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Gene Regulatory Network of Dorsolateral Prefrontal Cortex: a Master Regulator Analysis of Major Psychiatric Disorders. Mol Neurobiol 2019; 57:1305-1316. [PMID: 31728928 DOI: 10.1007/s12035-019-01815-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
Despite the strong genetic component of psychiatric disorders, traditional genetic studies have failed to find individual genes of large effect size. Thus, alternative methods, using bioinformatics, have been proposed to solve these biological puzzles. Of these, here we employ systems biology-based approaches to identify potential master regulators (MRs) of bipolar disorder (BD), schizophrenia (SZ), and major depressive disorder (MDD), their association with biological processes and their capacity to differentiate disorders' phenotypes. High-throughput gene expression data was used to reconstruct standard human dorsolateral prefrontal cortex regulatory transcriptional network, which was then queried for regulatory units and MRs associated with the psychiatric disorders of interest. Furthermore, the activity status (active or repressed) of MR candidates was obtained and used in cluster analysis to characterize disease phenotypes. Finally, we explored the biological processes modulated by the MRs using functional enrichment analysis. Thirty-one, thirty-four, and fifteen MR candidates were identified in BD, SZ, and MDD, respectively. The activity state of these MRs grouped the illnesses in three clusters: MDD only, mostly BD, and a third one with BD and SZ. While BD and SZ share several biological processes related to ion transport and homeostasis, synapse, and immune function, SZ showed peculiar enrichment of processes related to cytoskeleton and neuronal structure. Meanwhile, MDD presented mostly processes related to glial development and fatty acid metabolism. Our findings suggest notable differences in functional enrichment between MDD and BD/SZ. Furthermore, similarities between BD and SZ may impose particular challenges in attempts to discriminate these pathologies based solely on their transcriptional profiles. Nevertheless, we believe that systems-oriented approaches are promising strategies to unravel the pathophysiology peculiarities underlying mental illnesses and reveal therapeutic targets.
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Retrospectively reported childhood physical abuse, systemic inflammation, and resting corticolimbic connectivity in midlife adults. Brain Behav Immun 2019; 82:203-213. [PMID: 31445966 PMCID: PMC6956859 DOI: 10.1016/j.bbi.2019.08.186] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/07/2019] [Accepted: 08/21/2019] [Indexed: 12/24/2022] Open
Abstract
Childhood abuse confers risk for psychopathology and pathophysiology in midlife through intermediate pathways that remain unclear. Systemic inflammation was tested in the present study as one pathway that may link physical abuse in childhood to the adult functioning of corticolimbic brain circuits broadly implicated in risk for poor mental and physical health. Midlife adults (N = 303; 30-51 years of age; 149 women) without psychiatric, immune, or cardiovascular diagnoses provided retrospective reports of childhood physical abuse. Functional connectivity between corticolimbic brain areas (amygdala, hippocampus, ventromedial prefrontal cortex [vmPFC], anterior cingulate cortex [ACC]) was measured at rest using functional magnetic resonance imaging. Circulating levels of interleukin(IL)-6, a pro-inflammatory cytokine previously linked to childhood abuse and corticolimbic functionality, were measured via blood draw. Consistent with prior studies, retrospectively reported childhood physical abuse was associated positively with circulating IL-6, and negatively with connectivity between the amygdala and vmPFC. IL-6 was also associated negatively with several corticolimbic functional connections, including amygdala-vmPFC connectivity. Moreover, path analyses revealed an indirect effect of IL-6 that partially explained the association between childhood physical abuse and adult amygdala-vmPFC connectivity. Consistent with recent neurobiological models of early life influences on disease risk across the lifespan, associations between childhood physical abuse and adulthood corticolimbic circuit functionality may be partially explained by inflammatory processes.
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Whale R, Fialho R, Field AP, Campbell G, Tibble J, Harrison NA, Rolt M. Factor analyses differentiate clinical phenotypes of idiopathic and interferon-alpha-induced depression. Brain Behav Immun 2019; 80:519-524. [PMID: 31029797 DOI: 10.1016/j.bbi.2019.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/05/2019] [Accepted: 04/24/2019] [Indexed: 12/19/2022] Open
Abstract
The discovery that prolonged administration of interferon-alpha (a pro-inflammatory cytokine) readily precipitates depressive symptoms has played a key role in development of the inflammation theory of major depressive disorder (MDD). However, it remains unclear whether the clinical phenotype of patients with inflammation-associated depression significantly overlaps with, or can be distinguished from that of patients with 'idiopathic' depression. Here we explored the Hamilton depression scale factor structure of 172 patients undergoing interferon-alpha treatment for hepatitis-C at the point of transition to a depressive episode of DSM IV defined major depression severity. The resulting factor structure was first compared with a model derived from 6 previous studies of 'idiopathic' MDD (Cole et al., 2004). This confirmatory factor analysis revealed that the factor structure of HAMD scores in our interferon-alpha treated cohort did not plausibly fit that previously described for 'idiopathic' MDD. Instead, subsequent exploratory factor analysis revealed a distinct four factor model with a novel primary factor grouping cognitive symptoms of depression and anxiety (HAMD items 1, 2, 9, 10, 11, 15). The second sleep disorder factor (items 4, 5, 6) replicated previous findings in 'idiopathic' depression. A third and unique factor grouped somatic symptoms and function (items 7, 12, 13, 14 and item 1). The final factor (also common in idiopathic depression studies), grouped gastrointestinal symptoms and weight loss (items 12 and 16). Severe depression items (3, 8, and 17) were excluded from analysis due to very low variance. At transition, interferon-alpha induced major depressive episodes therefore appears to have more associated anxiety features that covary with depressed mood than classical or 'idiopathic' MDD and a low likelihood of severe features such as suicidal ideation. Identification of this clinical phenotype may help identify patients with an inflammatory depression etiology and support the development of more effective and personalized therapies.
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Affiliation(s)
- Richard Whale
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom; Department of Neuroscience, Brighton and Sussex Medical School, Brighton BN1 9RR, United Kingdom.
| | - Renata Fialho
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom; School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom
| | - Andy P Field
- School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom
| | - Graham Campbell
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom
| | - Jeremy Tibble
- Digestive Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE, United Kingdom
| | - Neil A Harrison
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom; Department of Neuroscience, Brighton and Sussex Medical School, Brighton BN1 9RR, United Kingdom
| | - Michael Rolt
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom; School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom
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Relationships between neural activation during a reward task and peripheral cytokine levels in youth with diverse psychiatric symptoms. Brain Behav Immun 2019; 80:374-383. [PMID: 30953769 PMCID: PMC6660409 DOI: 10.1016/j.bbi.2019.04.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/18/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Inflammation has been hypothesized to contribute to reward dysfunction across psychiatric conditions, but little is known about this relationship in youth. Therefore, the present study investigated the associations between general and specific markers of inflammation and neural activation during reward processing, including anticipation and attainment, in youth with diverse psychiatric symptoms. METHODS Forty-six psychotropic medication-free youth with diverse psychiatric symptoms underwent a blood draw to measure 41 cytokines, as well as structural and functional magnetic resonance imaging. The Reward Flanker Task examined neural activation during reward anticipation and attainment. Relationships between inflammation and neural activation were assessed using data reduction techniques across the whole-brain, as well as in specific reward regions of interest (basal ganglia, anterior and mid-cingulate cortex [ACC/MCC]). RESULTS Whole-brain principal component analyses showed that factor 3 (12 cytokines: FGF-2, Flt3-L, fractalkine, GM-CSF, IFN-α2, IFN-γ, IL-3, IL-4, IL-7, IL-17A, MDC, and VEGF) was negatively correlated with precuneus/posterior cingulate cortex activity during anticipation. Factor 2 (11 cytokines: eotaxin, IL-1α, IL-1Rα, IL-2, IL-5, IL-9, IL-12p40, IL-13, IL-15, MCP-3, and TNF-β) was negatively correlated with angular gyrus activity during attainment. ROI analyses additionally showed that multiple cytokines were related to activity in the basal ganglia (EGF, FGF-2, Flt-3L, IL-2, IL-13, IL-15, IL-1Rα, MCP-3) and ACC/MCC (Flt-3L) during attainment. C-reactive protein (CRP) was not associated with neural activation. CONCLUSIONS Investigation of specific markers of immune function showed associations between inflammatory processes and activation of posterior default mode network, prefrontal cortex, and basal ganglia regions during multiple phases of reward processing.
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55
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An Integrative and Mechanistic Model of Impaired Belief Updating in Schizophrenia. J Neurosci 2019; 39:5630-5633. [PMID: 31315964 DOI: 10.1523/jneurosci.0002-19.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 01/26/2023] Open
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56
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Cao B, Zhu J, Zuckerman H, Rosenblat JD, Brietzke E, Pan Z, Subramanieapillai M, Park C, Lee Y, McIntyre RS. Pharmacological interventions targeting anhedonia in patients with major depressive disorder: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:109-117. [PMID: 30611836 DOI: 10.1016/j.pnpbp.2019.01.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/24/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023]
Abstract
Anhedonia is defined as a diminished ability to experience interest or pleasure, and is a critical psychopathological dimension of major depressive disorder (MDD). The purpose of the current systematic review is to evaluate the therapeutic efficacy of pharmacological treatments on measures of anhedonia in adults with MDD. Electronic databases Cochrane Library (CENTRAL), Ovid MEDLINE, PubMed, PsycINFO, and Google Scholar were searched from inception to June 1, 2018 for longitudinal studies utilizing pharmacotherapy for the treatment of anhedonia in patients with MDD. A total of 17 eligible studies were identified (i.e., evaluated the effects of pharmacotherapy on a measure of anhedonia). Among the identified studies, the efficacy of 14 different pharmacotherapies on measures of anhedonia were evaluated, including melatonergic agents (i.e. agomelatine), monoaminergic agents (i.e. moclobemide, clomipramine, bupropion, venlafaxine, fluoxetine, amitifadine and levomilnacipran, escitalopram, and sertraline), glutamatergic agents (i.e., ketamine and riluzole), stimulants (i.e., methylphenidate), and psychedelics (i.e., psilocybin). Based on the available evidence, most antidepressants demonstrated beneficial effects on measures of anhedonia as well as the other depressive symptoms. Only escitalopram/riluzole combination treatment was ineffective in treating symptoms of anhedonia in MDD. Continued research is warranted to further support the efficacy of mechanistically-distinct antidepressants in treating symptoms of anhedonia in MDD. Future research should also aim to parse out the heterogeneous effects of different pharmacotherapies on anhedonic symptoms.
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Affiliation(s)
- Bing Cao
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, China; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
| | - Judy Zhu
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, Canada
| | - Hannah Zuckerman
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Elisa Brietzke
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Zihang Pan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Mehala Subramanieapillai
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Caroline Park
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Roger S McIntyre
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, China; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
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57
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A clinical model for identifying an inflammatory phenotype in mood disorders. J Psychiatr Res 2019; 113:148-158. [PMID: 30954775 DOI: 10.1016/j.jpsychires.2019.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/20/2019] [Accepted: 02/07/2019] [Indexed: 12/14/2022]
Abstract
Increasingly, clinical research has found inflammatory correlates of psychiatric disorders, particularly mood symptomatology. Biological measures may provide greater precision in many cases and may capture clinically-relevant inflammatory signposts, such as central obesity risk, inflammation-associated co-morbid medical conditions, or proinflammatory lifestyle choices. In order to expand understanding of the role of inflammation in mood disorders, we propose a more inclusive clinical model for capturing an inflammatory phenotype of depression by identifying clinically-relevant inflammatory phenotypes grounded in biology. Our model includes chronic conditions and lifestyle behaviors associated with clinically elevated inflammation in mood disorders. Elements of this "inflamed depression" model include: obesity, low HDL concentrations, elevated triglyceride concentrations, chronically elevated blood pressure, clinical diagnosis of hypothyroidism, migraines, rheumatoid arthritis, adult onset diabetes, inflammatory bowel diseases, inflammatory skin conditions, and lifestyle factors including smoking cigarettes and chronic stress.
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58
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Liu CH, Zhang GZ, Li B, Li M, Woelfer M, Walter M, Wang L. Role of inflammation in depression relapse. J Neuroinflammation 2019; 16:90. [PMID: 30995920 PMCID: PMC6472093 DOI: 10.1186/s12974-019-1475-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/01/2019] [Indexed: 12/13/2022] Open
Abstract
Major depressive disorder (MDD) is a leading cause of disability worldwide. After the first episode, patients with remitted MDD have a 60% chance of experiencing a second episode. Consideration of therapy continuation should be viewed in terms of the balance between the adverse effects of medication and the need to prevent a possible relapse. Relapse during the early stages of MDD could be prevented more efficiently by conducting individual risk assessments and providing justification for continuing therapy. Our previous work established the neuroimaging markers of relapse by comparing patients with recurrent major depressive disorder (rMDD) in depressive and remitted states. However, it is not known which of these markers are trait markers that present before initial relapse and, consequently, predict disease course. Here, we first describe how inflammation can be translated to subtype-specific clinical features and suggest how this could be used to facilitate clinical diagnosis and treatment. Next, we address the central and peripheral functional state of the immune system in patients with MDD. In addition, we emphasize the important link between the number of depressive episodes and rMDD and use neuroimaging to propose a model for the latter. Last, we address how inflammation can affect brain circuits, providing a possible mechanism for rMDD. Our review suggests a link between inflammatory processes and brain region/circuits in rMDD.
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Affiliation(s)
- Chun-Hong Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, 100010, China
| | - Guang-Zhong Zhang
- Dermatological Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Bin Li
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Meng Li
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany
| | - Marie Woelfer
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany.,Department of Psychiatry and Psychotherapy, University of Tuebingen, Tubeingen, 72074, Germany.,Leibniz Institute for Neurobiology, Magdeburg, 39118, Germany
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06030, USA.
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Abstract
The biological mechanisms underlying psychiatric diagnoses are not well defined. Clinical diagnosis based on categorical systems exhibit high levels of heterogeneity and co-morbidity. The Research Domain Criteria (RDoC) attempts to reconceptualize psychiatric disorders into transdiagnostic functional dimensional constructs based on neurobiological measures and observable behaviour. By understanding the underlying neurobiology and pathophysiology of the relevant processes, the RDoC aims to advance biomarker development for disease prediction and treatment response. This important evolving dimensional framework must also consider environmental factors. Emerging evidence suggests that gut microbes (microbiome) play a physiological role in brain diseases by modulating neuroimmune, neuroendocrine and neural signalling pathways between the gut and the brain. The integration of the gut microbiome signature as an additional dimensional component of the RDoC may enhance precision psychiatry.
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60
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Barbalho SM, Goulart RDA, Araújo AC, Guiguer ÉL, Bechara MD. Irritable bowel syndrome: a review of the general aspects and the potential role of vitamin D. Expert Rev Gastroenterol Hepatol 2019; 13:345-359. [PMID: 30791775 DOI: 10.1080/17474124.2019.1570137] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Irritable Bowel Syndrome (IBS) is a bowel disorder leading to symptoms such as abdominal pain, modifications in the motility and bowel habits, distention, bloating, and gas. Vitamin D (VD) may interfere in a plethora of cellular mechanisms, and act directly or indirectly in the regulation of the microbiome, the release of anti-microbial peptides, modulation of the immune system and inflammation processes; which in turn, may positively interfere with the altered gut function. The main purpose of this review was to survey studies involving the impacts of VD on IBS. Area covered: Eligible studies including the term VD and IBS were searched in the MEDLINE-PubMed and EMBASE (2009-2018). VD may act direct or indirectly in the regulation of the gut microbiome, immune response, and psychosocial factors that may be included in the list of IBS triggering factors. Expert opinion: Once VD plays an essential role in many processes associated with IBS, its deficiency may be associated with IBS, and the supplementation could help in the therapeutic approach for this condition. For these reasons, the understanding of the association of VD in IBS is indispensable for the development of new strategies that could improve the quality of life of the patient.
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Affiliation(s)
- Sandra Maria Barbalho
- a Medical School of Marília , UNIMAR , São Paulo , Brazil.,b Department of Nutrition , Food Technology School , São Paulo , Brazil
| | | | | | - Élen Landgraf Guiguer
- a Medical School of Marília , UNIMAR , São Paulo , Brazil.,b Department of Nutrition , Food Technology School , São Paulo , Brazil
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61
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Melo HM, Santos LE, Ferreira ST. Diet-Derived Fatty Acids, Brain Inflammation, and Mental Health. Front Neurosci 2019; 13:265. [PMID: 30983955 PMCID: PMC6448040 DOI: 10.3389/fnins.2019.00265] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/06/2019] [Indexed: 12/21/2022] Open
Abstract
Western societies experienced drastic changes in eating habits during the past century. The modern nutritional profile, typically rich in saturated fats and refined sugars, is recognized as a major contributing factor, along with reduced physical activity, to the current epidemics of metabolic disorders, notably obesity and diabetes. Alongside these conditions, recent years have witnessed a gradual and significant increase in prevalence of brain diseases, particularly mood disorders. While substantial clinical/epidemiological evidence supports a correlation between metabolic and neuropsychiatric disorders, the mechanisms of pathogenesis in the latter are often multifactorial and causal links have been hard to establish. Neuroinflammation stands out as a hallmark feature of brain disorders that may be linked to peripheral metabolic dyshomeostasis caused by an unhealthy diet. Dietary fatty acids are of particular interest, as they may play a dual role, both as a component of high-calorie obesogenic diets and as signaling molecules involved in inflammatory responses. Here, we review current literature connecting diet-related nutritional imbalance and neuropsychiatric disorders, focusing on the role of dietary fatty acids as signaling molecules directly relevant to inflammatory processes and to neuronal function.
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Affiliation(s)
- Helen M. Melo
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luís Eduardo Santos
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio T. Ferreira
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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62
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Genome-wide analysis of insomnia in 1,331,010 individuals identifies new risk loci and functional pathways. Nat Genet 2019; 51:394-403. [PMID: 30804565 DOI: 10.1038/s41588-018-0333-3] [Citation(s) in RCA: 426] [Impact Index Per Article: 85.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 12/13/2018] [Indexed: 01/18/2023]
Abstract
Insomnia is the second most prevalent mental disorder, with no sufficient treatment available. Despite substantial heritability, insight into the associated genes and neurobiological pathways remains limited. Here, we use a large genetic association sample (n = 1,331,010) to detect novel loci and gain insight into the pathways, tissue and cell types involved in insomnia complaints. We identify 202 loci implicating 956 genes through positional, expression quantitative trait loci, and chromatin mapping. The meta-analysis explained 2.6% of the variance. We show gene set enrichments for the axonal part of neurons, cortical and subcortical tissues, and specific cell types, including striatal, hypothalamic, and claustrum neurons. We found considerable genetic correlations with psychiatric traits and sleep duration, and modest correlations with other sleep-related traits. Mendelian randomization identified the causal effects of insomnia on depression, diabetes, and cardiovascular disease, and the protective effects of educational attainment and intracranial volume. Our findings highlight key brain areas and cell types implicated in insomnia, and provide new treatment targets.
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63
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Orio L, Alen F, Pavón FJ, Serrano A, García-Bueno B. Oleoylethanolamide, Neuroinflammation, and Alcohol Abuse. Front Mol Neurosci 2019; 11:490. [PMID: 30687006 PMCID: PMC6333756 DOI: 10.3389/fnmol.2018.00490] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/18/2018] [Indexed: 12/28/2022] Open
Abstract
Neuroinflammation is a complex process involved in the physiopathology of many central nervous system diseases, including addiction. Alcohol abuse is characterized by induction of peripheral inflammation and neuroinflammation, which hallmark is the activation of innate immunity toll-like receptors 4 (TLR4). In the last years, lipid transmitters have generated attention as modulators of parts of the addictive process. Specifically, the bioactive lipid oleoylethanolamide (OEA), which is an endogenous acylethanolamide, has shown a beneficial profile for alcohol abuse. Preclinical studies have shown that OEA is a potent anti-inflammatory and antioxidant compound that exerts neuroprotective effects in alcohol abuse. Exogenous administration of OEA blocks the alcohol-induced TLR4-mediated pro-inflammatory cascade, reducing the release of proinflammatory cytokines and chemokines, oxidative and nitrosative stress, and ultimately, preventing the neural damage in frontal cortex of rodents. The mechanisms of action of OEA are discussed in this review, including a protective action in the intestinal barrier. Additionally, OEA blocks cue-induced reinstatement of alcohol-seeking behavior and reduces the severity of withdrawal symptoms in animals, together with the modulation of alcohol-induced depression-like behavior and other negative motivational states associated with the abstinence, such as the anhedonia. Finally, exposure to alcohol induces OEA release in blood and brain of rodents. Clinical evidences will be highlighted, including the OEA release and the correlation of plasma OEA levels with TLR4-dependent peripheral inflammatory markers in alcohol abusers. In base of these evidences we hypothesize that the endogenous release of OEA could be a homeostatic signal to counteract the toxic action of alcohol and we propose the exploration of OEA-based pharmacotherapies to treat alcohol-use disorders.
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Affiliation(s)
- Laura Orio
- Department of Psychobiology and Methods in Behavioral Science, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain.,Red de Trastornos Adictivos (RTA), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Francisco Alen
- Department of Psychobiology and Methods in Behavioral Science, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Francisco Javier Pavón
- Red de Trastornos Adictivos (RTA), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga-Universidad de Málaga, Málaga, Spain
| | - Antonia Serrano
- Red de Trastornos Adictivos (RTA), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga-Universidad de Málaga, Málaga, Spain
| | - Borja García-Bueno
- Department of Pharmacology and Toxicology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, IMAS and IUING, Madrid, Spain
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64
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Dooley LN, Kuhlman KR, Robles TF, Eisenberger NI, Craske MG, Bower JE. The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. Neurosci Biobehav Rev 2018; 94:219-237. [PMID: 30201219 PMCID: PMC6192535 DOI: 10.1016/j.neubiorev.2018.09.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/28/2018] [Accepted: 09/06/2018] [Indexed: 12/25/2022]
Abstract
A wealth of evidence has implicated inflammation in the development of depression. Yet, the heterogeneous nature of depression has impeded efforts to understand, prevent, and treat the disease. The purpose of this integrative review is to summarize the connections between inflammation and established core features of depression that exhibit more homogeneity than the syndrome itself: exaggerated reactivity to negative information, altered reward processing, decreased cognitive control, and somatic syndrome. For each core feature, we first provide a brief overview of its relevance to depression and neurobiological underpinnings, and then review evidence investigating a potential role of inflammation. We focus primarily on findings from experimental paradigms of exogenously-induced inflammation. We conclude that inflammation likely plays a role in exaggerated reactivity to negative information, altered reward reactivity, and somatic symptoms. There is less evidence supporting an effect of inflammation on cognitive control as assessed by standard neuropsychological measures. Finally, we discuss implications for future research and recommendationsfor how to test the role of inflammation in the pathogenesis of heterogeneous psychiatric disorders.
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Affiliation(s)
| | - Kate R Kuhlman
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA.
| | - Theodore F Robles
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Naomi I Eisenberger
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Julienne E Bower
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
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Farioli Vecchioli S, Sacchetti S, Nicolis di Robilant V, Cutuli D. The Role of Physical Exercise and Omega-3 Fatty Acids in Depressive Illness in the Elderly. Curr Neuropharmacol 2018; 16:308-326. [PMID: 28901279 PMCID: PMC5843982 DOI: 10.2174/1570159x15666170912113852] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/20/2017] [Accepted: 07/30/2017] [Indexed: 02/07/2023] Open
Abstract
Background: In adulthood, depression is the most common type of mental illness and will be the second leading cause of disease by 2020. Major depression dramatically affects the function of the central nervous system and degrades the quality of life, especially in old age. Several mechanisms underlie the pathophysiology of depressive illness, since it has a multifactorial etiology. Human and an-imal studies have demonstrated that depression is mainly associated with imbalances in neurotransmitters and neurotrophins, hypothalamic-pituitary-adrenal axis alterations, brain volume changes, neurogenesis dysfunction, and dysregulation of in-flammatory pathways. Also the gut microbiota may influence mental health outcomes. Although depression is not a consequence of normal aging, depressive disorders are common in later life, even if often undi-agnosed or mis-diagnosed in old age. When untreated, depression reduces life expectancy, worsens medical illnesses, en-hances health care costs and is the primary cause of suicide among older people. To date, the underpinnings of depression in the elderly are still to be understood, and the pharmacological treatment is the most commonly used therapy. Objective: Since a sedentary lifestyle and poor eating habits have recently emerged as crucial contributors to the genesis and course of depression, in the present review, we have focused on the effects of physical activity and omega-3 fatty acids on depressive illness in the elderly. Results: A growing literature indicates that both exercise and dietary interventions can promote mental health throughout one’s lifespan. Conclusion: There thus emerges the awareness that an active lifestyle and a balanced diet may constitute valid low-cost pre-vention strategies to counteract depressive illness in the elderly.
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Affiliation(s)
- Stefano Farioli Vecchioli
- Institute of Cell Biology and Neurobiology, CNR/Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy
| | - Stefano Sacchetti
- Laboratory of Experimental and Behavioral Neurophysiology, Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy.,Department of Psychology, University Sapienza of Rome, Via dei Marsi 78, 00185, Rome, Italy
| | - V Nicolis di Robilant
- Institute of Cell Biology and Neurobiology, CNR/Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy
| | - Debora Cutuli
- Laboratory of Experimental and Behavioral Neurophysiology, Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy.,Department of Psychology, University Sapienza of Rome, Via dei Marsi 78, 00185, Rome, Italy
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Jha MK, Miller AH, Minhajuddin A, Trivedi MH. Association of T and non-T cell cytokines with anhedonia: Role of gender differences. Psychoneuroendocrinology 2018; 95:1-7. [PMID: 29783087 PMCID: PMC6312182 DOI: 10.1016/j.psyneuen.2018.05.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Among individual depressive symptoms, anhedonia has been reliably associated with activation of the innate immune response. However, it is unclear whether this association extends to T cell cytokines and if gender differentially affects this association. METHOD Concentrations of T (IL-17, T-helper (Th) 1- and Th2-) and non-T cell cytokines were measured in plasma using the Bioplex Pro™ human cytokine multiplex kit in Combining Medications to Enhance Depression Outcomes (CO-MED) trial participants who provided plasma at baseline (n = 166). Anhedonia was measured with three items of the clinician-rated Inventory of Depressive Symptomatology and depression severity (minus anhedonia item) was measured with Quick Inventory of Depression Severity Self-Report version (modified-QIDS-SR). Separate generalized linear models for anhedonia and modified-QIDS-SR as dependent variables were conducted with IL-17, Th1-, Th2-, and non-T cell- cytokines as primary independent variables and gender, body mass index (BMI), and age as covariates. Exploratory analyses included gender-by-biomarker interactions. RESULTS Higher levels of IL-17 (p = 0.032), Th1- (p = 0.002), Th2-(p = 0.001) and non-T-(p = 0.009) cell markers were associated with greater severity of anhedonia controlling for BMI, age, and gender. Gender also had a significant main effect on anhedonia, however, there was a significant gender by immune marker interaction only for IL-17 (p = 0.050). Anhedonia severity increased with higher IL-17 in males (r = 0.42, p = 0.003) but not in females (r = 0.09, p = 0.336). Only non-T cell markers were associated with the modified-QIDS-SR, and there were no significant gender-specific associations with this variable. CONCLUSIONS T and non-T cell-related inflammatory markers were associated with greater severity of anhedonia, while gender moderated the association of IL-17 with anhedonia in patients with major depressive disorder.
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Affiliation(s)
- Manish K Jha
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Andrew H Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Abu Minhajuddin
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States.
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Draper A, Koch RM, van der Meer JW, Aj Apps M, Pickkers P, Husain M, van der Schaaf ME. Effort but not Reward Sensitivity is Altered by Acute Sickness Induced by Experimental Endotoxemia in Humans. Neuropsychopharmacology 2018; 43:1107-1118. [PMID: 28948979 PMCID: PMC5854801 DOI: 10.1038/npp.2017.231] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 12/28/2022]
Abstract
Sickness behavior in humans is characterized by low mood and fatigue, which have been suggested to reflect changes in motivation involving reorganization of priorities. However, it is unclear which specific processes underlying motivation are altered. We tested whether bacterial endotoxin E. coli lipopolysaccharide (LPS) affected two dissociable constructs of motivational behavior, ie, effort and reward sensitivity. After familiarization with 5 effort levels, participants made a series of accept/reject decisions on whether the stake offered (1, 4, 8, 12, or 15 apples) was 'worth the effort' (10%, 27.5%, 45%, 62.5%, and 80% of maximal voluntary contraction in a hand-held dynamometer). Effort and reward levels were parametrically modulated to dissociate their influence on choice. Overall, 29 healthy young males were administered LPS (2 ng/kg; n=14) or placebo (0.9% saline; n=15). The effort-stake task, and self-reported depression and fatigue were assessed prior to LPS/placebo injection, 2 and 5 h post injection. Cytokines and sickness symptoms were assessed hourly till 8 h after LPS injection. LPS transiently increased interleukin-6 and tumor necrosis factor-α, sickness symptoms, body temperature and self-reported fatigue, and depression post injection relative to baseline and placebo. These changes were accompanied by LPS-induced decreases in acceptance rates of high-effort options, without significantly affecting reward sensitivity 2 h post injection, which were partially recovered 5 h post injection. We suggest that LPS-induced changes in motivation may be due to alterations to mesolimbic dopamine. Our behavioral paradigm could be used to further investigate effects of inflammation on motivational behavior in psychiatric and chronic illnesses.
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Affiliation(s)
- Amelia Draper
- Department of Experimental Psychology University of Oxford, Oxford, UK
| | - Rebecca M Koch
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Wm van der Meer
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Matthew Aj Apps
- Department of Experimental Psychology University of Oxford, Oxford, UK
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Masud Husain
- Department of Experimental Psychology University of Oxford, Oxford, UK
| | - Marieke E van der Schaaf
- Donders Institute for Brain, Centre for Cognitive Neuroimaging, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Zahr NM. Peripheral TNFα elevations in abstinent alcoholics are associated with hepatitis C infection. PLoS One 2018; 13:e0191586. [PMID: 29408932 PMCID: PMC5800541 DOI: 10.1371/journal.pone.0191586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/08/2018] [Indexed: 12/31/2022] Open
Abstract
Substantial evidence supports the view that inflammatory processes contribute to brain alterations in HIV infection. Mechanisms recently proposed to underlie neuropathology in Alcohol Use Disorder (AUD) include elevations in peripheral cytokines that sensitize the brain to the damaging effects of alcohol. This study included 4 groups: healthy controls, individuals with AUD (abstinent from alcohol at examination), those infected with HIV, and those comorbid for HIV and AUD. The aim was to determine whether inflammatory cytokines are elevated in AUD as they are in HIV infection. Cytokines showing group differences included interferon gamma-induced protein 10 (IP-10) and tumor necrosis factor α (TNFα). Follow-up t-tests revealed that TNFα and IP-10 were higher in AUD than controls but only in AUD patients who were seropositive for Hepatitis C virus (HCV). Specificity of TNFα and IP-10 elevations to HCV infection status was provided by correlations between cytokine levels and HCV viral load and indices of liver integrity including albumin/globulin ratio, fibrosis scores, and AST/platelet count ratio. Because TNFα levels were mediated by HCV infection, this study provides no evidence for elevations in peripheral cytokines in "uncomplicated", abstinent alcoholics, independent of liver disease or HCV infection. Nonetheless, these results corroborate evidence for elevations in IP-10 and TNFα in HIV and for IP-10 levels in HIV+HCV co-infection.
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Affiliation(s)
- Natalie M. Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
- Neuroscience Department, SRI International, Menlo Park, CA, United States of America
- * E-mail:
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Swardfager W, Hennebelle M, Yu D, Hammock BD, Levitt AJ, Hashimoto K, Taha AY. Metabolic/inflammatory/vascular comorbidity in psychiatric disorders; soluble epoxide hydrolase (sEH) as a possible new target. Neurosci Biobehav Rev 2018; 87:56-66. [PMID: 29407524 DOI: 10.1016/j.neubiorev.2018.01.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/17/2018] [Accepted: 01/21/2018] [Indexed: 02/06/2023]
Abstract
The common and severe psychiatric disorders, including major depressive disorder (MDD) and bipolar disorder (BD), are associated with inflammation, oxidative stress and changes in peripheral and brain lipid metabolism. Those pathways are implicated in the premature development of vascular and metabolic comorbidities, which account for considerable morbidity and mortality, including increased dementia risk. During endoplasmic reticulum stress, the soluble epoxide hydrolase (sEH) enzyme converts anti-inflammatory fatty acid epoxides generated by cytochrome p450 enzymes into their corresponding and generally less anti-inflammatory, or even pro-inflammatory, diols, slowing the resolution of inflammation. The sEH enzyme and its oxylipin products are elevated post-mortem in MDD, BD and schizophrenia. Preliminary clinical data suggest that oxylipins increase with symptoms in seasonal MDD and anorexia nervosa, requiring confirmation in larger studies and other cohorts. In rats, a soluble sEH inhibitor mitigated the development of depressive-like behaviors. We discuss sEH inhibitors under development for cardiovascular diseases, post-ischemic brain injury, neuropathic pain and diabetes, suggesting new possibilities to address the mood and cognitive symptoms of psychiatric disorders, and their most common comorbidities.
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Affiliation(s)
- W Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada; University Health Network Toronto Rehabilitation Institute, Toronto, Canada.
| | - M Hennebelle
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
| | - D Yu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
| | - B D Hammock
- Department of Entomology and Nematology and Comprehensive Cancer Center UCDMC, University of California, Davis, CA, USA
| | - A J Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - K Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - A Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
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Personalized Antidepressant Selection and Pathway to Novel Treatments: Clinical Utility of Targeting Inflammation. Int J Mol Sci 2018; 19:ijms19010233. [PMID: 29329256 PMCID: PMC5796181 DOI: 10.3390/ijms19010233] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/27/2017] [Accepted: 01/10/2018] [Indexed: 12/12/2022] Open
Abstract
Major depressive disorder (MDD) is a chronic condition that affects one in six adults in the US during their lifetime. The current practice of antidepressant medication prescription is a trial-and-error process. Additionally, over a third of patients with MDD fail to respond to two or more antidepressant treatments. There are no valid clinical markers to personalize currently available antidepressant medications, all of which have similar mechanisms targeting monoamine neurotransmission. The goal of this review is to summarize the recent findings of immune dysfunction in patients with MDD, the utility of inflammatory markers to personalize treatment selection, and the potential of targeting inflammation to develop novel antidepressant treatments. To personalize antidepressant prescription, a c-reactive protein (CRP)-matched treatment assignment can be rapidly implemented in clinical practice with point-of-care fingerstick tests. With this approach, 4.5 patients need to be treated for 1 additional remission as compared to a CRP-mismatched treatment assignment. Anti-cytokine treatments may be effective as novel antidepressants. Monoclonal antibodies against proinflammatory cytokines, such as interleukin 6, interleukin 17, and tumor necrosis factor α, have demonstrated antidepressant effects in patients with chronic inflammatory conditions who report significant depressive symptoms. Additional novel antidepressant strategies targeting inflammation include pharmaceutical agents that block the effect of systemic inflammation on the central nervous system. In conclusion, inflammatory markers offer the potential not only to personalize antidepressant prescription but also to guide the development of novel mechanistically-guided antidepressant treatments.
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Brown GM, McIntyre RS, Rosenblat J, Hardeland R. Depressive disorders: Processes leading to neurogeneration and potential novel treatments. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:189-204. [PMID: 28433459 DOI: 10.1016/j.pnpbp.2017.04.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/01/2017] [Indexed: 12/18/2022]
Abstract
Mood disorders are wide spread with estimates that one in seven of the population are affected at some time in their life (Kessler et al., 2012). Many of those affected with severe depressive disorders have cognitive deficits which may progress to frank neurodegeneration. There are several peripheral markers shown by patients who have cognitive deficits that could represent causative factors and could potentially serve as guides to the prevention or even treatment of neurodegeneration. Circadian rhythm misalignment, immune dysfunction and oxidative stress are key pathologic processes implicated in neurodegeneration and cognitive dysfunction in depressive disorders. Novel treatments targeting these pathways may therefore potentially improve patient outcomes whereby the primary mechanism of action is outside of the monoaminergic system. Moreover, targeting immune dysfunction, oxidative stress and circadian rhythm misalignment (rather than primarily the monoaminergic system) may hold promise for truly disease modifying treatments that may prevent neurodegeneration rather than simply alleviating symptoms with no curative intent. Further research is required to more comprehensively understand the contributions of these pathways to the pathophysiology of depressive disorders to allow for disease modifying treatments to be discovered.
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Affiliation(s)
- Gregory M Brown
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, 250 College St. Toronto, ON M5T 1R8, Canada.
| | - Roger S McIntyre
- Psychiatry and Pharmacology, University of Toronto, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON M5T 2S8, Canada.
| | - Joshua Rosenblat
- Resident of Psychiatry, Clinician Scientist Stream, University of Toronto, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON M5T 2S8, Canada
| | - Rüdiger Hardeland
- Johann Friedrich Blumenbach Institut für Zoologie und Anthropologie, Universität Göttingen, Buergerstrasse 50, D-37073 Göttingen, Germany.
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Darwish L, Beroncal E, Sison MV, Swardfager W. Depression in people with type 2 diabetes: current perspectives. Diabetes Metab Syndr Obes 2018; 11:333-343. [PMID: 30022843 PMCID: PMC6044353 DOI: 10.2147/dmso.s106797] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with depressive symptoms, and comorbid depression in those with T2DM has been associated with adverse clinical profiles. Recognizing and addressing psychological symptoms remain significant clinical challenges in T2DM. Possible mediators of the reciprocal relationship between T2DM and depression may include physical activity levels, effectiveness of self-management, distress associated with a new T2DM diagnosis, and frailty associated with advanced diabetes duration. The latter considerations contribute to a "J-shaped" trajectory from the time of diagnosis. There remain significant challenges to screening for clinical risks associated with psychological symptoms in T2DM; poorer outcomes may be associated with major depressive episodes, isolated (eg, anhedonic), or subsyndromal depressive symptoms, depressive-like symptoms more specific to T2DM (eg, diabetes-related distress), apathy or fatigue. In this review, we discuss current perspectives on depression in the context of T2DM with implications for screening and management of these highly comorbid conditions.
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Affiliation(s)
- Lina Darwish
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,
- Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada,
- Canadian Partnership for Stroke Recovery, Toronto, ON, Canada,
| | - Erika Beroncal
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,
- Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada,
| | - Ma Veronica Sison
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,
- Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada,
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,
- Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada,
- Canadian Partnership for Stroke Recovery, Toronto, ON, Canada,
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Jha MK, Minhajuddin A, Gadad BS, Greer TL, Mayes TL, Trivedi MH. Interleukin 17 selectively predicts better outcomes with bupropion-SSRI combination: Novel T cell biomarker for antidepressant medication selection. Brain Behav Immun 2017; 66:103-110. [PMID: 28698115 PMCID: PMC5699207 DOI: 10.1016/j.bbi.2017.07.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/28/2017] [Accepted: 07/07/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Interleukin 17 (IL-17) is produced by highly inflammatory Th17 cells and has been implicated in pathophysiology of depression. IL-17 putatively disrupts the blood brain barrier and affects dopamine synthesis whereas dopamine has been shown to decrease Th17 cell-mediated immune response. Nevertheless, whether IL-17 can predict differential treatment outcome with antidepressants modulating dopaminergic transmission is unknown. METHODS IL-17 and other T cell and non-T cell markers (Th1, Th2 and non-T cell markers) were measured with the Bioplex Pro™ human cytokine 27-plex kit in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial participants who provided baseline plasma and were treated with either bupropion plus escitalopram (bupropion-SSRI), escitalopram plus placebo (SSRI monotherapy), or venlafaxine plus mirtazapine (n=166). Differential changes in symptom severity and side-effects based on levels of IL-17 and other T and non-T cell markers were tested using a treatment-arm-by-biomarker interaction in separate repeated measures mixed model analyses. Subsequent analyses stratified by treatment arm were conducted for those markers with a significant interaction. RESULTS There was a significant treatment-arm-by-IL-17 interaction for depression severity (p=0.037) but not for side-effects (p=0.28). Higher baseline IL-17 level was associated with greater reduction in depression severity (effect size=0.78, p=0.008) in the bupropion-SSRI but not the other two treatment arms. Other T and non-T cell markers were not associated with differential treatment outcomes. CONCLUSION Higher baseline levels of IL-17 are selectively associated with greater symptomatic reduction in depressed patients treated with bupropion-SSRI combination.
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Affiliation(s)
- Manish K Jha
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Abu Minhajuddin
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Bharathi S Gadad
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Tracy L Greer
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, United States.
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Bipolar Disorder and Immune Dysfunction: Epidemiological Findings, Proposed Pathophysiology and Clinical Implications. Brain Sci 2017; 7:brainsci7110144. [PMID: 29084144 PMCID: PMC5704151 DOI: 10.3390/brainsci7110144] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 12/22/2022] Open
Abstract
Bipolar disorder (BD) is strongly associated with immune dysfunction. Replicated epidemiological studies have demonstrated that BD has high rates of inflammatory medical comorbidities, including autoimmune disorders, chronic infections, cardiovascular disease and metabolic disorders. Cytokine studies have demonstrated that BD is associated with chronic low-grade inflammation with further increases in pro-inflammatory cytokine levels during mood episodes. Several mechanisms have been identified to explain the bidirectional relationship between BD and immune dysfunction. Key mechanisms include cytokine-induced monoamine changes, increased oxidative stress, pathological microglial over-activation, hypothalamic-pituitary-adrenal (HPA) axis over-activation, alterations of the microbiome-gut-brain axis and sleep-related immune changes. The inflammatory-mood pathway presents several potential novel targets in the treatment of BD. Several proof-of-concept clinical trials have shown a positive effect of anti-inflammatory agents in the treatment of BD; however, further research is needed to determine the clinical utility of these treatments. Immune dysfunction is likely to only play a role in a subset of BD patients and as such, future clinical trials should also strive to identify which specific group(s) of BD patients may benefit from anti-inflammatory treatments.
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Kopschina Feltes P, Doorduin J, Klein HC, Juárez-Orozco LE, Dierckx RAJO, Moriguchi-Jeckel CM, de Vries EFJ. Anti-inflammatory treatment for major depressive disorder: implications for patients with an elevated immune profile and non-responders to standard antidepressant therapy. J Psychopharmacol 2017; 31:1149-1165. [PMID: 28653857 PMCID: PMC5606303 DOI: 10.1177/0269881117711708] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Major depressive disorder (MDD) is a prevalent and disabling psychiatric disease with rates of non-responsiveness to antidepressants ranging from 30-50%. Historically, the monoamine depletion hypothesis has dominated the view on the pathophysiology of depression. However, the lack of responsiveness to antidepressants and treatment resistance suggests that additional mechanisms might play a role. Evidence has shown that a subgroup of depressive patients may have an underlying immune deregulation that could explain the lack of therapeutic benefit from antidepressants. Stimuli like inflammation and infection can trigger the activation of microglia to release pro-inflammatory cytokines, acting on two main pathways: (1) activation of the hypothalamic-pituitary adrenal axis, generating an imbalance in the serotonergic and noradrenergic circuits; (2) increased activity of the enzyme indoleamine-2,3-dioxygenase, resulting in depletion of serotonin levels and the production of quinolinic acid. If this hypothesis is proven true, the subgroup of MDD patients with increased levels of pro-inflammatory cytokines, mainly IL-6, TNF-α and IL-1β, might benefit from an anti-inflammatory intervention. Here, we discuss the pre-clinical and clinical studies that have provided support for treatment with non-steroidal anti-inflammatory drugs in depressed patients with inflammatory comorbidities or an elevated immune profile, as well as evidences for anti-inflammatory properties of standard antidepressants.
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Affiliation(s)
- Paula Kopschina Feltes
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans C Klein
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Luis Eduardo Juárez-Orozco
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Rudi AJO Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Cristina M Moriguchi-Jeckel
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
- Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Erik FJ de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
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Ordway GA, Szebeni A, Hernandez LJ, Crawford JD, Szebeni K, Chandley MJ, Burgess KC, Miller C, Bakkalbasi E, Brown RW. Antidepressant-Like Actions of Inhibitors of Poly(ADP-Ribose) Polymerase in Rodent Models. Int J Neuropsychopharmacol 2017; 20:994-1004. [PMID: 29016792 PMCID: PMC5716178 DOI: 10.1093/ijnp/pyx068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/28/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Many patients suffering from depressive disorders are refractory to treatment with currently available antidepressant medications, while many more exhibit only a partial response. These factors drive research to discover new pharmacological approaches to treat depression. Numerous studies demonstrate evidence of inflammation and elevated oxidative stress in major depression. Recently, major depression has been shown to be associated with elevated levels of DNA oxidation in brain cells, accompanied by increased gene expression of the nuclear base excision repair enzyme, poly(ADP-ribose) polymerase-1. Given these findings and evidence that drugs that inhibit poly(ADP-ribose) polymerase-1 activity have antiinflammatory and neuroprotective properties, the present study was undertaken to examine the potential antidepressant properties of poly(ADP-ribose) polymerase inhibitors. METHODS Two rodent models, the Porsolt swim test and repeated exposure to psychological stressors, were used to test the poly(ADP-ribose) polymerase inhibitor, 3-aminobenzamide, for potential antidepressant activity. Another poly(ADP-ribose) polymerase inhibitor, 5-aminoisoquinolinone, was also tested. RESULTS Poly(ADP-ribose) polymerase inhibitors produced antidepressant-like effects in the Porsolt swim test, decreasing immobility time, and increasing latency to immobility, similar to the effects of fluoxetine. In addition, 3-aminobenzamide treatment increased sucrose preference and social interaction times relative to vehicle-treated control rats following repeated exposure to combined social defeat and unpredictable stress, mediating effects similar to fluoxetine treatment. CONCLUSIONS The poly(ADP-ribose) polymerase inhibitors 3-aminobenzamide and 5-aminoisoquinolinone exhibit antidepressant-like activity in 2 rodent stress models and uncover poly(ADP-ribose) polymerase as a unique molecular target for the potential development of a novel class of antidepressants.
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Affiliation(s)
- Gregory A Ordway
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi),Correspondence: Gregory A. Ordway, PhD, East Tennessee State University, PO Box 70577, Johnson City, 37614 ()
| | - Attila Szebeni
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
| | - Liza J Hernandez
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
| | - Jessica D Crawford
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
| | - Katalin Szebeni
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
| | - Michelle J Chandley
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
| | - Katherine C Burgess
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
| | - Corwin Miller
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
| | - Erol Bakkalbasi
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
| | - Russell W Brown
- Department of Biomedical Sciences (Drs Ordway and Szebeni, Ms Hernandez, Drs Crawford and Szebeni, Ms Burgess, and Dr Brown) and Department of Psychiatry and Behavioral Sciences (Dr Ordway), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Chandley); DS Therapeutics, Houston, Texas (Dr Miller and Dr Bakkalbasi)
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Jha MK, Minhajuddin A, Gadad BS, Trivedi MH. Platelet-Derived Growth Factor as an Antidepressant Treatment Selection Biomarker: Higher Levels Selectively Predict Better Outcomes with Bupropion-SSRI Combination. Int J Neuropsychopharmacol 2017; 20:919-927. [PMID: 29016822 PMCID: PMC5737519 DOI: 10.1093/ijnp/pyx060] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/18/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Platelet derived growth factor is integral to maintenance of blood brain barrier, increases in response to blood brain barrier disruption, and may reflect neuroinflammation. Based on previous reports of better outcomes with dopaminergic antidepressants in depressed patients with elevated inflammatory biomarkers, we hypothesize that elevated peripheral platelet derived growth factor levels can serve as a powerful biomarker for selecting dopaminergic antidepressants. METHODS Platelet derived growth factor, basic fibroblast growth factor, and granulocyte colony stimulating factor were measured as part of Bioplex Pro human cytokine 27-plex kit in participants of the Combining Medications to Enhance Depression Outcomes trial who provided baseline plasma (n=166) and were treated with either bupropion-plus-escitalopram, escitalopram-plus-placebo, or venlafaxine-plus-mirtazapine. Differential changes in overall symptom severity and anhedonia as well as side effects were tested with a treatment-arm-by-biomarker interaction in mixed model analyses. Effect of biomarkers with significant interaction was calculated in subsequent analyses stratified by treatment arm. RESULTS There was a significant treatment-arm-by-platelet derived growth factor interaction for depression severity (P=.03) and anhedonia (P=.008) but not for side effects (P=.44). Higher baseline platelet derived growth factor level was associated with greater reduction in depression severity (effect size=0.71, P=.015) and anhedonia (effect size=0.66, P=.02) in the bupropion- selective serotonin reuptake inhibitor but not the other two treatment arms. There was no significant treatment-arm-by-biomarker interaction for both depression severity and side effects with the other two biomarkers. CONCLUSION As compared with selective serotonin reuptake inhibitor monotherapy or venlafaxine-plus-mirtazapine, bupropion-plus-escitalopram selectively improves anhedonia, which in turn results in improved overall depression severity in depressed patients with elevated platelet derived growth factor levels.
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Affiliation(s)
- Manish K Jha
- Center for Depression Research and Clinical Care (Drs Jha, Gadad
and Trivedi), and Department of Clinical Sciences (Dr
Minhajuddin), University of Texas Southwestern Medical Center,
Dallas, Texas
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care (Drs Jha, Gadad
and Trivedi), and Department of Clinical Sciences (Dr
Minhajuddin), University of Texas Southwestern Medical Center,
Dallas, Texas
| | - Bharathi S Gadad
- Center for Depression Research and Clinical Care (Drs Jha, Gadad
and Trivedi), and Department of Clinical Sciences (Dr
Minhajuddin), University of Texas Southwestern Medical Center,
Dallas, Texas
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care (Drs Jha, Gadad
and Trivedi), and Department of Clinical Sciences (Dr
Minhajuddin), University of Texas Southwestern Medical Center,
Dallas, Texas.,Correspondence: Madhukar H. Trivedi, MD, Professor of Psychiatry, Betty Jo
Hay Distinguished Chair in Mental Health, Director, Center for Depression Research and
Clinical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd.,
Dallas, TX 75390–9119 ()
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Juengst SB, Kumar RG, Wagner AK. A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges. Psychol Res Behav Manag 2017; 10:175-186. [PMID: 28652833 PMCID: PMC5476717 DOI: 10.2147/prbm.s113264] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation
- Department of Neuroscience
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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Almeida RFD, Ganzella M, Machado DG, Loureiro SO, Leffa D, Quincozes-Santos A, Pettenuzzo LF, Duarte MMMF, Duarte T, Souza DO. Olfactory bulbectomy in mice triggers transient and long-lasting behavioral impairments and biochemical hippocampal disturbances. Prog Neuropsychopharmacol Biol Psychiatry 2017; 76:1-11. [PMID: 28223107 DOI: 10.1016/j.pnpbp.2017.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/17/2017] [Accepted: 02/16/2017] [Indexed: 12/31/2022]
Abstract
Major depressive disorder (MDD) is a neuropsychiatric disease that is associated with profound disturbances in affected individuals. Elucidating the pathophysiology of MDD has been frustratingly slow, especially concerning the neurochemical events and brain regions associated with disease progression. Thus, we evaluated the time-course (up to 8weeks) behavioral and biochemical effects in mice that underwent to a bilateral olfactory bulbectomy (OBX), which is used to modeling depressive-like behavior in rodents. Similar to the symptoms in patients with MDD, OBX induced long-lasting (e.g., impairment of habituation to novelty, hyperactivity and an anxiety-like phenotype) and transient (e.g., loss of self-care and motivational behavior) behavioral effects. Moreover, OBX temporarily impaired hippocampal synaptosomal mitochondria, in a manner that would be associated with hippocampal-related synaptotoxicity. Finally, long-lasting pro-oxidative (i.e., increased levels of reactive oxygen species and nitric oxide and decreased glutathione levels) and pro-inflammatory (i.e., increased levels of pro-inflammatory cytokines IL-1, IL-6, TNF-α and decreased anti-inflammatory cytokine IL-10 levels) effects were induced in the hippocampus by OBX. Additionally, these parameters were transiently affected in the posterior and frontal cortices. This study is the first to suggest that the transient and long-lasting behavioral effects from OBX strongly correlate with mitochondrial, oxidative and inflammatory parameters in the hippocampus; furthermore, these effects show a weak correlation with these parameters in the cortex. Our findings highlight the underlying mechanisms involved in the biochemical time course of events related to depressive behavior.
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Affiliation(s)
- Roberto Farina de Almeida
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Marcelo Ganzella
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Max Planck Institute for Biophysical Chemistry, Neurobiology Department, Göttingen, Germany.
| | - Daniele Guilhermano Machado
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Samanta Oliveira Loureiro
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Douglas Leffa
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - André Quincozes-Santos
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Letícia Ferreira Pettenuzzo
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | | | - Thiago Duarte
- Departamento de Ciências da Saúde, Universidade Luterana do Brasil - Campus Santa Maria, RS, Brazil.
| | - Diogo Onofre Souza
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Systemic inflammation enhances stimulant-induced striatal dopamine elevation. Transl Psychiatry 2017; 7:e1076. [PMID: 28350401 PMCID: PMC5404612 DOI: 10.1038/tp.2017.18] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/10/2016] [Accepted: 01/09/2017] [Indexed: 12/25/2022] Open
Abstract
Changes in the mesolimbic dopamine (DA) system are implicated in a range of neuropsychiatric conditions including addiction, depression and schizophrenia. Dysfunction of the neuroimmune system is often comorbid with such conditions and affects similar areas of the brain. The goal of this study was to use positron emission tomography with the dopamine D2 antagonist tracer, 11C-raclopride, to explore the effect of acute immune activation on striatal DA levels. DA transmission was modulated by an oral methylphenidate (MP) challenge in order to reliably elicit DA elevation. Elevation in DA concentration due to MP was estimated via change in 11C-raclopride binding potential from the baseline scan. Prior to the post-MP scan, subjects were pre-treated with either the immune activator lipopolysaccharide (LPS) or placebo (PBO) in a cross-over design. Immune activation was confirmed by measuring tumor necrosis factor alpha (TNFα), interleukin (IL)-6 and IL-8 concentration in plasma. Eight healthy subjects were scanned four times each to determine the MP-induced DA elevation under both LPS and PBO pre-treatment conditions. MP-induced DA elevation in the striatum was significantly greater (P<0.01) after LPS pre-treatment compared to PBO pre-treatment. Seven of eight subjects responded similarly. This effect was observed in the caudate and putamen (P<0.02), but was not present in ventral striatum. DA elevation induced by MP was significantly greater when subjects were pre-treated with LPS compared to PBO. The amplification of stimulant-induced DA signaling in the presence of systemic inflammation may have important implications for our understanding of addiction and other diseases of DA dysfunction.
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81
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Berridge MJ. Vitamin D and Depression: Cellular and Regulatory Mechanisms. Pharmacol Rev 2017; 69:80-92. [DOI: 10.1124/pr.116.013227] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Di Benedetto S, Müller L, Wenger E, Düzel S, Pawelec G. Contribution of neuroinflammation and immunity to brain aging and the mitigating effects of physical and cognitive interventions. Neurosci Biobehav Rev 2017; 75:114-128. [PMID: 28161508 DOI: 10.1016/j.neubiorev.2017.01.044] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 01/08/2023]
Abstract
It is widely accepted that the brain and the immune system continuously interact during normal as well as pathological functioning. Human aging is commonly accompanied by low-grade inflammation in both the immune and central nervous systems, thought to contribute to many age-related diseases. This review of the current literature focuses first on the normal neuroimmune interactions occurring in the brain, which promote learning, memory and neuroplasticity. Further, we discuss the protective and dynamic role of barriers to neuroimmune interactions, which have become clearer with the recent discovery of the meningeal lymphatic system. Next, we consider age-related changes of the immune system and possible deleterious influences of immunosenescence and low-grade inflammation (inflammaging) on neurodegenerative processes in the normally aging brain. We survey the major immunomodulators and neuroregulators in the aging brain and their highly tuned dynamic and reciprocal interactions. Finally, we consider our current understanding of how physical activity, as well as a combination of physical and cognitive interventions, may mediate anti-inflammatory effects and thus positively impact brain aging.
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Affiliation(s)
- Svetlana Di Benedetto
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Lentzeallee 94, 14195, Berlin, Germany; Center for Medical Research, Department of Internal Medicine II, University of Tübingen, Waldhörnlestr. 22, 72072 Tübingen, Germany
| | - Ludmila Müller
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Lentzeallee 94, 14195, Berlin, Germany.
| | - Elisabeth Wenger
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Lentzeallee 94, 14195, Berlin, Germany
| | - Sandra Düzel
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Lentzeallee 94, 14195, Berlin, Germany
| | - Graham Pawelec
- Center for Medical Research, Department of Internal Medicine II, University of Tübingen, Waldhörnlestr. 22, 72072 Tübingen, Germany
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84
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Therapeutic Implications of Brain-Immune Interactions: Treatment in Translation. Neuropsychopharmacology 2017; 42:334-359. [PMID: 27555382 PMCID: PMC5143492 DOI: 10.1038/npp.2016.167] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/22/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023]
Abstract
A wealth of data has been amassed that details a complex, yet accessible, series of pathways by which the immune system, notably inflammation, can influence the brain and behavior. These data have opened the window to a diverse array of novel targets whose potential efficacy is tied to specific neurotransmitters and neurocircuits as well as specific behaviors. What is clear is that the impact of inflammation on the brain cuts across psychiatric disorders and engages dopaminergic and glutamatergic pathways that regulate motivation and motor activity as well as the sensitivity to threat. Given the ability to identify patient populations with increased inflammation, the precision of interventions can be further tuned, in conjunction with the ability to establish target engagement in the brain through the use of multiple neuroimaging strategies. After a brief overview of the mechanisms by which inflammation affects the brain and behavior, this review examines the extant literature on the efficacy of anti-inflammatory treatments, while forging guidelines for future intelligent clinical trial design. An examination of the most promising therapeutic strategies is also provided, along with some of the most exciting clinical trials that are currently being planned or underway.
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Szebeni A, Szebeni K, DiPeri TP, Johnson LA, Stockmeier CA, Crawford JD, Chandley MJ, Hernandez LJ, Burgess KC, Brown RW, Ordway GA. Elevated DNA Oxidation and DNA Repair Enzyme Expression in Brain White Matter in Major Depressive Disorder. Int J Neuropsychopharmacol 2016; 20:363-373. [PMID: 28034960 PMCID: PMC5412018 DOI: 10.1093/ijnp/pyw114] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/20/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pathology of white matter in brains of patients with major depressive disorder (MDD) is well-documented, but the cellular and molecular basis of this pathology are poorly understood. METHODS Levels of DNA oxidation and gene expression of DNA damage repair enzymes were measured in Brodmann area 10 (BA10) and/or amygdala (uncinate fasciculus) white matter tissue from brains of MDD (n=10) and psychiatrically normal control donors (n=13). DNA oxidation was also measured in BA10 white matter of schizophrenia donors (n=10) and in prefrontal cortical white matter from control rats (n=8) and rats with repeated stress-induced anhedonia (n=8). RESULTS DNA oxidation in BA10 white matter was robustly elevated in MDD as compared to control donors, with a smaller elevation occurring in schizophrenia donors. DNA oxidation levels in psychiatrically affected donors that died by suicide did not significantly differ from DNA oxidation levels in psychiatrically affected donors dying by other causes (non-suicide). Gene expression levels of two base excision repair enzymes, PARP1 and OGG1, were robustly elevated in oligodendrocytes laser captured from BA10 and amygdala white matter of MDD donors, with smaller but significant elevations of these gene expressions in astrocytes. In rats, repeated stress-induced anhedonia, as measured by a reduction in sucrose preference, was associated with increased DNA oxidation in white, but not gray, matter. CONCLUSIONS Cellular residents of brain white matter demonstrate markers of oxidative damage in MDD. Medications that interfere with oxidative damage or pathways activated by oxidative damage have potential to improve treatment for MDD.
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Affiliation(s)
- Attila Szebeni
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Katalin Szebeni
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Timothy P. DiPeri
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Luke A. Johnson
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Craig A. Stockmeier
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Jessica D. Crawford
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Michelle J. Chandley
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Liza J. Hernandez
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Katherine C. Burgess
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Russell W. Brown
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
| | - Gregory A. Ordway
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee (Drs A. Szebeni and K. Szebeni, Mr DiPeri, Mr Johnson, Dr Crawford, Ms Hernandez, Dr Brown, and Ms Burgess); Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr Stockmeier); Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Stockmeier); Departments of Health Sciences & Biomedical Sciences (Dr Chandley), and Departments of Biomedical Sciences & Psychiatry and Behavioral Sciences (Dr Ordway), East Tennessee State University, Johnson City, Tennessee
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Barrett LF, Quigley KS, Hamilton P. An active inference theory of allostasis and interoception in depression. Philos Trans R Soc Lond B Biol Sci 2016; 371:20160011. [PMID: 28080969 PMCID: PMC5062100 DOI: 10.1098/rstb.2016.0011] [Citation(s) in RCA: 231] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 12/30/2022] Open
Abstract
In this paper, we integrate recent theoretical and empirical developments in predictive coding and active inference accounts of interoception (including the Embodied Predictive Interoception Coding model) with working hypotheses from the theory of constructed emotion to propose a biologically plausible unified theory of the mind that places metabolism and energy regulation (i.e. allostasis), as well as the sensory consequences of that regulation (i.e. interoception), at its core. We then consider the implications of this approach for understanding depression. We speculate that depression is a disorder of allostasis, whose myriad symptoms result from a 'locked in' brain that is relatively insensitive to its sensory context. We conclude with a brief discussion of the ways our approach might reveal new insights for the treatment of depression.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.
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Affiliation(s)
- Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Karen S Quigley
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Paul Hamilton
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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McIntyre RS. Sleep and Inflammation: Implications for Domain Approach and Treatment Opportunities. Biol Psychiatry 2016; 80:9-11. [PMID: 27312233 DOI: 10.1016/j.biopsych.2016.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, Department of Pharmacology, and Institute of Medical Science, University of Toronto, Toronto, Canada.
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