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Wu J, Sun H, Ma J. Causal association between depression and intracranial aneurysms: a bidirectional two-sample Mendelian randomization study. Front Neurol 2024; 15:1346703. [PMID: 38419712 PMCID: PMC10899323 DOI: 10.3389/fneur.2024.1346703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Background Although observational studies have suggested a bidirectional relation between depression and intracranial aneurysms (IAs), their causal relations remain unclear. Thus we aimed to assess the causal association between depression and IAs. Methods We conducted a bidirectional two-sample Mendelian randomization (MR) study using summary-level data from publicly available genome-wide association studies of depression (n = 500,199), IAs (n = 79,429), unruptured intracranial aneurysm (uIA) (n = 74,004), and subarachnoid hemorrhage (SAH) (n = 77,074). MR analyses included the inverse-variance weighted (IVW) method as the primary analytic, plus weighted-median, simple mode, weighted mode, MR-Egger, and MR PRESSO. Results Genetically predicted depression was strongly positively related to IAs (odds ratio [OR] = 1.69, 95% confidence interval [CI] 1.19-2.39, p = 0.003), uIA (OR = 1.96, 95% CI 1.06-3.64, p = 0.032), and SAH (OR = 1.73, 95% CI 1.14-2.61, p = 0.009). Reverse MR analyses showed that while genetically predicted uIA was positively related to depression (OR = 1.02, 95% CI 1.00-1.05, p = 0.044), no causal relations were observed for either IAs or SAH for depression. Conclusion Our findings provide evidence of a causal effect of depression on IAs, uIA, and SAH. For the reverse MR analyses, we found a causal impact of uIA on depression, but no causal influence of either IAs or SAH for depression.
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Affiliation(s)
- Jujiang Wu
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hao Sun
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Junqiang Ma
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Population Medicine, Shantou University Medical College, Shantou, China
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Sörbo A, Eiving I, Theodorsson E, Rydenhag B, Jonsdottir IH. Pre-traumatic conditions can influence cortisol levels before and after a brain injury. Acta Neurol Scand 2020; 141:342-350. [PMID: 31879940 DOI: 10.1111/ane.13212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/01/2019] [Accepted: 12/21/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Satisfactory anabolic reactions, including the activation of the hypothalamic-pituitary-adrenal (HPA) axis, are essential following severe traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH). Many factors may influence this activation. This study aimed to investigate whether individuals who reported chronic diseases, psychosocial afflictions, or stressful events before a severe brain injury display a different pattern regarding cortisol levels retrospectively and up to three months compared with those who did not report stressful experiences. MATERIALS AND METHODS Fifty-five patients aged 16-68 years who were admitted to the neurointensive care unit (NICU) were included. Hair cortisol measurements offer a unique opportunity to monitor cortisol levels retrospectively and after the trauma. Hair strands were collected as soon as possible after admission to the NICU and every month until three months after the injury/insult. The participants/relatives were asked about stressful events, psychosocial afflictions and recent and chronic diseases. RESULTS The group who reported chronic diseases and/or stressful events before the brain injury had more than twice as high median hair cortisol levels before the brain injury compared with those who did not report stress, but the difference was not statistically significant (P = .12). Those who reported stress before the brain injury had statistically significantly lower hair cortisol values after the brain injury and they remained until three months after the injury. CONCLUSIONS Stressful events and/or chronic disease before brain injury might affect mobilization of adequate stress reactions following the trauma. However, the large variability in cortisol levels in these patients does not allow firm conclusions and more studies are needed.
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Affiliation(s)
- Ann Sörbo
- Department of Neurology and Rehabilitation Södra Älvsborg Hospital Borås Sweden
- Department of Neurology and Rehabilitation Uddevalla Hospital Uddevalla Sweden
- Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Ingrid Eiving
- Neurointensive Care Unit Department of Anesthesiology and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Elvar Theodorsson
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Bertil Rydenhag
- Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurosurgery Sahlgrenska University Hospital Gothenburg Sweden
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Tang WK, Wang L, Kwok Chu Wong G, Ungvari GS, Yasuno F, Tsoi KKF, Kim JS. Depression after Subarachnoid Hemorrhage: A Systematic Review. J Stroke 2020; 22:11-28. [PMID: 32027789 PMCID: PMC7005349 DOI: 10.5853/jos.2019.02103] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/08/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Purpose Depression is common and debilitating illness accompanying many neurological disorders including non-traumatic subarachnoid hemorrhage (SAH). The aim of this systematic review was to identify and critically appraise all published studies that have reported the frequency, severity and time course of depression after SAH, the factors associated with its development and the impact of depression on patients’ quality of life after SAH.
Methods The PubMed database was searched for studies published in English that recruited at least 40 patients (>18 years old) after SAH who were also diagnosed with depression.
Results Altogether 55 studies covering 6,327 patients met study entry criteria. The frequency of depression ranged from 0% to 61.7%, with a weighted proportion of 28.1%. Depression remained common even several years after the index SAH. Depression after SAH was associated with female sex, premorbid depression, anxiety, substance use disorders or any psychiatric disorders, and coping styles. Comorbid cognitive impairment, fatigue, and physical disability also increased the risk of depression. Aneurysmal SAH and infarction may be related to depression as well. Depression reduces the quality of life and life satisfaction in patients after SAH.
Conclusions Depression is common after SAH and seems to persist. Further research is needed to clarify its time course and identify the neuroendocrine and neurochemical factors and brain circuits associated with the development of post-SAH depression. Randomized controlled treatment trials targeting SAH-related depression are warranted.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Lisha Wang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | | | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia.,Division of Psychiatry, Medical School, University of Western Australia, Crawley, Australia
| | - Fumihiko Yasuno
- Department of Psychiatry, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.,Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong, China
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Can A, Gross BA, Smith TR, Dammers R, Dirven CMF, Woodmansee WW, Laws ER, Du R. Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis. Neurosurgery 2017; 79:253-64. [PMID: 26645970 DOI: 10.1227/neu.0000000000001157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of hypothalamic-pituitary dysfunction after aneurysmal subarachnoid hemorrhage has not been precisely determined, and conflicting results have been reported in the literature. OBJECTIVE To perform a systematic review and meta-analysis investigating the prevalence of pituitary insufficiency after aneurysmal subarachnoid hemorrhage and to focus on basal serum and dynamic test differences. METHODS The prevalence of pituitary dysfunction was quantified at 3 to 6 months and >6 months after aneurysmal subarachnoid hemorrhage. Proportions were transformed with the logit transformation. A subgroup analysis was performed focusing on the differences in outcome between basal serum and dynamic tests for the diagnosis of growth hormone deficiency (GHD) and secondary adrenal insufficiency. RESULTS Overall prevalence of hypopituitarism differed considerably between studies, ranging from 0.05 to 0.45 in studies performed between 3 and 6 months after the event and from 0 to 0.55 in long-term studies (>6 months), with pooled frequencies of 0.31 (95% confidence interval [CI]: 0.22-0.43) and 0.25 (95% CI: 0.16-0.36), respectively. Pooled frequency of GHD at 3 to 6 months was 0.14 (95% CI: 0.08-0.24). At >6 months, GHD prevalence was 0.19 (95% CI: 0.13-0.26) overall, but ranged from 0.15 (95% CI: 0.06-0.33) with the insulin tolerance test to 0.25 (95% CI: 0.15-0.36) using the growth hormone releasing hormone + arginine test. CONCLUSION Hypopituitarism is a common complication in patients with aneurysmal subarachnoid hemorrhage, with GHD being the most prevalent diagnosis. We showed that variations in prevalence rates in the literature are partly due to methodological differences among pituitary function tests. ABBREVIATIONS ACTH, adrenocorticotropic hormoneaSAH, aneurysmal subarachnoid hemorrhageGHD, growth hormone deficiencyGHRH, growth hormone-releasing hormoneGST, glucagon stimulation testIGF, insulin-like growth factor 1ITT, insulin tolerance testSAH, subarachnoid hemorrhage.
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Affiliation(s)
- Anil Can
- *Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; §Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands; ¶Division of Endocrinology, Brigham and Women's Hospital, Boston, Massachusetts
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Kutlubaev MA, Akhmadeeva LR. [Depression and depression-related disorders after a subarachnoid hemorrhage]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:20-26. [PMID: 28980577 DOI: 10.17116/jnevro20171178220-26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Psychiatric disorders often develop after subarachnoid hemorrhage (SAH); the most frequent of them are depression and depression-related disorders (anxiety, apathy, pathological fatigue, posttraumatic stress disorder, etc.). Both biological and psychological mechanisms may underlie the development of these disorders. Depression and depression-related disorders decrease patients' quality of life and prevent the full recovery after SAH. Identification and correction of these disorders should take a prominent place in the rehabilitation of post-SAH patients. More research is needed in this area.
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Takala RSK, Kiviranta R, Olkkola KT, Vahlberg T, Laukka D, Kotkansalo A, Rahi M, Sankinen M, Posti J, Katila A, Rinne J. Acute hormonal findings after aneurysmal subarachnoid hemorrhage - report from a single center. Endocr Res 2017; 42:125-131. [PMID: 27754735 DOI: 10.1080/07435800.2016.1242603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim was to assess anterior pituitary hormone levels during the acute phase of aneurysmal subarachnoid hemorrhage (aSAH) and analyze the possible association with the clinical condition and outcome. MATERIAL AND METHODS Forty patients with aSAH whose aneurysm was secured by endovascular coiling were enrolled. Basal secretions of cortisol, testosterone, luteinizing hormone (LH), prolactin (PRL), and sex hormone binding globulin (SHBG) levels were measured up to 14 days after the incident. RESULTS The main finding was that hypocortisolism was rare whereas testosterone deficiency was common in male patients. Furthermore, various other hormone deviations were frequent and there was wide interindividual variability. We found no association between delayed cerebral ischemia (DCI), outcome of the patients or aneurysm location, and hormone abnormalities, while both Hunt & Hess and Fisher grade were associated with low PRL levels. Hunt & Hess 5 was associated with low PRL concentration when compared to grades 1 (OR = 4.81, 95% CI 1.15-20.14, p = 0.03), 3 (OR 7.73, 95% CI 1.33-45.01, p = 0.02), and 4 (OR = 6.86 95% CI 1.28-26.83, p = 0.02). Fisher grade 4 was associated with low PRL concentration when compared to grades 3 (OR 3.37, 95% CI 1.06-10.73, p = 0.03) and 2 (OR 9.71, 95% CI 1.22-77.10, p = 0.04). CONCLUSION Deviations from normal and huge interindividual differences are common in hormone levels during the acute phase of aSAH. Routine assessment of anterior pituitary function in the acute phase of aSAH is not warranted. During the follow-up in the outpatient clinic, hormone concentrations were not measured, which would have brought a more long-term perspective into our findings.
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Affiliation(s)
- Riikka S K Takala
- a Perioperative Services, Intensive Care Medicine and Pain Management , Turku University Hospital and University of Turku , Turku , Finland
| | - Riku Kiviranta
- b Division of Internal Medicine, Department of Endocrinology , Turku University Hospital , Turku , Finland
- c Departments of Medicine and Medical Biochemistry and Genetics , University of Turku , Turku , Finland
| | - Klaus T Olkkola
- d Department of Anaesthesiology and Intensive Care Medicine , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Tero Vahlberg
- e Department of Clinical Medicine, Biostatistics , University of Turku, and Turku University Hospital , Turku , Finland
| | - Dan Laukka
- f Division of Clinical Neurosciences, Department of Neurosurgery , Turku University Hospital and University of Turku , Turku , Finland
| | - Anna Kotkansalo
- f Division of Clinical Neurosciences, Department of Neurosurgery , Turku University Hospital and University of Turku , Turku , Finland
| | - Melissa Rahi
- f Division of Clinical Neurosciences, Department of Neurosurgery , Turku University Hospital and University of Turku , Turku , Finland
| | - Matti Sankinen
- f Division of Clinical Neurosciences, Department of Neurosurgery , Turku University Hospital and University of Turku , Turku , Finland
| | - Jussi Posti
- f Division of Clinical Neurosciences, Department of Neurosurgery , Turku University Hospital and University of Turku , Turku , Finland
- g Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma , Turku University Hospital and University of Turku and University of Turku , Turku , Finland
| | - Ari Katila
- a Perioperative Services, Intensive Care Medicine and Pain Management , Turku University Hospital and University of Turku , Turku , Finland
| | - Jaakko Rinne
- e Department of Clinical Medicine, Biostatistics , University of Turku, and Turku University Hospital , Turku , Finland
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Poll EM, Gilsbach JM, Hans FJ, Kreitschmann-Andermahr I. Blunted serum and enhanced salivary free cortisol concentrations in the chronic phase after aneurysmal subarachnoid haemorrhage--is stress the culprit? Stress 2013; 16:153-62. [PMID: 22735076 DOI: 10.3109/10253890.2012.697946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spontaneous aneurysmal subarachnoid haemorrhage (SAH) is a cause of stroke, which constitutes a severe trauma to the brain and may lead to serious long-term medical, psychosocial and endocrinological sequelae. Adrenocorticotrophic hormone deficiency, which is considered to occur in up to 20% of all survivors, is a possible consequence of bleeding. Moreover, preliminary data suggest that a poor psychosocial outcome in SAH survivors is linked to alterations in cortisol secretion. Despite these findings, investigation of diurnal cortisol profiles and the cortisol awakening response (CAR) in chronic SAH patients has not been done so far. In this study, basal serum cortisol and salivary cortisol concentration profiles were investigated in 31 SAH patients more than 1 year after the acute event and in 25 healthy controls. Additionally, low-dose dexamethasone (DEX) suppression tests were conducted, and sensitivity to stress was measured with a psychometric questionnaire (Neuropattern(TM)). Although significantly higher salivary cortisol concentrations were observed on waking in SAH patients (p = 0.013, ANOVA), without a CAR change, total serum cortisol concentrations were blunted, but only in patients with high levels of perceived stress (SAH high stress: 337 nmol/l, SAH low stress: 442 nmol/l, controls: 467 nmol/l; Controls vs. SAH high stress p = 0.018). DEX suppression of cortisol secretion was not significantly different between patients and controls. The results indicate that total (serum) and free (salivary) cortisol concentrations give different information about cortisol availability in patients after aneurysmal SAH. Enhanced free cortisol concentrations may reflect a meaningful biological coping mechanism in SAH patients.
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Affiliation(s)
- E M Poll
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany.
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Affiliation(s)
- Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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Kutlubaev MA, Barugh AJ, Mead GE. Fatigue after subarachnoid haemorrhage: a systematic review. J Psychosom Res 2012; 72:305-10. [PMID: 22405226 DOI: 10.1016/j.jpsychores.2011.12.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/18/2011] [Accepted: 12/19/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fatigue is common and debilitating symptom in many neurological disorders and it has been reported in patients after non-traumatic subarachnoid haemorrhage (SAH). OBJECTIVES We undertook a systematic review to identify and critically appraise all published studies that have reported frequency, severity and time course of fatigue after SAH, the factors associated with its development and the impact of fatigue on patients' life after SAH. METHODS We searched Medline, EMBASE, CINAHL, PsycINFO, AMED, PubMed and included in the review all studies published in English, recruiting at least 10 patients (> 18 years old) after SAH, which reported fatigue. RESULTS We identified 13 studies (total number of subjects 737) meeting our inclusion criteria. The frequency of fatigue ranged from 31 to 90%. Fatigue remained common even several years after the ictus. According to some studies fatigue after SAH was associated with sleep disturbances, anxiety, depression, posttraumatic stress disorder, cognitive and physical impairment, but these could not explain all cases of fatigue. Fatigue reduces quality of life and life satisfaction in patients after SAH. CONCLUSIONS Fatigue is common after SAH and seems to persist. Further research is needed to clarify its time course and identify factors associated with its development.
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