiometabolic risk" before showing a structure that branches into T2D and CVD by type.

The hazard ratios by type are:

• Severe AES Profile: Type 2 Diabetes HR 2.87 (95%CI 1.92–4.30)

• Severe Melancholic Symptoms Profile: Cardiovascular Disease HR 1.53 (95%CI 1.03–2.25)
  as presented.

Even more intriguing are the "background signs." The AES profile was suggested to be strongly associated with inflammation and metabolism-related metabolites and proteins (e.g., glycoprotein acetyls, isoleucine, specific lipoprotein markers, cytokine-receptor interaction pathway-rich proteins, etc.).

The news release also mentions that in atypical/energy-related types, disturbances in inflammatory and metabolic processes are observed, whereas similar "biological signatures" may not be seen in the melancholic type.santelog.com

Why Does It Diverge? (Including Speculative "Maps")

From here, we clarify points that cannot be determined solely from the current data and organize the thinking.

Atypical/Energy-Related → More Prone to Diabetes Direction (Hypothesis)

• Tendency for overeating, oversleeping, and weight gain

• Lack of energy to move the body

• When combined with inflammation and metabolic abnormalities, insulin resistance may progress
  These "combined effects of lifestyle changes and biological changes" may increase the likelihood of glucose metabolism breakdown (hypothesis).

Melancholic Type → More Prone to Cardiovascular Direction (Hypothesis)

Factors such as insomnia (early morning awakening), strong stress responses, autonomic nervous system disorders, smoking, and alcohol consumption may increase cardiovascular risk through blood pressure and vascular function (the mechanism cannot be determined from the current materials alone).

Important Note: This is a "Risk Clue," Not a "Diagnosis"

This study is observational, and the ECNP materials clearly state "not peer-reviewed."
Additionally, "type classification" is more about symptom clusters (profiles) identifiable through questionnaires than medical diagnoses. Therefore, the conclusion should be realistically interpreted as follows:

It's a tool for prioritizing tests and collaborations, not a label that determines the future

Furthermore, it's important to note that the NEO Study is an obesity epidemiology cohort. Whether the same branching is reproduced in the general population or clinically diagnosed depression patients requires future verification.

From Here to Practice: Changing "Inspection Items" in Healthcare and Daily Life

If these findings gain credibility, what will be effective in practice is not a "major shift in treatment methods" but rather "parallel checks."

For those with strong atypical/energy-related symptoms (advance glucose metabolism checks)

• Check HbA1c, fasting blood glucose, lipids, blood pressure, weight, and waist circumference early

• The longer the period of inactivity continues, the more quietly the numbers may change

• Advice on diet and exercise should be accumulated in small amounts on "doable days" (without increasing self-blame on days when it's not possible)

• If on medication, consult with your doctor about the effects on weight and metabolism (avoid self-discontinuation)

For those with strong melancholic symptoms (carefully check cardiovascular aspects)

• Carefully monitor blood pressure, lipids, smoking, sleep quality, and cardiovascular signs such as palpitations and chest pain

• If early morning awakening persists, evaluate sleep quality and stress load

• Don't assume "being thin = safe," and conduct a comprehensive evaluation including family history and lifestyle background

The key here is to design it so that **"the medical side checks and supports first"** rather than pushing for "lifestyle changes." During periods of strong depression, the options for action are inherently limited.

Reactions on Social Media (Trends): A Theme That Simultaneously Evokes Empathy and Anxiety

While this type of topic tends to gain traction on social media, it is also prone to misunderstandings. Observing the tone of posts, reactions generally fall into the following five categories (not quotes from individual posts but "trends in discussion points").

1. Empathy: "During a depressive period, my appetite was disrupted, leading to weight and blood sugar increases. This makes sense."

2. Surprise: "Does mental illness directly connect to diabetes and heart issues like this?"

3. Calm Critique: "Isn't the causality reversed? Maybe both are influenced by genetics or living conditions."

4. Caution Against Self-Responsibility: "I'm worried it will be used like 'depression that leads to weight gain = unhealthy lifestyle.' Inability to act is part of the illness."

5. Hope: "If care changes by type, it might finally lead to 'treatment tailored to me.'"

The point that particularly tends to cause controversy on social media is number ④. The purpose of the research is to explore "ways to protect," not "materials for blame," but when information is condensed, it can easily shift towards "self-responsibility."
Therefore, adding just one phrase can change the impression conveyed.

• This is not about personality but aboutsymptom profiles

• Depression