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Positive emotion regulation strategies as mediators in depression and generalized anxiety disorder symptoms: A Transdiagnostic framework investigation. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01392-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Despite the overwhelming prevalence of anxiety disorders in modern society, medications and psychotherapy often fail to achieve complete symptom resolution. A complementary approach to medicating symptoms is to address the underlying metabolic pathologies associated with mental illnesses and anxiety. This may be achieved through nutritional interventions. In this perspectives piece, we highlight the roles of the microbiome and inflammation as influencers of anxiety. We further discuss the evidence base for six specific nutritional interventions: avoiding artificial sweeteners and gluten, including omega-3 fatty acids and turmeric in the diet, supplementation with vitamin D, and ketogenic diets. We attempt to integrate insights from the nutrition science-literature in order to highlight some practices that practitioners may consider when treating individual patients. Notably, this piece is not meant to serve as a comprehensive review of the literature, but rather argue our perspective that nutritional interventions should be more widely considered among clinical psychiatrists. Nutritional psychiatry is in its infancy and more research is needed in this burgeoning low-risk and potentially high-yield field.
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Affiliation(s)
- Nicholas G Norwitz
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.,Harvard Medical School, Boston, MA, United States
| | - Uma Naidoo
- Harvard Medical School, Boston, MA, United States.,Department of Nutrition and Lifestyle Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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53
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Nunes-Reis AR, Da Luz RA, de Deus JM, Martinez EZ, Conde DM. Association of religiosity with mental health and quality of life in women with chronic pelvic pain. Int J Psychiatry Med 2020; 55:408-420. [PMID: 32064976 DOI: 10.1177/0091217420906979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study evaluated religiosity and its association with mental health, quality of life, and the intensity of pelvic pain in women with chronic pelvic pain. METHODS A cross-sectional study was conducted with 100 women with chronic pelvic pain. Religiosity was investigated using the Duke University Religion Index. Quality of life was evaluated using the abbreviated version of the World Health Organization's quality of life instrument. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, while pain intensity was evaluated using a visual analog scale. RESULTS Almost half the participants attended religious services at least once a week and 62% prayed, meditated, or studied the Bible at least once a day. There was no association between religiosity and anxiety or depression. The intrinsic religiosity score was lower for women with mixed anxiety-depressive disorder compared to those without mixed anxiety-depressive disorder. There was a positive association between intrinsic religiosity and the psychological health domain of the quality of life instrument. There was no association between religiosity and pain intensity. CONCLUSIONS Women with chronic pelvic pain were strongly religious. Women with mixed anxiety-depressive disorder had lower levels of intrinsic religiosity. On the other hand, intrinsic religiosity was positively associated with quality of life in women with chronic pelvic pain. Religiosity was not associated with the intensity of pelvic pain. These data suggest that health-care professionals should take religiosity into account when treating women with chronic pelvic pain.
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Affiliation(s)
- Aline R Nunes-Reis
- Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Rosa A Da Luz
- Women's Health Unit, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - José M de Deus
- Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil.,Women's Health Unit, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Edson Z Martinez
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Délio M Conde
- Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
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Quevedo LDA, Loret de Mola C, Pearson R, Murray J, Hartwig FP, Gonçalves H, Pinheiro RT, Gigante DP, Motta JVDS, Quadros LDCMD, Barros FC, Horta BL. Mental disorders, comorbidities, and suicidality at 30 years of age in a Brazilian birth cohort. Compr Psychiatry 2020; 102:152194. [PMID: 32730959 DOI: 10.1016/j.comppsych.2020.152194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Studies on mental disorders prevalence and comorbidity, including suicidality, are scarce in low and middle-income settings. We aimed to describe the pattern of comorbidity between mental disorders and their association with suicidality. METHODS In 1982, all hospital deliveries in Pelotas (Southern Brazil) were identified (n = 5914) and have been prospectively followed. Participants were evaluated for the presence of common mental disorders (CMD) at the ages of 18-19, 23 and 30 years. In 2012-13 (30 years of age), trained psychologists evaluated 3657 individuals for disorders using the Mini International Neuropsychiatric Interview. RESULTS Prevalence of suicidal wishing, suicidal planning and lifetime suicidal attempt was 4.9%, 3.8% and 6.6%, respectively. Suicidal wishing was most strongly associated with having joint major depressive episode (MD) and lifetime suicidal attempt (OR = 26.4, 95%CI:13.9-50.4) with comorbid MD with mania/hypomania (OR = 21.2, 95%CI:6.93-65.1). Suicidal planning was most strongly associated with having joint MD and lifetime suicidal attempt (OR = 44.7, 95%CI:22.6-88.4), with comorbid MD and social anxiety disorder (OR = 30.6, 95%CI:13.0-72.0), and joint social anxiety disorder with lifetime suicidal attempt (OR = 26.3, 95%CI:8.33-82.7). Independently of other disorders, prospective and cross-sectional measures of CMD were associated with higher rates of suicidality. LIMITATIONS We do not have data on suicide deaths in follow-up and the diagnostic instrument used at 30 years of age was not used in all previous follow-up. CONCLUSION MD and social anxiety have independent and combined associations with suicidality, and also with they occur with lifetime suicidal attempt and other mental disorders.
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Affiliation(s)
- Luciana de Avila Quevedo
- Health and Behavior Postgraduate Program, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil.
| | - Christian Loret de Mola
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Rebecca Pearson
- School of Social & Community Medicine, University of Bristol, Bristol, UK; Section of Child & Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Fernando Pires Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Ricardo Tavares Pinheiro
- Health and Behavior Postgraduate Program, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil
| | - Denise Petrucci Gigante
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Janaína Vieira Dos Santos Motta
- Health and Behavior Postgraduate Program, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
| | | | - Fernando C Barros
- Health and Behavior Postgraduate Program, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Bernardo Lessa Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
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Yu Y, Li Y, Li T, Xi S, Xiao X, Xiao S, Tebes JK. New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China. J Med Internet Res 2020; 22:e18663. [PMID: 32945774 PMCID: PMC7532456 DOI: 10.2196/18663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background The past few decades have seen an exponential increase in using mobile phones to support medical care (mobile health [mHealth]) among people living with psychosis worldwide, yet little is known about WeChat use and WeChat-based mHealth among people living with schizophrenia (PLS) in China. Objective This study aims to assess WeChat use, endorsement of WeChat-based mHealth programs, and health related to WeChat use among PLS. Methods We recruited a random sample of 400 PLS from 12 communities in Changsha City of Hunan Province, China. WeChat use was assessed using the adapted WeChat Use Intensity Questionnaire (WUIQ). We also compared psychiatric symptoms, functioning, disability, recovery, quality of life, and general well-being between WeChat users and nonusers using one-to-one propensity-score matching. Results The WeChat use rate was 40.8% in this sample (163/400); 30.7% (50/163) had more than 50 WeChat friends and nearly half (81/163, 49.7%) spent more than half an hour on WeChat, a pattern similar to college students and the elderly. PLS also showed higher emotional connectedness to WeChat use than college students. About 80.4% (131/163) of PLS were willing to participate in a WeChat-based mHealth program, including psychoeducation (91/163, 55.8%), professional support (82/163, 50.3%), and peer support (67/163, 41.1%). Compared with nonusers, WeChat users were younger, better educated, and more likely to be employed. WeChat use was associated with improved health outcomes, including lower psychiatric symptoms, lower depression, higher functioning, better recovery, and higher quality of life. Conclusions WeChat-based mHealth programs hold promise as an empowering tool to provide cost-effective interventions, to foster global recovery, and to improve both physical and mental well-being among PLS. WeChat and WeChat-based mHealth programs have the potential to offer a new path to recovery and well-being for PLS in China.
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Affiliation(s)
- Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tongxin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shijun Xi
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xi Xiao
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jacob Kraemer Tebes
- Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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56
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Armbrecht E, Shah A, Schepman P, Shah R, Pappadopulos E, Chambers R, Stephens J, Haider S, McIntyre RS. Economic and humanistic burden associated with noncommunicable diseases among adults with depression and anxiety in the United States. J Med Econ 2020; 23:1032-1042. [PMID: 32468879 DOI: 10.1080/13696998.2020.1776297] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: This study estimated the economic and humanistic burden associated with chronic non-communicable diseases (NCCDs) among adults with comorbid major depressive and/or any anxiety disorders (MDD and/or AAD).Materials and methods: A retrospective analysis was conducted using the Medical Expenditure Panel Survey data (2010-2015). The analytic cohort included adults (≥18 years) with MDD only (C1), AAD only (C2), or both (C3). The presence of either of 6 NCCDs (cardiovascular diseases [CVD], pulmonary disorders [PD], pain, high cholesterol, diabetes, and obesity) were assessed. Study outcomes included healthcare costs, activity limitations, and quality of life. Multivariate regressions were conducted in each of the 3 cohorts to evaluate the association between the presence of NCCDs and outcomes.Results: The analytic sample included 9,160,465 patients: C1 (4,391,738), C2 (3,648,436), C3 (1,120,292). Pain (59%) was the most common condition, followed by CVD (55%), high cholesterol (50%), obesity (42%), PD (17%), and diabetes (14%). Mean annual healthcare costs were the greatest for C3 ($14,317), followed by C1 ($10,490) and C2 ($7,906). For C1, CVD was associated with the highest increment in annual costs ($3,966) followed by pain ($3,617). For C2, diabetes was associated with the highest incremental annual costs ($4,281) followed by PD ($2,997). For C3, cost trends were similar to those seen in C2. NCCDs resulted in a significant decrease in physical quality of life across all cohorts. Pain was associated with a significantly higher likelihood of self-reported physical, social, cognitive, and activity limitations compared to those without pain.Conclusions: 60% of patients with MDD and/or AAD had at least one additional NCCD, which significantly increased the economic and humanistic burden. These findings are important for payers and clinicians in making treatment decisions. These results underscore the need for development of multi-pronged interventions which aim to improve quality of life and reduce activity limitations among patients with mental health disorders and NCCDs.
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Affiliation(s)
- Eric Armbrecht
- Saint Louis University Center for Health Outcomes Research, St. Louis, MO, USA
| | - Anuj Shah
- Pharmerit International, Bethesda, MD, USA
| | | | | | | | | | | | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, ON, Canada
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Van Someren EJW. Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiol Rev 2020; 101:995-1046. [PMID: 32790576 DOI: 10.1152/physrev.00046.2019] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.
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Affiliation(s)
- Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit University Amsterdam, Amsterdam, The Netherlands; and Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
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58
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Bhatt S, Nagappa AN, Patil CR. Role of oxidative stress in depression. Drug Discov Today 2020; 25:1270-1276. [DOI: 10.1016/j.drudis.2020.05.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
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Ross EJ, Vivier H, Cassisi JE, Dvorak RD. Gastrointestinal health: An investigation of mediating effects on mood and quality of life. Health Psychol Open 2020; 7:2055102920974524. [PMID: 34104459 PMCID: PMC8162204 DOI: 10.1177/2055102920974524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
High prevalence rates for depression, anxiety, and gastrointestinal (GI) symptoms are found in emerging adults. However, the consequences of mood, anxiety, and GI health on health-related quality of life (HRQOL) are not well established. The biopsychosocial model and the gut-brain axis (GBA) explains the interactions of these psychological phenomenon on social and biological functioning. Following this theoretical framework, it was hypothesized that pathways between depression, anxiety, and HRQOL would be mediated by GI health. Data was cross-sectional. Undergraduates in psychology courses (N = 956) were recruited for course credit as part of ongoing research monitoring physical and psychological health of students at a major southeastern university. Participants were between 18 and 25 years old and measures were administered online. Pathways between depression, anxiety, and HRQOL were investigated using SEM analysis. The SEM was tested and specified for mediating effects. A well-fitting latent variable of GI health was created from the PROMIS-GI® scales, advancing its utility. The mediation model demonstrated anxiety and depression have significant consequences for HRQOL in emerging adults. Direct pathways from GAD7 and PHQ9 scores were found between Physical and Mental HRQOL. Notably, the path from anxiety to Physical HRQOL was fully mediated by GI health. The direct path from depressive symptoms to Physical and Mental HRQOL was partially mediated by GI health, and anxiety to Mental HRQOL was partially mediated by GI health. Findings were consistent with the biopsychosocial model and GBA. The mediation model tested here has treatment and conceptual implications. Individuals presenting with anxiety or depression should be assessed for GI symptoms and conversely, those presenting with GI complaints should be evaluated for anxiety and depression. Research is needed to develop a scoring approach to combine the PROMIS-GI® scales, so the latent construct of GI health may be used in related applications.
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60
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Mathialagan K, Ceren Amuk O, Eskander N, Patel RS. Comorbid Anxiety and Suicidal Behaviors in American Adolescents With Major Depression. Cureus 2020; 12:e8598. [PMID: 32676238 PMCID: PMC7362591 DOI: 10.7759/cureus.8598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective The aim of this study was to evaluate the odds of association between suicidal behaviors and comorbid anxiety disorders in adolescents with major depressive disorder (MDD). Methods We included 122,020 adolescent inpatients with MDD from the Nationwide Inpatient Sample (NIS) and further grouped them by co-diagnosis of anxiety disorders. Logistic regression analysis was used to evaluate the odds ratio (OR) of suicidal behaviors due to comorbid anxiety disorders. Results Out of total MDD inpatients, 45.8% had comorbid anxiety disorders. Around 53.5% MDD inpatients with anxiety disorders had suicidal behaviors, which were significantly higher than seen in 52.6% non-anxiety cohort (P = 0.002). Comorbid anxiety disorders had a minimally positive association with suicidal behaviors and were not statistically significant (OR: 1.01; P = 0.710) after controlling the logistic regression analysis for demographic confounders and psychiatric comorbidities. MDD inpatients with comorbid psychotic disorders were positively associated (OR: 1.16; P = 0.007) with suicidal behaviors. Conclusions MDD with comorbid anxiety had a statistically non-significant association with suicidal behaviors in adolescents. Depression has a direct and independent effect on adolescent suicidal behaviors, whereas anxiety has a direct effect only on perpetuating depression. Early diagnosis and management of comorbid anxiety and psychosis with MDD reduce functional impairment and suicide risk in at-risk populations.
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Affiliation(s)
| | - Ozge Ceren Amuk
- Psychiatry, Koç University School of Medicine, Istanbul, TUR
| | - Noha Eskander
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Cowden RG, Chapman I, Houghtaling A. Additive, Curvilinear, and Interactive Relations of Anxiety and Depression With Indicators of Psychosocial Functioning. Psychol Rep 2020; 124:627-650. [DOI: 10.1177/0033294120918809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines additive, curvilinear, and interactive relations of anxiety and depression with several subjective indicators of intrapersonal (i.e., hope, self-compassion, shame) and interpersonal (i.e., social connectedness, quality of social relationships) functioning in a sample of adults ( N = 547, Mage = 43.37 ± 12.02, female = 56.88%) seeking treatment for psychological difficulties. Results of complementary analyses were largely consistent with the hypothesis that increasing levels of anxiety and depression would correspond with worse psychosocial functioning, although nonlinear relations indicated that the effect of depression progressively attenuated at higher levels of symptom severity. Whereas the findings generally supported additive effects of anxiety and depression, the hypothesis that there would be synergistic effects of anxiety and depression was not supported. Supplementary group comparisons revealed that the functional implications of subsyndromal combinations of anxiety and depression may be comparable to those associated with symptoms that meet more traditional standards (i.e., syndromal or dimensional definitions) of comorbid anxiety–depression. The findings offer further insight into the complex relations of anxiety and depression with psychosocial functioning and emphasize the importance of detecting and offering appropriate treatments for anxiety and depression symptoms that coexist at subsyndromal levels.
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Affiliation(s)
| | - Ian Chapman
- Clinical Research Department, Onsite Partners, Inc., Cumberland Furnace, TN, USA
| | - Austin Houghtaling
- Clinical Research Department, Onsite Partners, Inc., Cumberland Furnace, TN, USA
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Golovina E, Vickers MH, Erb CD, O'Sullivan JM. GWAS SNPs Impact Shared Regulatory Pathways Amongst Multimorbid Psychiatric Disorders and Cognitive Functioning. Front Psychiatry 2020; 11:560751. [PMID: 33192679 PMCID: PMC7649776 DOI: 10.3389/fpsyt.2020.560751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/18/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Epidemiological research has reported that attention-deficit hyperactivity disorder (ADHD), anxiety, bipolar disorder (BD), schizophrenia (SCZ), and unipolar depression (UD) are multimorbid conditions that are typically accompanied by cognitive advantages or deficits, suggesting that common biological mechanisms may underlie these phenotypes. Genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNPs) associated with psychiatric disorders and cognitive functioning. However, the mechanisms by which these SNPs contribute to multimorbidities amongst psychiatric and cognitive phenotypes remains largely unknown. Objective: To identify shared regulatory mechanisms amongst multimorbid psychiatric disorders and cognitive functioning. Methods: We integrated data on 3D genome organization, expression quantitative trait loci (eQTLs), and pathway analyses to identify shared and specific regulatory impacts of 2,893 GWAS SNPs (p < 1 × 10-6) associated with ADHD, anxiety, BD, SCZ, UD, and cognitive functioning on genes and biological pathways. Drug-gene interaction analysis was performed to identify potential pharmacological impacts on these genes and pathways. Results: The analysis revealed 33 genes and 62 pathways that were commonly affected by tissue-specific gene regulatory interactions associated with all six phenotypes despite there being no common SNPs in our original dataset. The analysis of brain-specific regulatory connections revealed similar patterns at eQTL and eGene levels, but no pathways shared by all six phenotypes. Instead, pairwise overlaps and individualized pathways were identified for psychiatric and cognitive phenotypes in brain tissues. Conclusions: This study offers insight into the shared genes and biological pathways that are affected by tissue-specific regulatory impacts resulting from psychiatric- and cognition-associated genetic variants. These results provide limited support for the "p-factor" hypothesis for psychiatric disorders and potential mechanisms that explain drug side-effects. Our results highlight key biological pathways for development of therapies that target single or multiple psychiatric and cognitive phenotypes.
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Affiliation(s)
- Evgeniia Golovina
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start National Science Challenge, Auckland, New Zealand
| | - Mark H Vickers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Justin M O'Sullivan
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start National Science Challenge, Auckland, New Zealand
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63
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Liu J, Dong Q, Lu X, Sun J, Zhang L, Wang M, Liu B, Ju Y, Wan P, Guo H, Zhao F, Zhang X, Zhang Y, Li L. Influence of comorbid anxiety symptoms on cognitive deficits in patients with major depressive disorder. J Affect Disord 2020; 260:91-96. [PMID: 31493645 DOI: 10.1016/j.jad.2019.08.091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) patients with comorbid anxiety symptoms showed obvious cognitive deficits. However, it remains unclear whether comorbid anxiety symptoms will make a specific contribution to cognitive deficits in MDD. METHODS Executive function, processing speed, attention and memory were assessed in 162 MDD patients, and 142 healthy controls (HCs) by a comprehensive neuropsychological battery. 14-item Hamilton Anxiety Rating Scale (HAM-A) was used for anxiety symptoms and MDD patients with HAM-A total score >14 were classified into MDD with comorbid anxiety (MDDA) group. A multivariate analysis of covariance and regression models was conducted to evaluate the effects of anxiety symptoms on cognitive deficits. RESULTS There were no significantly differences in all 4 cognitive domains between MDD alone and MDDA patients (all p < 0.05). In MDDA subgroup, HAM-A total score contributed to executive function and memory (both p < 0.05), while HAM-A psychic symptoms contributed to all 4 domains (all p < 0.05). Moreover, after controlling for the severity of depression, either anxiety symptoms shown as HAMA total score or psychic anxiety symptoms only contributed significantly to the executive function performance. LIMITATIONS The cross-sectional design made it hard to acquire a cognitive performance trajectory accompanied by the fluctuations in anxiety symptoms. CONCLUSION Our findings suggest that there is no significant difference in cognitive performance between MDD alone and MDDA patients. However, comorbid anxiety, especially psychic anxiety may contribute to extensive cognitive deficits in MDDA patients. Notably, anxiety symptoms only independently triggered executive dysfunction when eliminating effect of the severity of depression.
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Affiliation(s)
- Jin Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Qiangli Dong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Xiaowen Lu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Jinrong Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Liang Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Mi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Bangshan Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Yumeng Ju
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Ping Wan
- Zhumadian Psychiatric Hospital, Zhumadian, Henan 463000, China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, Henan 463000, China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, Henan 463000, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yan Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
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Hung CI, Liu CY, Yang CH, Gan ST. Comorbidity with more anxiety disorders associated with a poorer prognosis persisting at the 10-year follow-up among patients with major depressive disorder. J Affect Disord 2020; 260:97-104. [PMID: 31493646 DOI: 10.1016/j.jad.2019.08.085] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/30/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE No study has investigated the association between number of anxiety disorders (NADs) and long-term outcome over 10 years among patients with major depressive disorder (MDD). This study investigated this issue. METHODS At baseline, 290 outpatients with MDD were enrolled, 149 with at least one anxiety disorder (AD). Subjects were followed-up at six-month, two-year, and 10-year points. The Structured Clinical Interview for DSM-IV-TR was used to confirm psychiatric diagnoses. NADs at baseline was recorded. The Hamilton Depression Rating Scale (HAMD), the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the somatic subscale (SS) of the Depression and Somatic Symptoms Scale were employed. Generalized Estimating Equation models were used for statistical analysis. RESULTS MDD patients with ADs had greater depression, anxiety, and somatic severities at the three follow-up points than those without. NADs was significantly and positively correlated with the three dimensions and total duration of pharmacotherapy at follow-up. NADs was independently associated with symptom severity after controlling for depression and anxiety at baseline and pharmacotherapy. When the DSM-5 criteria for ADs were applied, the results were unchanged. Specific phobia, panic disorder and social phobia, and panic disorder and specific phobia were independently associated with depression, anxiety, and somatic symptoms, respectively. LIMITATION Pharmacotherapy at follow-up was not controlled. The three follow-up intervals were unequal. CONCLUSIONS Comorbidity with more ADs was associated with a poorer prognosis. The negative impacts of ADs on MDD persisted at the ten-year follow-up point. NADs was associated with the long-term prognosis of MDD.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, 5 Fu-Shing St, Kweishan,Tao-Yuan 333 Taiwan.
| | - Chia-Yih Liu
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, 5 Fu-Shing St, Kweishan,Tao-Yuan 333 Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Shu-Ting Gan
- Center for Big Data Analytics and Statistics, Chang-Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
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Gupta RS, Kujawa A, Vago DR. The neural chronometry of threat-related attentional bias: Event-related potential (ERP) evidence for early and late stages of selective attentional processing. Int J Psychophysiol 2019; 146:20-42. [PMID: 31605728 PMCID: PMC6905495 DOI: 10.1016/j.ijpsycho.2019.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/04/2019] [Accepted: 08/12/2019] [Indexed: 01/04/2023]
Abstract
Rapid and accurate detection of threat is adaptive. Yet, threat-related attentional biases, including hypervigilance, avoidance, and attentional disengagement delays, may contribute to the etiology and maintenance of anxiety disorders. Behavioral measures of attentional bias generally indicate that threat demands more attentional resources; however, indices exploring differential allocation of attention using reaction time fail to clarify the time course by which attention is deployed under threatening circumstances in healthy and anxious populations. In this review, we conduct an interpretive synthesis of 28 attentional bias studies focusing on event-related potentials (ERPs) as a primary outcome to inform an ERP model of the neural chronometry of attentional bias in healthy and anxious populations. The model posits that both healthy and anxious populations display modulations of early ERP components, including the P1, N170, P2, and N2pc, in response to threatening and emotional stimuli, suggesting that both typical and abnormal patterns of attentional bias are characterized by enhanced allocation of attention to threat and emotion at earlier stages of processing. Compared to anxious populations, healthy populations more clearly demonstrate modulations of later components, such as the P3, indexing conscious and evaluative processing of threat and emotion and disengagement difficulties at later stages of processing. Findings from the interpretive synthesis, existing bias models, and extant neural literature on attentional systems are then integrated to inform a conceptual model of the processes and substrates underlying threat appraisal and resource allocation in healthy and anxious populations. To conclude, we discuss therapeutic interventions for attentional bias and future directions.
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Affiliation(s)
- Resh S Gupta
- Contemplative Neuroscience & Integrative Medicine Laboratory, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, 3401 West End Ave., Suite 380, Nashville, TN 37203, USA.
| | - Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721, USA.
| | - David R Vago
- Contemplative Neuroscience & Integrative Medicine Laboratory, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, 3401 West End Ave., Suite 380, Nashville, TN 37203, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children's Way, Suite 1318, Nashville, TN 37212, USA.
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66
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Lewis G, Duffy L, Ades A, Amos R, Araya R, Brabyn S, Button KS, Churchill R, Derrick C, Dowrick C, Gilbody S, Fawsitt C, Hollingworth W, Jones V, Kendrick T, Kessler D, Kounali D, Khan N, Lanham P, Pervin J, Peters TJ, Riozzie D, Salaminios G, Thomas L, Welton NJ, Wiles N, Woodhouse R, Lewis G. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. Lancet Psychiatry 2019; 6:903-914. [PMID: 31543474 PMCID: PMC7029306 DOI: 10.1016/s2215-0366(19)30366-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/26/2019] [Accepted: 08/13/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Depression is usually managed in primary care, but most antidepressant trials are of patients from secondary care mental health services, with eligibility criteria based on diagnosis and severity of depressive symptoms. Antidepressants are now used in a much wider group of people than in previous regulatory trials. We investigated the clinical effectiveness of sertraline in patients in primary care with depressive symptoms ranging from mild to severe and tested the role of severity and duration in treatment response. METHODS The PANDA study was a pragmatic, multicentre, double-blind, placebo-controlled randomised trial of patients from 179 primary care surgeries in four UK cities (Bristol, Liverpool, London, and York). We included patients aged 18 to 74 years who had depressive symptoms of any severity or duration in the past 2 years, where there was clinical uncertainty about the benefit of an antidepressant. This strategy was designed to improve the generalisability of our sample to current use of antidepressants within primary care. Patients were randomly assigned (1:1) with a remote computer-generated code to sertraline or placebo, and were stratified by severity, duration, and site with random block length. Patients received one capsule (sertraline 50 mg or placebo orally) daily for one week then two capsules daily for up to 11 weeks, consistent with evidence on optimal dosages for efficacy and acceptability. The primary outcome was depressive symptoms 6 weeks after randomisation, measured by Patient Health Questionnaire, 9-item version (PHQ-9) scores. Secondary outcomes at 2, 6 and 12 weeks were depressive symptoms and remission (PHQ-9 and Beck Depression Inventory-II), generalised anxiety symptoms (Generalised Anxiety Disorder Assessment 7-item version), mental and physical health-related quality of life (12-item Short-Form Health Survey), and self-reported improvement. All analyses compared groups as randomised (intention-to-treat). The study is registered with EudraCT, 2013-003440-22 (protocol number 13/0413; version 6.1) and ISRCTN, ISRCTN84544741, and is closed to new participants. FINDINGS Between Jan 1, 2015, and Aug 31, 2017, we recruited and randomly assigned 655 patients-326 (50%) to sertraline and 329 (50%) to placebo. Two patients in the sertraline group did not complete a substantial proportion of the baseline assessment and were excluded, leaving 653 patients in total. Due to attrition, primary outcome analyses were of 550 patients (266 in the sertraline group and 284 in the placebo group; 85% follow-up that did not differ by treatment allocation). We found no evidence that sertraline led to a clinically meaningful reduction in depressive symptoms at 6 weeks. The mean 6-week PHQ-9 score was 7·98 (SD 5·63) in the sertraline group and 8·76 (5·86) in the placebo group (adjusted proportional difference 0·95, 95% CI 0·85-1·07; p=0·41). However, for secondary outcomes, we found evidence that sertraline led to reduced anxiety symptoms, better mental (but not physical) health-related quality of life, and self-reported improvements in mental health. We observed weak evidence that depressive symptoms were reduced by sertraline at 12 weeks. We recorded seven adverse events-four for sertraline and three for placebo, and adverse events did not differ by treatment allocation. Three adverse events were classified as serious-two in the sertraline group and one in the placebo group. One serious adverse event in the sertraline group was classified as possibly related to study medication. INTERPRETATION Sertraline is unlikely to reduce depressive symptoms within 6 weeks in primary care but we observed improvements in anxiety, quality of life, and self-rated mental health, which are likely to be clinically important. Our findings support the prescription of SSRI antidepressants in a wider group of participants than previously thought, including those with mild to moderate symptoms who do not meet diagnostic criteria for depression or generalised anxiety disorder. FUNDING National Institute for Health Research.
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Affiliation(s)
- Gemma Lewis
- Division of Psychiatry, University College London, London, UK.
| | - Larisa Duffy
- Division of Psychiatry, University College London, London, UK
| | - Anthony Ades
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebekah Amos
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Ricardo Araya
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Simon Gilbody
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | | | - Vivien Jones
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Tony Kendrick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - David Kessler
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Daphne Kounali
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Naila Khan
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Paul Lanham
- School of Nursing and Health Studies, University of Dundee, Dundee, UK; Department of Liberal Arts, Durham University, Durham, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - Tim J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Derek Riozzie
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Laura Thomas
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Wiles
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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Braund TA, Palmer DM, Williams LM, Harris AW. Characterising anxiety in major depressive disorder and its use in predicting antidepressant treatment outcome: An iSPOT-D report. Aust N Z J Psychiatry 2019; 53:782-793. [PMID: 30880405 DOI: 10.1177/0004867419835933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Major depressive disorder commonly co-occurs with one or more anxiety disorders or with clinically significant levels of anxiety symptoms. Although evidence suggests that anxious forms of depression are prognostic of poorer antidepressant outcomes, there is no clear definition of anxious depression, and inferences about clinical outcomes are thus limited. Our objective was to compare and evaluate definitions of anxious depression and anxiety-related scales according to clinical and antidepressant outcome criteria. METHOD A total of 1008 adults with a current diagnosis of single-episode or recurrent, nonpsychotic, major depressive disorder were assessed at baseline on clinical features. Participants were then randomised to one of three antidepressants and reassessed at 8 weeks regarding remission and response of the 17-item Hamilton Rating Scale Depression (HRSD17) and the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR16). Anxious depression was defined as major depressive disorder with one or more anxiety disorders or major depressive disorder with a HRSD17 anxiety/somatisation factor score ⩾7. Anxiety-related scales included the HRSD17 anxiety/somatisation factor and the 42-item Depression Anxiety Stress Scales (DASS42) anxiety and stress subscales. RESULTS Anxious depression definitions showed poor agreement (κ = 0.15) and the HRSD17 anxiety/somatisation factor was weakly correlated with both DASS42 anxiety (r = 0.24) and stress subscales (r = 0.20). Anxious depression definitions were also associated with few impairments on clinical features and did not predict poorer antidepressant treatment outcome. However, higher DASS42 anxiety predicted poorer HRSD17 and QIDS-SR16 remission, and item-level analysis found higher scores on items 9 (situational anxiety) and 23 (somatic anxiety) of the DASS42 predicted poorer treatment outcome, even after adjusting for covariates and multiple comparisons. CONCLUSION Common definitions of anxious depression show poor agreement and do not predict poorer treatment outcome. Anxiety symptoms may be better characterised dimensionally using DASS42 when predicting treatment outcome.
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Affiliation(s)
- Taylor A Braund
- 1 Brain Dynamics Centre, The Westmead Institute for Medical Research, Sydney, NSW, Australia.,2 Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,3 The Brain Resource Company, Sydney, NSW, Australia
| | - Donna M Palmer
- 1 Brain Dynamics Centre, The Westmead Institute for Medical Research, Sydney, NSW, Australia.,3 The Brain Resource Company, Sydney, NSW, Australia
| | - Leanne M Williams
- 4 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,5 Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Anthony Wf Harris
- 1 Brain Dynamics Centre, The Westmead Institute for Medical Research, Sydney, NSW, Australia.,2 Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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68
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Furtado M, Van Lieshout RJ, Van Ameringen M, Green SM, Frey BN. Biological and psychosocial predictors of anxiety worsening in the postpartum period: A longitudinal study. J Affect Disord 2019; 250:218-225. [PMID: 30870771 DOI: 10.1016/j.jad.2019.02.064] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/21/2019] [Accepted: 02/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND As many as 20% of women will experience an anxiety disorder during the perinatal period. Women with pre-existing anxiety disorders are at increased risk of worsening during this time, yet little is known about its predictors. STUDY AIM To investigate the psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders. METHODS Thirty-five (n = 35) pregnant women with pre-existing DSM-5 anxiety disorders were enrolled in this prospective study investigating the psychosocial (e.g., childhood trauma, intolerance of uncertainty, depression) and biological risk factors (e.g. C-reactive protein, interleukin-6, tumor necrosis factor-α) for anxiety worsening in the postpartum period. Anxiety worsening was defined as an increase of ≥50% or greater on Hamilton Anxiety Rating Scale scores from the third trimester of pregnancy (32.94 ± 3.35 weeks) to six weeks postpartum. RESULTS Intolerance of uncertainty, depressive symptom severity, and obsessive-compulsive disorder symptoms present in pregnancy were significant predictors of anxiety worsening in the postpartum. LIMITATIONS Sample heterogeneity and limited sample size may affect study generalizability. CONCLUSIONS To our knowledge, this is the first longitudinal study to investigate psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders. Continued research investigating these risk factors is needed to elucidate whether they differ from women experiencing new-onset anxiety disorders in the perinatal period, and those in non-puerperal groups. Identifying these risk factors can guide the development of screening measures for early and accurate symptom detection. This can lead to the implementation of appropriate interventions aimed at decreasing the risk of perinatal anxiety worsening.
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Affiliation(s)
- Melissa Furtado
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada
| | - Sheryl M Green
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada.
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In Vitro Probiotic and Antioxidant Potential of Lactococcus lactis subsp. cremoris LL95 and Its Effect in Mice Behaviour. Nutrients 2019; 11:nu11040901. [PMID: 31013601 PMCID: PMC6521076 DOI: 10.3390/nu11040901] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 12/19/2022] Open
Abstract
The composition of intestinal microbiota is widely believed to not only affect gut health but also influence behaviour. This study aimed to evaluate the probiotic characteristics, antioxidant activity, and antidepressant- and anxiolytic-like activities of Lactococcus lactis subsp. cremoris LL95. This strain showed probiotic properties such as resistance in a simulated gastric tract model and survival at different concentrations of NaCl and bile salts. Moreover, antioxidant activity of LL95 was demonstrated through DPPH radical scavenging activity, scavenging of ABTS•+ radical and ferric ion reducing antioxidant power (FRAP) assays. Female C57BL/6 mice received LL95 orally at a dose of 109 UFC/day for 28 days. LL95 improved depressive- and anxiety-like behaviour, demonstrated by decreased immobility time in the tail suspension test and forced swim test and increased per cent of time spent in the open arms on the elevated plus maze. These findings indicate the potential antioxidant activity of LL95 and its role in behaviour, suggesting that probiotic may have therapeutic applications.
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Hoorelbeke K, Van den Bergh N, Wichers M, Koster EHW. Between vulnerability and resilience: A network analysis of fluctuations in cognitive risk and protective factors following remission from depression. Behav Res Ther 2019; 116:1-9. [PMID: 30710666 DOI: 10.1016/j.brat.2019.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/15/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
Research exploring how cognitive risk- and protective factors relate following remission from internalizing disorders suggests a central role for resilience. However, it remains unclear what constitutes resilience in this context. Furthermore, previous studies have typically relied on cross-sectional data which do not allow to map the temporal dynamics of such relations. Using a seven-day experience sampling period in 85 remitted depressed patients, we examined the interplay between five transdiagnostic vulnerability- and protective factors in daily life. We present a temporal, contemporaneous, and a between-subjects network, providing an in-depth analysis of how these factors relate to daily life fluctuations in residual symptomatology. Furthermore, we test the role of positive affect as a main resilience factor. Resilience uniquely predicted all other factors over time (temporal network). Higher levels of resilience were related to less momentary use of rumination, more deployment of positive appraisal, and lower occurrence of residual symptoms (contemporaneous network). Participants scoring high on resilience mostly engaged in positive appraisal (between-subjects network). Similar structures were obtained when substituting self-reported resilience by positive affect. This highlights the importance of resilience, and in particular, positive affectivity, to cope with stressors following remission. This may be fostered by facilitating the use of positive appraisal.
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Affiliation(s)
- Kristof Hoorelbeke
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium.
| | - Nathan Van den Bergh
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Ernst H W Koster
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
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Amorim IS, Lach G, Gkogkas CG. The Role of the Eukaryotic Translation Initiation Factor 4E (eIF4E) in Neuropsychiatric Disorders. Front Genet 2018; 9:561. [PMID: 30532767 PMCID: PMC6265315 DOI: 10.3389/fgene.2018.00561] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/06/2018] [Indexed: 12/24/2022] Open
Abstract
Protein synthesis in eukaryotic cells is a complex, multi-step and tightly regulated process. Translation initiation, the rate limiting step in protein synthesis, is dependent on the activity of eukaryotic translation Initiation Factor 4E (eIF4E). eIF4E is the cap-binding protein which, in synergy with proteins such as the helicase eIF4A and the scaffolding protein eIF4G, binds to mRNA, allowing the recruitment of ribosomes and translation initiation. The function of eIF4E is tightly regulated in cells under normal physiological conditions and can be controlled by post-translational modifications, such as phosphorylation, and by the binding of inhibitory proteins, including eIF4E binding proteins (4E-BPs) and CYFIP1. Recent studies have highlighted the importance of eIF4E in normal or aberrant function of the nervous system. In this mini-review, we will highlight the role of eIF4E function and regulation in the pathophysiology of neurodevelopmental and neuropsychiatric disorders.
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Affiliation(s)
- Inês S Amorim
- Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Gilliard Lach
- Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Christos G Gkogkas
- Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom.,The Patrick Wild Centre, The University of Edinburgh, Edinburgh, United Kingdom
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Wersebe H, Lieb R, Meyer AH, Miche M, Mikoteit T, Imboden C, Hoyer J, Bader K, Hatzinger M, Gloster AT. Well-being in major depression and social phobia with and without comorbidity. Int J Clin Health Psychol 2018; 18:201-208. [PMID: 30487925 PMCID: PMC6225024 DOI: 10.1016/j.ijchp.2018.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/29/2018] [Indexed: 11/22/2022] Open
Abstract
Background/Objective: Lower levels in well-being have been observed in individuals with Major Depression (MDD) and Social Phobia (SP), but well-planned direct comparisons with control individuals, not suffering from a mental disorder, are lacking. Furthermore, MDD is highly comorbid with anxiety disorders, and SP with depressive disorders. This study is among the first to examine differences in well-being in individuals with a clinical diagnosis of MDD or SP compared to individuals with no such diagnosis and to test differences in well-being within the combined diagnostic categories respective with and without anxiety-depressive comorbidity. Method: Participants were 119 individuals with a diagnosis of MDD, 47 SP and 118 controls. Results: Results revealed that overall well-being as well as emotional, psychological, and social well-being were lower in the MDD and SP group compared to the control group. Individuals with comorbidity reported lower well-being than individuals without comorbidity. Conclusions: These findings have clinical implications as presence of comorbidity may require a different therapeutic approach than with no comorbidity.
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Affiliation(s)
- Hanna Wersebe
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Roselind Lieb
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Marcel Miche
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services Solothurn and University of Basel, Switzerland
- Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Christian Imboden
- Psychiatric Services Solothurn and University of Basel, Switzerland
- Private Clinic Wyss, Muenchenbuchsee, Switzerland
| | - Jürgen Hoyer
- Technische Universität Dresden, Clinical Psychology and Psychotherapy, Germany
| | - Klaus Bader
- Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services Solothurn and University of Basel, Switzerland
| | - Andrew T. Gloster
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Switzerland
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Silva MT, Caicedo Roa M, Martins SS, da Silva ATC, Galvao TF. Generalized anxiety disorder and associated factors in adults in the Amazon, Brazil: A population-based study. J Affect Disord 2018; 236:180-186. [PMID: 29747135 DOI: 10.1016/j.jad.2018.04.079] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/06/2018] [Accepted: 04/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to assess the prevalence and associated factors of generalized anxiety disorder (GAD) in adults using the seven-item GAD scale (GAD-7) and to evaluate the properties of the two-item (GAD-2) as a population screening tool. METHODS We carried out a cross-sectional population-based study in the Manaus Metropolitan Region in 2015, Brazil. Adults aged 18 years or more were eligible to participate. We performed probabilistic three-phase sampling and collected sociodemographic and clinical variables. Descriptive statistics and a Poisson regression with robust variance with corrections for complex sampling were used. The accuracy of GAD-2 was assessed using GAD-7 as the gold standard. RESULTS We included 4001 participants. The prevalence of GAD was 8.4% (95% confidence interval 7.6-9.4%) and was significantly associated with self-reported poor health status and presenting depressive symptoms (p < 0.01). GAD-2 sensitivity was 63.9%, and its specificity was 97.4%. LIMITATIONS Because of the cross-sectional design of the study, the results are prone to reverse causality and recall bias. The surveyed people were not questioned about their medical diagnosis of anxiety, access to mental health services, or alcohol, tobacco or other drug use. The screening tools were not validated in the Brazilian or Amazon population. CONCLUSION About eight in 100 adults living in Manaus presented GAD, and it is more prevalent among people with a poorer health status and depression. Because of its low sensitivity, GAD-2 is not useful as a screening tool.
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Affiliation(s)
- Marcus T Silva
- Faculty of Medicine, Federal University of Amazonas, Rua Afonso Pena, 1053, Manaus, Amazonas 69020-160, Brazil.
| | - Mónica Caicedo Roa
- Postgraduate Program of Collective Health, Faculty of Medicinal Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brazil
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 509, New York, NY 10032, USA
| | - Andréa Tenório Correia da Silva
- Santa Marcelina Faculty of Medicine, Rua São João das Duas Barras, 95, Vila Carmosina, São Paulo, São Paulo 08270-080, Brazil; Department of Preventive Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 Room 2218, Cerqueira César, São Paulo, São Paulo 01246-903, Brazil
| | - Tais F Galvao
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Rua Candido Portinari, 200, Campinas, São Paulo 13083-871, Brazil
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Maes M, Bonifacio KL, Morelli NR, Vargas HO, Moreira EG, St Stoyanov D, Barbosa DS, Carvalho AF, Nunes SOV. Generalized Anxiety Disorder (GAD) and Comorbid Major Depression with GAD Are Characterized by Enhanced Nitro-oxidative Stress, Increased Lipid Peroxidation, and Lowered Lipid-Associated Antioxidant Defenses. Neurotox Res 2018; 34:489-510. [PMID: 29736827 DOI: 10.1007/s12640-018-9906-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/30/2018] [Accepted: 04/13/2018] [Indexed: 02/06/2023]
Abstract
Accumulating evidence shows that nitro-oxidative pathways play an important role in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD) and maybe anxiety disorders. The current study aims to examine superoxide dismutase (SOD1), catalase, lipid hydroperoxides (LOOH), nitric oxide metabolites (NOx), advanced oxidation protein products (AOPP), malondialdehyde (MDA), glutathione (GSH), paraoxonase 1 (PON1), high-density lipoprotein cholesterol (HDL), and uric acid (UA) in participants with and without generalized anxiety disorder (GAD) co-occurring or not with BD, MDD, or tobacco use disorder. Z unit-weighted composite scores were computed as indices of nitro-oxidative stress driving lipid and protein oxidation. SOD1, LOOH, NOx, and uric acid were significantly higher and HDL and PON1 significantly lower in participants with GAD than in those without GAD. GAD was more adequately predicted by increased SOD + LOOH + NOx and lowered HDL + PON1 composite scores. Composite scores of nitro-oxidative stress coupled with aldehyde and AOPP production were significantly increased in participants with comorbid GAD + MDD as compared with all other study groups, namely MDD, GAD + BD, BD, GAD, and healthy controls. In conclusion, GAD is characterized by increased nitro-oxidative stress and lipid peroxidation and lowered lipid-associated antioxidant defenses, while increased uric acid levels in GAD may protect against aldehyde production and protein oxidation. This study suggests that increased nitro-oxidative stress and especially increased SOD1 activity, NO production, and lipid peroxidation as well as lowered HDL-cholesterol and PON1 activity could be novel drug targets for GAD especially when comorbid with MDD.
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Affiliation(s)
- Michael Maes
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil.
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Department of Psychiatry, Medical University of Plovdiv and Technological Center for Emergency Medicine, Plovdiv, Bulgaria.
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
| | - Kamila Landucci Bonifacio
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Nayara Rampazzo Morelli
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Heber Odebrecht Vargas
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | | | - Drozdstoy St Stoyanov
- Department of Psychiatry, Medical University of Plovdiv and Technological Center for Emergency Medicine, Plovdiv, Bulgaria
| | - Décio Sabbatini Barbosa
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction & Mental Health, Toronto, ON, Canada
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Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome. Curr Opin Psychiatry 2018; 31:17-25. [PMID: 29120914 DOI: 10.1097/yco.0000000000000376] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Major depressive disorder with a comorbid anxiety disorder or with significant anxiety symptoms (here called anxious depression) is common and has been associated with poor clinical course trajectories. However, various dichotomous as well as dimensional definitions have been used to label anxious depression and it remains unclear to which extent these result in inconsistent findings. This review provides an overview of recent literature on the impact of anxiety in depressed patients on clinical course trajectories, treatment outcomes, and underlying neurobiological dysregulations. RECENT FINDINGS Anxious depression seems associated with poorer clinical course trajectories and treatment nonresponse as compared with 'pure' depression, regardless of which definition is used. Recent studies have attempted to determine specific efficacy of novel pharmacological treatments for anxious depressed patients, but have not been conclusive because of the insufficient number of studies and differences in definitions and assessment of anxious depression. Neurobiology studies suggest that anxious depression is associated with increased immune dysregulation, more cortical thinning, and corticolimbic dysfunctions as compared with 'pure' depression. SUMMARY Anxious depression appears to be a common and clinically relevant subtype of depression as it predicts poorer course trajectories. As populations with anxious depression may benefit from specific treatment regimens, further research is necessary to better delineate its definition and neurobiology. The relatively new Diagnostic and Statistical Manual of Mental Disorders-5 anxious distress specifier is a welcome development and should be further investigated and compared against other anxiety constructs.
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