Cholesterol and suicide attempts: a prospective study of depressed inpatients

Low cholesterol levels have commonly been associated with various suicide measures. We sought to examine suicide attempts in a prospective sample of depressed patients that on prior analysis demonstrated an association between low cholesterol and subsequent suicide completions. Seventy-four inpatients with Research Diagnostic Criteria unipolar major depression, bipolar depression or schizoaffective depression entered a prospective follow-up study from 1978 to 1981. Kaplan-Meier survival analysis and Cox regression were utilized to elucidate the relationship between cholesterol levels and subsequent severe suicide attempts as well as all suicide attempts regardless of severity. Attempts preceding index hospitalization and other lifetime attempts were evaluated cross-sectionally. Low serum cholesterol levels did not predict subsequent suicide attempts. Contrary to our hypothesis, the high cholesterol group was associated with increased risk of suicide attempts on survival analysis in those less than median age. Nonetheless, in cross-sectional analysis, the low cholesterol group had more suicide attempts preceding index hospitalization and more remote lifetime attempts. The results from this prospective dataset do not support an association between low cholesterol and subsequent suicide attempts despite replicating the retrospective findings of previous case-control and cross-sectional studies.

Combined dexamethasone/corticotropin releasing hormone test predicts treatment response in major depression - a potential biomarker?

BACKGROUND

Exaggerated corticotropin (ACTH) and cortisol response to the combined dexamethasone (DEX)/corticotropin releasing hormone (CRH) test, indicating impaired regulation of the hypothalamus-pituitary-adrenocortical (HPA) system, is frequently observed in depression. In the present study, we examined whether change in HPA system function during the first weeks of hospitalization predicts response to antidepressant treatment in major depression and thus constitutes a potential biomarker.

METHODS

We conducted the DEX/CRH test in 50 inpatients suffering from severe major depression, once after study inclusion and a second time 2 to 3 weeks later while under continuous antidepressant treatment.

RESULTS

We found increased ACTH and cortisol responses to the first DEX/CRH test compared with healthy control subjects. In the second DEX/CRH test 2 to 3 weeks later, 36 of the 50 patients showed an attenuated cortisol response, while 14 patients did not display improvement or exhibited even aggravation of the altered HPA system function. Improved HPA system regulation in the second DEX/CRH test was associated with beneficial treatment response after 5 weeks and a higher remission rate at the end of hospitalization.

CONCLUSIONS

The results suggest that change in HPA system regulation assessed with repeated DEX/CRH tests is a potential biomarker that may predict clinical outcome at follow-up. There is consensus that the drug development process could be improved, once reliable biomarkers become available that help to allow a judgement regarding the efficacy of a novel drug candidate. The combined DEX/CRH test seems to be a promising candidate for such a biomarker.

Major Depressive Disorder and Inflammatory Markers in Elderly Patients With Heart Failure

The authors evaluated levels of inflammatory markers in 34 chronic heart failure (CHF) out-patients age 65 years and over, with (N=18) and without (N=16) major depressive disorder (MDD), and healthy-control subjects (N=13). Patients with CHF had left-ventricular ejection fractions <0.40 and were in the New York Heart Association functional class II or III. The authors used the SCID DSM-IV to diagnosis MDD. High-sensitivity C-reactive protein levels were significantly higher in patients with CHF and MDD as compared with healthy-control subjects. No differences regarding tumor necrosis factor(alpha) or interleukin(6) were found among the three groups.

Serum brain-derived neurotrophic factor level in dysthymia: a comparative study with major depressive disorder

In this present work, it is aimed to demonstrate BDNF serum concentrations in patients with dysthymia and to compare them with BDNF serum concentrations in patients with major depressive disorder and healthy subjects. The study was carried out in Celal Bayar University Hospital, Manisa, Turkey. Seventeen patients with dysthymia, 24 patients with major depressive disorder and 26 subjects without any psychiatric diagnosis and any psychiatric treatment were included in the study. The severity of depression was assessed with 17-item HAM-D. All subjects were asked to give their written consent. Blood samples were collected at baseline. Serum BDNF was kept at -70 degrees C before testing, and assayed with an ELISA Kit (Promega; Madison, WI, USA), after dilution with the Block and Sample solution provided with the kit. The data were subjected to the analysis of variance. The BDNF serum concentrations of the dysthymia group (mean=28.9+/-9.2 ng/ml) were significantly higher than that of the major depressive disorder group (21.2+/-11.3 ng/ml) (p=0.002), and it was not different from the level of the control group (31.4+/-8.8 ng/ml). BDNF serum concentrations and HAM-D score did not have any significant correlation in the dysthymia and major depression groups (r=-0.276, p=0.086). The low level of BDNF in patients with dysthymic disorder seems to point out that BDNF changes in mood disorders are state-dependent and vary according to the severity of depressive episodes.

Sex differences in ACTH pulsatility following metyrapone blockade in patients with major depression

Numerous studies suggest that increased central drive to the hypothalamic-pituitary adrenal (HPA) axis occurs in patients with major depression. To determine if increased central drive occurs throughout the 24 h, we evaluated ACTH secretion under metyrapone blockade of cortisol production. We collected blood every 10 min for measurement of ACTH and data were analyzed for ACTH pulsatility using the pulse detection algorithm deconvolution. We studied 28 patients with major depression and 28 age and sex-matched control subjects, of which 9 pairs were men and 19 pairs were women. We found a significant group x sex interaction with number of ACTH pulses (p=0.04); depressed men showed more ACTH pulses over 24h than matched control men (p=0.02). There was also a significant sex difference in AUC pulses with men showing a smaller AUC ACTH than women. Previous analyses of these data with RM-ANOVA showed a smaller ACTH response in depressed men compared to control men. These data suggest that pulsatility and mean ACTH levels are examining different aspects of HPA axis function, and that the types of HPA axis dysregulation in depression may differ between men and women.

Platelet 5-HT2A receptor subresponsivity and lethality of attempted suicide in depressed in-patients

In depressed patients, high-lethality suicidal acts are accompanied by serotonin system abnormalities analogous to those seen in completed suicides. We have previously reported greater platelet 5-HT2A receptor density, and impaired serotonin enhancement of ADP-induced platelet aggregation, an indirect measure of signal transduction, in high-lethality suicide attempters. We hypothesized that serotonin-activated phosphoinositide (PI) hydrolysis, a direct measure of platelet serotonin 5-HT2A receptor responsivity would be lower in depressed high-lethality suicide attempters. Twenty-three depressed in-patients that had previously made suicide attempts (low-lethality, n=6; high-lethality, n=17) had platelet 5-HT2A-mediated serotonin-simulated PI hydrolysis assayed. Platelet 5-HT2A receptor responsivity in high-lethality suicide attempters was 41% that of low-lethality suicide attempters (p<0.05). A seasonal effect was also observed. High-lethality suicidal acts are associated with more 5-HT2A receptors but impaired signal transduction.

Lithium, arginine vasopressin and the dex/CRH test in mood disordered patients

The impact of lithium on arginine vasopressin (AVP) release has implications for our understanding of the pathophysiology and treatment of mood disorders and for the interpretation of neuroendocrine studies. In this secondary analysis of neuroendocrine, data from 23 patients with chronic major depressive disorder, 41 patients with bipolar disorder and 18 healthy controls, we examine the relationship between lithium therapy, AVP levels and the cortisol response to the dexamethasone/corticotropin-releasing hormone (dex/CRH) test. These data demonstrate that patients taking lithium have elevated post-dexamethasone AVP levels compared to both healthy controls and patients not on lithium.

Association of cardiovascular risk factors and disease with depression in later life

OBJECTIVE

The objective of this study is to determine the association between established cardiovascular risk factors and depression among older men.

METHODS

The authors conducted a cross-sectional study of a community-representative sample of 5,439 men aged 71-89 years. Cardiovascular disease and risk factors assessed included history of diabetes, hypertension, angina, myocardial infarction, and stroke; current smoking; total cholesterol and fractions; triglycerides; total plasma homocysteine; and MTHFR677 genotype. Depression was defined by a Geriatric Depression Scale 15 items score of 7 or greater.

RESULTS

A complete data set was available for 4,204 men, of whom 212 were depressed (5%). Men who were depressed reported higher frequency of diabetes (23.1% versus 13.2%), angina (30.2% versus 20.4%), myocardial infarction (26.2% versus 16.0%), and stroke (23.6% versus 9.1%) than nondepressed men. Participants with depression were also more likely to have plasma homocysteine above 15 mumol/L (39.1% versus 25.5%) and high triglycerides (32.1% versus 20.9%) than nondepressed subjects. Depressed older men were also more likely to be active smokers (9.9% versus 4.8%). The other factors measured in the study were not significantly associated with depression. Estimation of the population-attributable fraction (PAF) after logistic regression showed that high plasma homocysteine had the highest PAF for depression (PAF:15%, 95% confidence interval [95% CI]: 5%-23%) followed by high triglycerides (PAF: 11%, 95% CI: 2%-18%), angina (PAF: 9%, 95% CI: 2%-15%), stroke (PAF: 8%, 95% CI: 3%-13%), diabetes (PAF: 7%, 95% CI: 1%-13%), myocardial infarction (PAF: 5%, 95% CI: 0%-11%), and smoking (PAF: 5%, 95% CI: 1%-9%).

CONCLUSIONS

High plasma homocysteine and triglycerides appear to account for a considerable proportion of cases of depression in older men. The successful management of these risk factors may contribute to decrease the prevalence of depression in later life.

Elevated plasma N-terminal ProBNP levels in unmedicated patients with major depressive disorder

There is considerable evidence that cardiovascular diseases are more prevalent in patients with major depressive disorder (MDD). Secretion of N-terminal pro-B-type natriuretic peptide (NT-proBNP) increases in several cardiac illnesses, making this neurohormone a reliable diagnostic and prognostic biomarker of cardiovascular risk. We measured plasma NT-proBNP levels in the following three groups of subjects free of overt cardiovascular disease: unmedicated patients with MDD (n=40), unmedicated patients with schizophrenia (n=44), and normal control subjects (n=42). The severity of depressive symptoms was rated using the Hamilton Depression Rating Scale (HAMD). Plasma NT-proBNP levels were assayed by ELISA. Plasma NT-proBNP levels were significantly higher in the MDD group (median: 217.1 pmol/L; interquartile range: 179.4-277.1 pmol/L) than in patients with schizophrenia (175.7 pmol/L [139.0-218.9]; P<0.05) or in the control group (158.9 pmol/L [98.3-212.1]; P<0.001). Among patients with MDD, there was a significant positive correlation (Spearman's rank correlation=0.422, P=0.008) between plasma NT-proBNP and HAMD scores. Altogether, our results indicate that elevated NT-proBNP levels may play a role in linking MDD with increased cardiovascular risk.

Plasma oxytocin levels and anxiety in patients with major depression

Cerebrospinal fluid and plasmatic levels of oxytocin (OT) have been found to change in mood disorders. In post-mortem studies, the numbers of OT-expressing neurons in the paraventricular nucleus have been reported to be increased. Moreover, OT is considered as an endogenous antistress hormone. It has also revealed antidepressive effects. OT may contribute to the dysregulation of the HPA system in major depression. The aim of the study was to assess a possible relationship between anxiety and plasma oxytocin (OT) levels in depressive patients. Severity of depression was estimated with the Hamilton Depression Rating Scale and anxiety by using the Spielberger State-Anxiety Inventory. Results showed a significant negative correlation between oxytocin and the scored symptoms depression (r=-0.58, p=0.003) and anxiety (r=-0.61, p=0.005).

Immune-endocrine host response to endotoxin in major depression

OBJECTIVE

An impaired hypothalamic-pituitary-adrenocortical (HPA) function is a well-established finding in major depression (MD), but it is still unclear how this dysfunction affects immune responses in this disorder.

METHOD

To further examine the relationship between immune and endocrine responses in MD, 0.4ng/kg body weight endotoxin [LPS] or 100mug hCRH were sequentially applied to 12 patients with MD and to 12 age- and gender-matched healthy controls after pre-treatment with 1.5mg dexamethasone (DEX). Immune (TNF-alpha, IL-6, rectal temperature) and endocrine (ACTH, cortisol) parameters were examined as area under the curve (AUC) levels.

RESULTS

After pre-treatment with DEX, LPS evoked an immune response in all participants of the study with most immune parameters significantly related to the endotoxin challenge. However, only a marked immune response resulted in an additional endocrine reaction. Subsequently, the quantitative extent of the endocrine reaction was related to the extent of the immune response after DEX/LPS challenge. Pre-LPS AUC levels of cortisol, ACTH and post-LPS levels of IL-6 as well as the post-CRH AUC levels of cortisol and ACTH were related to the depressive symptomatology as measured by the Beck depression inventory (BDI). In depressive patients who showed increased cortisol plasma levels before LPS, the later increase in IL-6 was reduced.

CONCLUSIONS

The challenge with DEX/LPS did not reveal major impairments of evoked immune functions in MD. Only the endocrine parameters and the IL-6 response were related to the depressive symptomatology, suggesting a limited interaction between immune and endocrine dysfunctions in MD.

Depressive symptoms, omega-6:omega-3 fatty acids, and inflammation in older adults

OBJECTIVE

To address how interactions between polyunsaturated fatty acid (PUFA) levels and depressive symptoms were related to proinflammatory cytokine synthesis. Depression and stress promote proinflammatory cytokine production. Dietary intakes of omega-3 (n-3) and omega-6 (n-6) PUFAs also influence inflammation; high n-6:n-3 ratios enhance proinflammatory cytokine production, although n-3 has anti-inflammatory properties.

METHODS

Blood samples from 43 older adults (mean age = 66.67 years, SD = 10.09) provided data on PUFAs and tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-6 soluble receptor (sIL-6r). Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale.

RESULTS

Depressive symptoms and n-6:n-3 ratios worked together to enhance proinflammatory cytokines beyond the contribution provided by either variable alone, with substantial variance explained by their interaction: 13% for IL-6 and 31% for TNF-alpha, whereas full models accounted for 18% and 40%, respectively. Although predicted cytokine levels were consistent across n-6:n-3 ratios with low depressive symptoms, higher n-6:n-3 ratios were associated with progressively elevated TNF-alpha and IL-6 levels as depressive symptoms increased. Higher levels of sIL-6r were associated with higher n-6:n-3 ratios. Six individuals who met the criteria for major depressive disorder had higher n-6:n-3 ratios and TNF-alpha, IL-6, and sIL-6r levels than those who did not meet the criteria; excluding these six individuals reduced the variance explained by the depressive symptoms and n-6:n-3 ratio interaction.

CONCLUSIONS

Diets with high n-6:n-3 PUFA ratios may enhance the risk for both depression and inflammatory diseases.

Plasma cytokine profiles in depressed patients who fail to respond to selective serotonin reuptake inhibitor therapy

OBJECTIVE

Approximately 30% of patients with depression fail to respond to a selective serotonin reuptake inhibitor (SSRI). Few studies have attempted to define these patients from a biological perspective. Studies suggest that overall patients with depression show increased production of proinflammatory cytokines. We examined pro- and anti-inflammatory cytokine levels in patients who were SSRI resistant.

METHODS

Plasma concentrations of IL-6, IL-8, IL-10, TNF-alpha and sIL-6R were measured with enzyme linked immunosorbent assays (ELISA) in DSM-1V major depressives who were SSRI resistant, in formerly SSRI resistant patients currently euthymic and in healthy controls.

RESULTS

Patients with SSRI-resistant depression had significantly higher production of the pro-inflammatory cytokines IL-6 (p=0.01) and TNF-alpha (p=0.004) compared to normal controls. Euthymic patients who were formerly SSRI resistant had proinflammatory cytokine levels which were similar to the healthy subject group. Anti-inflammatory cytokine levels did not differ across the 3 groups.

CONCLUSION

Suppression of proinflammatory cytokines does not occur in depressed patients who fail to respond to SSRIs and is necessary for clinical recovery.

Increased plasma concentration of brain-derived neurotrophic factor with electroconvulsive therapy: a pilot study in patients with major depression

OBJECTIVE

The therapeutic mechanism of electroconvulsive therapy (ECT) is unknown. Animal research supports a neurotrophic effect of ECT. To investigate a neurotrophic effect in humans, we examined whether plasma concentration of brain-derived neurotrophic factor (BDNF) increases in patients receiving ECT for major depression.

METHOD

We conducted a prospective, self-controlled study of 15 patients with a DSM-IV diagnosis of major depressive episode who were referred for ECT at the University of Maryland Medical Center (Baltimore, Md.) between January 2004 and September 2005. Plasma BDNF concentration was measured by enzyme-linked immunosorbent assay before and during an acute course of ECT. Depression severity was measured using the 21-item Hamilton Rating Scale for Depression (HAM-D).

RESULTS

ECT resulted in a significant increase in plasma BDNF (Z = 2.897, p = .004) from a pre-ECT median of 84.9 pg/mL to a post-ECT median of 141.2 pg/mL. This change was accompanied by a significant decrease in HAM-D score (Z = 3.411, p = .001) from a pre-ECT median of 30.0 to a post-ECT median of 9.0. BDNF increased in 13 (86.7%) of 15 subjects.

CONCLUSION

This is the first report of an increase in plasma BDNF concentration in patients receiving ECT. These preliminary results encourage further investigation of a neurotrophic mechanism for the antidepressant effect of ECT.

Duloxetine: review of its pharmacology, and therapeutic use in depression and other psychiatric disorders

BACKGROUND

The discovery of antidepressant medications has revolutionized the treatment of depression and other psychiatric illnesses. The coming of the selective serotonin (5-HT) reuptake inhibitors (SSRIs) marked a new era in the treatment of depression. These therapies frequently fall short of getting the patient to remission. Agents with a dual action have subsequently been developed which inhibit the reuptake of both 5-HT and NE, getting more patients to remission. Physical symptoms are associated with depression, preventing the patient from obtaining complete recovery. This article provides an overview of the pharmacology, efficacy, and techniques for the clinical use of duloxetine, a dual reuptake inhibitor, which has recently become available.

METHODS

The English literature has been reviewed including both controlled and uncontrolled studies.

RESULTS

Duloxetine is a dual reuptake inhibitor with actions on serotonin as well as norepinephrine. It has been shown to have efficacy in treating depressive symptoms including those with painful physical symptoms. Common side effects include nausea, insomnia, and dizziness.

CONCLUSIONS

The article has been written with clinicians as the target audience, the data suggesting it can be used as a first line agent.

Changes in plasma cholesterol in mood disorder patients: does treatment make a difference?

OBJECTIVES

To examine the impact of treatment in patients with acute episodes of major depressive (MD) and manic or hypomanic (M/HM) episodes and co-morbid generalized anxiety symptoms, on the total cholesterol blood levels (TC).

METHOD

A consenting series of patients with acute episodes of DSM IV-R confirmed diagnosis of MD or M/H were included. Subjects were treated with antidepressants, mood stabilizers, or both. The Hamilton depression scale (HAM-D21), the modified mania rating scale (MMRS), and the Hamilton anxiety scale (HAM-A) were utilized to evaluate clinical symptoms. Blood samples were drawn for TC estimations after 10 h of fasting on two occasions over time. The first sample was taken before treatment was started, and the second 4 weeks after treatment. The relationship between changes in TC and the severity of psychiatric symptoms, as measured on HAM-D, MMRS, and the HAM-A, were analysed.

RESULTS

56 subjects (34 with MD and 22 with M/HM episodes) completed the study. About 4 weeks after treatment there was a statistically significant increase in the TC in patients with MD versus a significant decrease in patients with M/HM episodes.

CONCLUSION

Our results replicate earlier reports of significant increase in the cholesterol levels in depressed patients after treatment. We report a significant decrease of TC levels in M/HM episodes with treatment. Although the results in previous reports and in our study are statistically significant, their clinical significance requires further examination in longer-term studies.

Combined biological tests for suicide prediction

Disturbances in serotonin neuroregulation and in hypothalamic-pituitary-adrenal axis activity are both likely, and possibly independent, factors in the genesis of suicidal behavior. This analysis considers whether clinically accessible measures of these two disturbances have additive value in the estimation of risk for suicide. Seventy-four inpatients with RDC major or schizoaffective depressive disorders entered a prospective follow-up study from 1978-1981, underwent a dexamethasone suppression test (DST) and had fasting serum cholesterol levels available in the medical record. As reported earlier, patients who had had an abnormal DST result were significantly more likely to commit suicide during follow-up. Serum cholesterol concentrations did not differ by DST result and low cholesterol values were associated with subsequent suicide when age was included as a covariate. These results indicate that, with the use of age-appropriate thresholds, serum cholesterol concentrations may be combined with DST results to provide a clinically useful estimate of suicide risk.

High-sensitivity C-reactive protein levels in patients with major depressive disorder and bipolar mania

The serum high-sensitivity C-reactive protein (hsCRP) levels in patients with major depressive disorder and bipolar I disorder in acute phases were investigated. During a 1-year period, a total of 67 participants including 23 patients with major depressive disorder, 13 patients with bipolar I disorder (manic episode) and 31 healthy controls were recruited in this study. The diagnoses of mental disorders in participants were made by one psychiatrist according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Both patient groups with major depression and bipolar disorder had higher mean serum hsCRP levels than the healthy control group. Using analysis of covariance with age adjustment, patients with bipolar I disorders still had significantly higher hsCRP levels than healthy controls (P=0.043). However, patients with major depression did not have significantly higher hsCRP levels than healthy controls (P=0.172). These results suggest that patients with bipolar I disorder might have a more severe inflammation reaction than patients without major depression. However, larger samples and adequate statistical methods are needed to prove these results.

Emotional bias and waking salivary cortisol in relatives of patients with major depression

BACKGROUND

Biases in the processing of emotional information have been shown to be abnormal in subjects with major depression, both during an episode and after full recovery. However, it is unclear whether these biases are a cause or an effect of the depression. This study set out to explore whether such biases represent a vulnerability factor for depression by looking at unaffected first-degree relatives of those with major depressive disorder. We also measured waking salivary cortisol, as the regulation of the hypothalamo-pituitary-adrenal (HPA) axis is thought to be impaired in depressive disorder.

METHOD

Twenty-five female relatives and 21 age-matched controls completed a facial expression recognition task, an emotional categorization task with positive and negative personality characteristics, and had their waking salivary cortisol measured on a work day and a non-work day.

RESULTS

The depressed relative group was significantly faster to recognize facial expressions of fear than controls. The depressed relative group also showed significantly increased reaction time to recognize positive versus negative personality characteristics in the categorization task. There was no difference in waking salivary cortisol between groups, although there was an effect of work day versus non-work day.

CONCLUSIONS

Subtle biases in the processing of emotional information may exist in the unaffected first-degree relatives of those with depression. As such, this may represent a familial vulnerability factor to developing a depressive illness.

Effects of electroacupuncture and fluoxetine on the density of GTP-binding-proteins in platelet membrane in patients with major depressive disorder

BACKGROUND

Electroacupuncture (EA) has been used to treat Major Depressive Disorder (MDD). However, its efficacy is inconclusive and the mechanism is still unclear. Thus, the objective of this study is to investigate the therapeutic effect of EA on GTP-binding-protein (G protein) in platelet membrane using fluoxetine as a comparison.

METHODS

A randomized controlled trial (RCT) was performed on 90 MDD patients, who were divided into three groups treated with fluoxetine, EA and sham EA respectively. Antibodies were utilized to quantify the levels of G protein alpha subtypes in the platelet membrane before and after 6-week anti-depressive treatment. Thirty age and sex-matched normal individuals were used as controls.

RESULT

All the treatments had the same therapeutic effects in treating moderate depression. Both levels of Galphai and Galphaq in depression patients were significantly higher than those in controls and were not reduced by treatments, although the severity was considerably relieved.

LIMITATIONS

The duration of treatment was limited to six weeks only.

CONCLUSION

EA might be served as an alternative treatment for moderate depression and we further demonstrate that the abnormal levels of Galpha protein in platelet membrane might be a potential risk factor for MDD.

Major depressive disorder is accompanied with oxidative stress: short-term antidepressant treatment does not alter oxidative-antioxidative systems

OBJECTIVE

The aim of the present study was to investigate the oxidative-antioxidative systems and effects of different antidepressants on these systems in patients with major depressive disorder (MDD).

METHOD

Ninety-six patients with a Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) diagnosis of MDD and 54 healthy controls were included in the study. Plasma malondialdehyde (MDA) levels and susceptibility of red blood cells (RBCs) to oxidation were determined to investigate the oxidative status, plasma vitamin E, vitamin C, serum total carotenoid levels, total antioxidant capacity (TAOC), RBC superoxide dismutase (SOD) and whole blood glutathione peroxidase (GPx) activities were measured to investigate the antioxidative defence before and after 6 weeks of antidepressant treatment.

RESULTS

Plasma MDA levels and susceptibility of RBCs to oxidation were significantly higher in the MDD group compared with the control group. RBC SOD activity was significantly increased in patients with MDD, and furthermore there was a significant positive correlation between the severity of the disease and SOD activity.

CONCLUSION

MDD is accompanied with oxidative stress; however, oxidative-antioxidative systems do not seem to be affected by 6 weeks of antidepressant treatment.

Relation of cortisol levels and bone mineral density among premenopausal women with major depression

We aimed to investigate the relationship between cortisol levels and bone mineral density (BMD) among premenopausal women with major depression. We compared BMD, plasma cortisol, osteocalcin and C-telopeptide (CTx) levels of 36 premenopausal women with major depression with 41 healthy women who were matched for age and body mass index. Osteocalcin and CTx were used for the evaluation of bone turnover. The clinical diagnosis of major depression was made by using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The 21-item Hamilton Rating Scale for Depression was used for the assessment of depressive symptoms. In comparison with the controls, the mean BMD of the depressed women was significantly lower at the lumbar spine and at all sites of the proximal femur (p = 0.02, 0.01). Plasma cortisol levels were significantly higher in depressive patients than in controls (p = 0.001). Osteocalcin was lower and CTx was higher in the patient group than in controls (p = 0.04, p = 0.008). Lumbar and femur BMD scores were negatively correlated with cortisol levels in the patient group. Major depression had important effects on BMD and bone turnover markers. Depression should be considered among risk factors for osteoporosis in premenopausal women.

Assessment of the immune system activity in Iranian patients with Major Depression Disorder (MDD)

BACKGROUND

Major Depression Disorder (MDD) is a common disorder with prevalence of 15% among men and up to 25% among women. In recent years the association of immune system alterations and MDD has been investigated. Assessments of immunologic and inflammatory responses in these patients enhance our knowledge of the etiology and pathogenesis of this disease.

OBJECTIVE

To investigate the changes in immunoglobulin and cytokine serum levels and lymphocyte subsets in patients with MDD.

METHODS

We studied 37 adult patients with MDD, diagnosed based on DSM-IV diagnostic criteria, and 15 healthy controls matched with the patients. Plasma concentration of interleukin-4 (IL-4), IL-10, TNF alpha, and IFN gamma were measured by ELISA and serum immunoglobulins by SRID. Total number of NK cells (CD16 and CD56), B cells (CD19), and T cells (CD8, CD4, and CD3) were determined by flow cytometry.

RESULTS

We found no significant differences in plasma concentration of IL-4, IL-10, TNF-alpha, IFN-gamma, and immunoglobulins as well as total number of NK cells, B cells, and T cells between major depressed patients and healthy control subjects.

CONCLUSION

We conclude that in our patients, there were no significant differences in immune system activity between MDD patients and controls.