1
|
Sheng W, Cui Q, Jiang K, Chen Y, Tang Q, Wang C, Fan Y, Guo J, Lu F, He Z, Chen H. Individual variation in brain network topology is linked to course of illness in major depressive disorder. Cereb Cortex 2022; 32:5301-5310. [PMID: 35152289 DOI: 10.1093/cercor/bhac015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/09/2021] [Accepted: 01/13/2022] [Indexed: 12/27/2022] Open
Abstract
Major depressive disorder (MDD) is a chronic and highly recurrent disorder. The functional connectivity in depression is affected by the cumulative effect of course of illness. However, previous neuroimaging studies on abnormal functional connection have not mainly focused on the disease duration, which is seen as a secondary factor. Here, we used a data-driven analysis (multivariate distance matrix regression) to examine the relationship between the course of illness and resting-state functional dysconnectivity in MDD. This method identified a region in the anterior cingulate cortex, which is most linked to course of illness. Specifically, follow-up seed analyses show this phenomenon resulted from the individual differences in the topological distribution of three networks. In individuals with short-duration MDD, the connection to the default mode network was strong. By contrast, individuals with long-duration MDD showed hyperconnectivity to the ventral attention network and the frontoparietal network. These results emphasized the centrality of the anterior cingulate cortex in the pathophysiology of the increased course of illness and implied critical links between network topography and pathological duration. Thus, dissociable patterns of connectivity of the anterior cingulate cortex is an important dimension feature of the disease process of depression.
Collapse
Affiliation(s)
- Wei Sheng
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.,MOE Key Lab for Neuroinformation, High Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Qian Cui
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Kexing Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yuyan Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Qin Tang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Chong Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yunshuang Fan
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Jing Guo
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Fengmei Lu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Zongling He
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.,MOE Key Lab for Neuroinformation, High Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu 611731, China
| |
Collapse
|
2
|
Goldstein TR, Franzen PL. A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions. CURRENT SLEEP MEDICINE REPORTS 2022; 8:1-19. [PMID: 36274826 PMCID: PMC9586157 DOI: 10.1007/s40675-022-00222-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/16/2022]
Abstract
Purpose of Review Suicide is currently the second leading cause of death among youth. Identification of modifiable near-term risk factors can inform suicide prevention strategies. One promising, readily assessed factor is sleep. We critically review the literature on sleep and suicidal thoughts and behaviors among youth. Recent Findings Most studies examining the youth sleep-suicidality relationship are from epidemiological samples in which both sleep problems and suicidality were assessed over variable timeframes using limited items from scales not designed to measure these constructs. Nonetheless, these data overwhelmingly support an association between suicidality and a range of sleep difficulties (e.g., insomnia, short/long sleep, weekend oversleep), above and beyond depressive symptoms. Limited studies include clinical samples or prospective designs. We review potential mechanisms and present a developmentally-informed integrative model. Summary Literature supports a clear association between sleep difficulties and youth suicidality. Future directions include prospective longitudinal studies and targeted prevention efforts.
Collapse
Affiliation(s)
- Tina R Goldstein
- Western Psychiatric Hospital and the Center for Sleep and Circadian Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Peter L Franzen
- Western Psychiatric Hospital and the Center for Sleep and Circadian Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
3
|
Aseem A, Chaudhry N, Hussain ME. Effect of moderate intensity aerobic exercise training on electrophysiological and biochemical correlates of sleep. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00746-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
4
|
Scott J, Kallestad H, Vedaa O, Sivertsen B, Etain B. Sleep disturbances and first onset of major mental disorders in adolescence and early adulthood: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101429. [PMID: 33549912 DOI: 10.1016/j.smrv.2021.101429] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023]
Abstract
Despite several high-quality reviews of insomnia and incidence of mental disorders, prospective longitudinal relationships between a wider range of sleep disturbances and first onset of a depressive, bipolar, or psychotic disorders during the peak age range for onset of these conditions has not been addressed. Database searches were undertaken to identify publications on insomnia, but also on other sleep problems such as hypersomnia, short sleep duration, self-identified and/or generic 'sleep problems' and circadian sleep-wake cycle dysrhythmias. We discovered 36 studies that were eligible for systematic review and from these publications, we identified 25 unique datasets that were suitable for meta-analysis (Number>45,000; age ∼17). Individuals with a history of any type of sleep disturbance (however defined) had an increased odds of developing a mood or psychotic disorder in adolescence or early adulthood (Odds ratio [OR]:1.88; 95% Confidence Intervals:1.67, 2.25) with similar odds for onset of bipolar disorders (OR:1.72) or depressive disorders (OR:1.62). The magnitude of associations differed according to type of exposure and was greatest for sleep disturbances that met established diagnostic criteria for a sleep disorder (OR: 2.53). However, studies that examined observer or self-rated symptoms, also reported a significant association between hypersomnia symptoms and the onset of a major mental disorder (OR:1.39). Overall study quality was moderate with evidence of publication bias and meta-regression identified confounders such as year of publication. We conclude that evidence indicates that subjective, observer and objective studies demonstrate a modest but significant increase in the likelihood of first onset of mood and psychotic disorders in adolescence and early adulthood in individuals with broadly defined sleep disturbances. Although findings support proposals for interventions for sleep problems in youth, we suggest a need for greater consensus on screening strategies and for more longitudinal, prospective studies of circadian sleep-wake cycle dysrhythmias in youth.
Collapse
Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK; Universite de Paris, Paris, France; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Havard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway; Department of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Oystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Voss District Psychiatric Hospital, NKS Bjorkeli, Voss, Norway
| | - Borge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway
| | - Bruno Etain
- Universite de Paris, Paris, France; AP-HP Paris Nord, GH Saint-Louis-Lariboisiere-Fernand-Widal, Departement de Psychiatrie et de Medicine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
| |
Collapse
|
5
|
Marino C, Andrade B, Aitken M, Bonato S, Haltigan JD, Wang W, Szatmari P. Do insomnia and/or sleep disturbances predict the onset, relapse or worsening of depression in community and clinical samples of children and youth? Protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e034606. [PMID: 32868348 PMCID: PMC7462160 DOI: 10.1136/bmjopen-2019-034606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Disturbed sleep represents a potentially important modifiable risk factor for the development of depression in children and youth. This protocol for a systematic review proposes to investigate whether insomnia and/or sleep disturbances predict child and youth depression in community and clinical-based samples. METHODS AND ANALYSIS The protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. English-written, longitudinal studies that quantitatively estimated the prediction of depression by insomnia and/or sleep disturbances in individuals 5-24 years of age will be included. EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science and grey literature will be searched from 1980 to the present. For the selection of studies, two reviewers will be involved. Data extraction will be conducted by one author and checked independently by a second author. Risk of bias will be appraised using the Research Triangle Institute Item Bank tool. Heterogeneity will be measured using the I2 statistics. Meta-analysis will be carried out if ≥3 results are available and if outcome measures can be pooled. The choice between a random-effect or fixed-effect model will be based both on the I2 statistics and the participant and study characteristics of the combined studies. Results of the meta-analyses will be summarised by a forest plot. Analyses will be performed in subgroups stratified by key variables defined depending on the amount and type of information retrieved.A narrative synthesis will be conducted in place of the meta-analysis should the pooling of data not be possible. Quality of evidence will be rated using the Grading of Recommendations Assessment, Development and Evaluation guidelines.As this is a protocol for systematic review and meta-analysis of published data, ethics review and approval are not required. The findings will be published in a peer-reviewed journal and disseminated at scientific conferences and in patient advocacy organisations. PROSPERO REGISTRATION NUMBER CRD42019136729.
Collapse
Affiliation(s)
- Cecilia Marino
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Andrade
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madison Aitken
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Bonato
- Library Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - John D Haltigan
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Kearns JC, Coppersmith DDL, Santee AC, Insel C, Pigeon WR, Glenn CR. Sleep problems and suicide risk in youth: A systematic review, developmental framework, and implications for hospital treatment. Gen Hosp Psychiatry 2020; 63:141-151. [PMID: 30301558 DOI: 10.1016/j.genhosppsych.2018.09.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/15/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Sleep problems are transdiagnostic symptoms that confer significant risk for suicidal thoughts and behaviors (STBs) in adults. However, less is known about the sleep-STB association in adolescence-a developmental period when rates of STBs increase drastically, and sleep problems may be particularly pernicious. This article provides a systematic review of research on the sleep-STB association in youth, an overview of changes in sleep regulation during adolescence that may make sleep problems particularly detrimental for youth, and a discussion of the clinical implications of the sleep-STB association for hospitalized youth. METHOD The systematic review included all longitudinal studies in which sleep problems were examined as prospective predictors of STBs in adolescents (aged 10-24 years). The search was conducted on December 1, 2017 using PsychINFO, PubMed, and Web of Science databases. RESULTS Ten studies qualified for inclusion in this review. Of these, seven studies found at least one type of sleep problem significantly predicted a STB outcome. CONCLUSIONS Although findings are mixed, growing research suggests that sleep problems may be a unique risk factor for STBs in youth. Sleep problems may be particularly important intervention target because they are easily assessed across healthcare settings and are amenable to treatment.
Collapse
Affiliation(s)
- Jaclyn C Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | | | - Angela C Santee
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Catherine Insel
- Department of Psychology, Harvard University, Cambridge, MA, USA; Center for Brain Science, Harvard University, Cambridge, MA, USA
| | - Wilfred R Pigeon
- VISN 2 Center for Excellence at Canandaigua VA Medical Center, Canandaigua, NY, USA; Sleep and Neurophysiology Research Lab, Department of Psychiatry, University of Rochester Medical Center Rochester, NY, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Catherine R Glenn
- Department of Psychology, University of Rochester, Rochester, NY, USA.
| |
Collapse
|
7
|
Meir P, Alfano CA, Lau S, Hill RM, Palmer CA. Sleep Patterns and Anxiety in Children Interact to Predict Later Suicidal Ideation. CHILDRENS HEALTH CARE 2019; 48:372-393. [PMID: 32675893 PMCID: PMC7365578 DOI: 10.1080/02739615.2019.1630283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Elevated levels of childhood anxiety pose risk for suicide; however, factors that accentuate this risk are unknown. Seventy-one children participated in a longitudinal study investigating anxiety and sleep in childhood (between 7-11 years) and later suicidal ideation (SI; M = 3.3 years later). Sleep was assessed via subjective reports and objective measures (actigraphy and polysomnography). Children with greater anxiety symptoms were at greater risk for later SI when sleep disturbances were present in childhood. Results suggest that sleep disruption may amplify SI risk in anxious children.
Collapse
Affiliation(s)
- Priel Meir
- Department of Psychology, University of Houston, Houston, TX 77004
| | | | - Simon Lau
- Department of Psychology, University of Houston, Houston, TX 77004
| | - Ryan M. Hill
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - Cara A. Palmer
- Department of Psychology, Montana State University, Bozeman, MT 59717
| |
Collapse
|
8
|
McIntosh R, Antoni M, Seay J, Fletcher MA, Ironson G, Klimas N, Kumar M, Schneiderman N. Associations Among Trajectories of Sleep Disturbance, Depressive Symptomology and 24-Hour Urinary Cortisol in HIV+ Women Following a Stress Management Intervention. Behav Sleep Med 2019; 17:605-620. [PMID: 29461096 DOI: 10.1080/15402002.2018.1435545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The burden of sleep disturbance and depressive symptomology is high for persons living with HIV and particularly so for women. While cognitive behavioral stress management (CBSM) is shown to reduce symptoms of depression and 24-hr urinary free cortisol output (CORT) in HIV+ men, less is known about the effects of CBSM on mood and concomitant sleep disturbance in HIV+ women. The study aim is to model longitudinal change in sleep disturbance, depressive symptomology, and CORT for HIV+ women exposed to a 12-week CBSM intervention or control condition. Methods: Self-reported sleep quality and depressive symptomology, along with CORT, was collected from surveys at baseline and approximately every three months thereafter for nine months from 130 HIV+ women (Mage = 38.44, SD = 7.73). The data was used to specify a parallel process latent growth model with CORT as a time-varying covariate. Results: The model showed acceptable fit. There was a linear decline in sleep disturbance (β = -0.32, p < .05) and logarithmic decline in depressive symptomology (β = -0.33, p < .05) for those receiving the intervention. Decline in sleep disturbance predicted lower CORT at nine months. Furthermore, having less depressive symptoms at baseline was associated with lower initial levels of sleep disturbance and greater improvement in sleep quality over time. There was no discernible association between sleep and mood disturbance in the control group. Across groups, there was a consistent association between older age and greater sleep disturbance (r = 0.34, p < .01). Conclusion: Sleep disturbance appears to be a behavioral target for CBSM in HIV+ women although older age, preintervention levels of depressive mood, and time-varying levels of CORT output may limit improvement in sleep quality over time.
Collapse
Affiliation(s)
- Roger McIntosh
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA
| | - Michael Antoni
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA.,b Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami , Miami , Florida , USA.,e Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Julia Seay
- b Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami , Miami , Florida , USA
| | - Mary Ann Fletcher
- c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,d Institute for Neuro-immune Medicine, Nova Southeastern University , Davie , Florida , USA
| | - Gail Ironson
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA
| | - Nancy Klimas
- c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,d Institute for Neuro-immune Medicine, Nova Southeastern University , Davie , Florida , USA
| | - Mahendra Kumar
- e Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Neil Schneiderman
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA.,c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,f Behavioral Medicine Research Center, Miller School of Medicine, University of Miami , Miami , Florida , USA
| |
Collapse
|
9
|
Morris MC, Kouros CD, Mielock AS, Rao U. Depressive symptom composites associated with cortisol stress reactivity in adolescents. J Affect Disord 2017; 210:181-188. [PMID: 28049103 PMCID: PMC5292072 DOI: 10.1016/j.jad.2016.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/01/2016] [Accepted: 12/17/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Altered hypothalamic-pituitary-adrenal (HPA) function is common in youth with major depressive disorder (MDD) but variability in the strength and direction of HPA alterations has prompted a search for symptom-based subtypes with unique neuroendocrine signatures. This study investigated the extent to which depressive symptom composites were differentially associated with cortisol responses to psychosocial stress. METHODS This study examined salivary cortisol responses to the Trier Social Stress Test (TSST) in 145 adolescents who varied in their risk for MDD: 38 had current MDD; 35 were healthy but at high risk for MDD based on having one or both parents with unipolar MDD; and 72 were healthy youth with no personal or family history of a psychiatric disorder. Multilevel models examined within-person change in cortisol levels during a 2-h resting phase prior to the TSST and both linear and quadratic changes in cortisol levels following the TSST. RESULTS Anticipatory cortisol reactivity was lower in MDD youth compared to low-risk youth, and in youth with higher compared to lower depressive symptom severity. Whereas affective symptoms were associated with increased anticipatory cortisol reactivity and more rapid recovery to the TSST, neurovegetative symptoms were associated with decreased anticipatory cortisol reactivity and slower recovery. LIMITATIONS The cross-sectional design does not permit inferences regarding temporal relations between cortisol responses and depressive symptom composites. CONCLUSIONS The present findings suggest that heterogeneity among studies examining HPA reactivity in depressed youth may be driven, in part, by differences in depressive symptom composites across samples.
Collapse
Affiliation(s)
- Matthew C Morris
- Department of Family and Community Medicine (ASM, MCM), Meharry Medical College, USA; Molecular and Behavioral Neuroscience (MCM), Meharry Medical College, USA; Departments of Psychology (MCM), Pediatrics (UR) and Kennedy Center (UR), Vanderbilt University, USA.
| | | | - Alyssa S Mielock
- Department of Family and Community Medicine (ASM, MCM), Meharry Medical College, USA
| | - Uma Rao
- Departments of Psychology (MCM), Pediatrics (UR) and Kennedy Center (UR), Vanderbilt University, USA; Center for Behavioral Health Research, University of Tennessee (UR), Knoxville, USA
| |
Collapse
|
10
|
Lovato N, Short MA, Micic G, Hiller RM, Gradisar M. An investigation of the longitudinal relationship between sleep and depressed mood in developing teens. Nat Sci Sleep 2017; 9:3-10. [PMID: 28243156 PMCID: PMC5315345 DOI: 10.2147/nss.s111521] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The prospective, bidirectional relationship between sleep disturbance and depressed mood was assessed in a school-based sample of adolescents. METHOD One hundred and thirty-eight Australian adolescents (mean age time 1 =15.69, standard deviation =0.92; 64% male) completed questionnaires to assess sleep parameters and depressed mood, on two occasions over 1 year. RESULTS Cross-sectional associations were observed between depressed mood and sleep duration, as well as wakefulness in bed. Prospective analyses revealed depressed mood predicted less total sleep time on school nights and a longer latency to sleep onset on weekends 1 year later. There was no prospective support for sleep predicting later depressed mood. CONCLUSION Contrary to prediction, our results suggest in this case that depressed mood may act as a precursor to poor sleep rather than the converse.
Collapse
Affiliation(s)
- Nicole Lovato
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Repatriation General Hospital, Flinders University
| | | | - Gorica Micic
- School of Psychology, Flinders University, Adelaide, SA, Australia
| | - Rachel M Hiller
- Department of Psychology, University of Bath, North East Somerset, UK
| | - Michael Gradisar
- School of Psychology, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
11
|
Packard AEB, Egan AE, Ulrich-Lai YM. HPA Axis Interactions with Behavioral Systems. Compr Physiol 2016; 6:1897-1934. [PMID: 27783863 DOI: 10.1002/cphy.c150042] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Perhaps the most salient behaviors that individuals engage in involve the avoidance of aversive experiences and the pursuit of pleasurable experiences. Engagement in these behaviors is regulated to a significant extent by an individual's hormonal milieu. For example, glucocorticoid hormones are produced by the hypothalamic-pituitary-adrenocortical (HPA) axis, and influence most aspects of behavior. In turn, many behaviors can influence HPA axis activity. These bidirectional interactions not only coordinate an individual's physiological and behavioral states to each other, but can also tune them to environmental conditions thereby optimizing survival. The present review details the influence of the HPA axis on many types of behavior, including appetitively-motivated behaviors (e.g., food intake and drug use), aversively-motivated behaviors (e.g., anxiety-related and depressive-like) and cognitive behaviors (e.g., learning and memory). Conversely, the manuscript also describes how engaging in various behaviors influences HPA axis activity. Our current understanding of the neuronal and/or hormonal mechanisms that underlie these interactions is also summarized. © 2016 American Physiological Society. Compr Physiol 6:1897-1934, 2016.
Collapse
Affiliation(s)
- Amy E B Packard
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ann E Egan
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yvonne M Ulrich-Lai
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
12
|
Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, Reynolds CF, Riemann D. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull 2016; 142:969-990. [PMID: 27416139 PMCID: PMC5110386 DOI: 10.1037/bul0000053] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the "Comprehensive Meta-Analysis" and "R" software. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges' g). Sources of variability, that is, sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable. (PsycINFO Database Record
Collapse
Affiliation(s)
- Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Wolfram Regen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Christoph Nissen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | | | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| |
Collapse
|
13
|
Robillard R, Hermens DF, Lee RSC, Jones A, Carpenter JS, White D, Naismith SL, Southan J, Whitwell B, Scott EM, Hickie IB. Sleep-wake profiles predict longitudinal changes in manic symptoms and memory in young people with mood disorders. J Sleep Res 2016; 25:549-555. [PMID: 27242171 DOI: 10.1111/jsr.12413] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Abstract
Mood disorders are characterized by disabling symptoms and cognitive difficulties which may vary in intensity throughout the course of the illness. Sleep-wake cycles and circadian rhythms influence emotional regulation and cognitive functions. However, the relationships between the sleep-wake disturbances experienced commonly by people with mood disorders and the longitudinal changes in their clinical and cognitive profile are not well characterized. This study investigated associations between initial sleep-wake patterns and longitudinal changes in mood symptoms and cognitive functions in 50 young people (aged 13-33 years) with depression or bipolar disorder. Data were based on actigraphy monitoring conducted over approximately 2 weeks and clinical and neuropsychological assessment. As part of a longitudinal cohort study, these assessments were repeated after a mean follow-up interval of 18.9 months. No significant differences in longitudinal clinical changes were found between the participants with depression and those with bipolar disorder. Lower sleep efficiency was predictive of longitudinal worsening in manic symptoms (P = 0.007). Shorter total sleep time (P = 0.043) and poorer circadian rhythmicity (P = 0.045) were predictive of worsening in verbal memory. These findings suggest that some sleep-wake and circadian disturbances in young people with mood disorders may be associated with less favourable longitudinal outcomes, notably for subsequent manic symptoms and memory difficulties.
Collapse
Affiliation(s)
- Rébecca Robillard
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Daniel F Hermens
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Rico S C Lee
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew Jones
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Joanne S Carpenter
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Django White
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Sharon L Naismith
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - James Southan
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Bradley Whitwell
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Elizabeth M Scott
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Ian B Hickie
- Clinical Research Unit, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
| |
Collapse
|
14
|
Iorfino F, Hickie IB, Lee RSC, Lagopoulos J, Hermens DF. The underlying neurobiology of key functional domains in young people with mood and anxiety disorders: a systematic review. BMC Psychiatry 2016; 16:156. [PMID: 27215830 PMCID: PMC4878058 DOI: 10.1186/s12888-016-0852-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mood and anxiety disorders are leading causes of disability and mortality, due largely to their onset during adolescence and young adulthood and broader impact on functioning. Key factors that are associated with disability and these disorders in young people are social and economic participation (e.g. education, employment), physical health, suicide and self-harm behaviours, and alcohol and substance use. A better understanding of the objective markers (i.e. neurobiological parameters) associated with these factors is important for the development of effective early interventions that reduce the impact of disability and illness persistence. METHODS We systematically reviewed the literature for neurobiological parameters (i.e. neuropsychology, neuroimaging, sleep-wake and circadian biology, neurophysiology and metabolic measures) associated with functional domains in young people (12 to 30 years) with mood and/or anxiety disorders. RESULTS Of the one hundred and thirty-four studies selected, 7.6 % investigated social and economic participation, 2.1 % physical health, 15.3 % suicide and self-harm behaviours, 6.9 % alcohol and substance use, whereas the majority (68.1 %) focussed on clinical syndrome. CONCLUSIONS Despite the predominance of studies that solely examine the clinical syndrome of young people the literature also provides evidence of distinct associations among objective measures (indexing various aspects of brain circuitry) and other functional domains. We suggest that a shift in focus towards characterising the mechanisms that underlie and/or mediate multiple functional domains will optimise personalised interventions and improve illness trajectories.
Collapse
Affiliation(s)
- Frank Iorfino
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Ian B Hickie
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Rico S C Lee
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Jim Lagopoulos
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Daniel F Hermens
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia.
| |
Collapse
|
15
|
Walia HK, Mehra R. Overview of Common Sleep Disorders and Intersection with Dermatologic Conditions. Int J Mol Sci 2016; 17:E654. [PMID: 27144559 PMCID: PMC4881480 DOI: 10.3390/ijms17050654] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 01/12/2023] Open
Abstract
Sleep disorders are very common, often under-recognized and therefore undertreated, are associated with a myriad of medical conditions and could lead to significant impairment of quality of life. This review provides an up-to-date synopsis of common sleep disorders encompassing insufficient sleep syndrome, insomnia, circadian rhythm disorders and obstructive sleep apnea with a brief overview of epidemiology, screening, diagnostic testing and treatment. We also emphasize the emerging area of the intersection of sleep disorders and dermatologic conditions and present compelling data regarding underlying mechanisms including sleep dysfunction in relation to disorders of skin inflammation, aging and skin cancer.
Collapse
Affiliation(s)
- Harneet K Walia
- Center for Sleep Disorders Cleveland Clinic 11203, Stokes Blvd Cleveland, Cleveland, OH 44195, USA.
| | - Reena Mehra
- Center for Sleep Disorders Cleveland Clinic 11203, Stokes Blvd Cleveland, Cleveland, OH 44195, USA.
| |
Collapse
|
16
|
Urrila AS, Paunio T, Palomäki E, Marttunen M. Sleep in adolescent depression: physiological perspectives. Acta Physiol (Oxf) 2015; 213:758-77. [PMID: 25561272 DOI: 10.1111/apha.12449] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 06/02/2014] [Accepted: 12/24/2014] [Indexed: 12/14/2022]
Abstract
Depression and disturbed sleep are intimately and bidirectionally related. During adolescence, the incidence of both insomnia and major depression increases simultaneously, in a gender-specific manner. The majority of depressed adolescents suffer from different types of subjective sleep complaints. Despite these complaints, the results from polysomnographic studies in depressed adolescents remain inconsistent. In general, similar features to those seen among adults with depressive disorder (e.g. abnormalities in rapid eye movement sleep and difficulties in sleep onset) have been reported, but expressed to a lesser degree. The inconsistency in findings may be linked with maturational factors, factors related to the stage of illness and greater heterogeneity in the clinical spectrum of depression among adolescents. The exact neurobiological mechanisms by which sleep alterations and depression are linked during adolescence are not fully understood. Aberrations in brain maturation, expressed at different levels of organization, for example gene expression, neurotransmitter and hormone metabolism, and activity of neuronal networks have been suggested. The circadian systems may change in adolescent depression beyond that observed during healthy adolescent development (i.e. beyond the typical circadian shift towards eveningness). A number of therapeutic approaches to alleviate sleep disruption associated with depression have been proposed, but research on the efficacy of these interventions in adolescents is lacking. Knowledge of the neurobiological links between sleep and depression during adolescence could lead to new insights into effective prevention and treatment of depression.
Collapse
Affiliation(s)
- A. S. Urrila
- Department of Health, Mental Health Unit; National Institute for Health and Welfare; Helsinki Finland
- Department of Adolescent Psychiatry; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - T. Paunio
- Department of Health, Genomics and Biomarkers Unit; National Institute for Health and Welfare; Helsinki Finland
- Department of Psychiatry; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - E. Palomäki
- Department of Physiology; Institute of Biomedicine; University of Helsinki; Helsinki Finland
| | - M. Marttunen
- Department of Health, Mental Health Unit; National Institute for Health and Welfare; Helsinki Finland
- Department of Adolescent Psychiatry; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| |
Collapse
|
17
|
Robillard R, Hermens DF, Naismith SL, White D, Rogers NL, Ip TK, Mullin SJ, Alvares GA, Guastella AJ, Smith KL, Rong Y, Whitwell B, Southan J, Glozier N, Scott EM, Hickie IB. Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders. J Psychiatry Neurosci 2015; 40:28-37. [PMID: 25203899 PMCID: PMC4275328 DOI: 10.1503/jpn.130247] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The nature of sleep-wake abnormalities in individuals with mental disorders remains unclear. The present study aimed to examine the differences in objective ambulatory measures of the sleep-wake and activity cycles across young people with anxiety, mood or psychotic disorders. METHODS Participants underwent several days of actigraphy monitoring. We divided participants into 5 groups (control, anxiety disorder, unipolar depression, bipolar disorder, psychotic disorder) according to primary diagnosis. RESULTS We enrolled 342 participants aged 12-35 years in our study: 41 healthy controls, 56 with anxiety disorder, 135 with unipolar depression, 80 with bipolar disorder and 30 with psychotic disorders. Compared with the control group, sleep onset tended to occur later in the anxiety, depression and bipolar groups; sleep offset occurred later in all primary diagnosis groups; the sleep period was longer in the anxiety, bipolar and psychosis groups; total sleep time was longer in the psychosis group; and sleep efficiency was lower in the depression group, with a similar tendency for the anxiety and bipolar groups. Sleep parameters were significantly more variable in patient subgroups than in controls. Cosinor analysis revealed delayed circadian activity profiles in the anxiety and bipolar groups and abnormal circadian curve in the psychosis group. LIMITATIONS Although statistical analyses controlled for age, the sample included individuals from preadolescence to adulthood. Most participants from the primary diagnosis subgroups were taking psychotropic medications, and a large proportion had other comorbid mental disorders. CONCLUSION Our findings suggest that delayed and disorganized sleep offset times are common in young patients with various mental disorders. However, other sleep-wake cycle disturbances appear to be more prominent in broad diagnostic categories.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ian B. Hickie
- Correspondence to: I.B. Hickie, Brain & Mind Research Institute, University of Sydney, Level 4, 94 Mallett St., Camperdown NSW 2050 Australia;
| |
Collapse
|
18
|
Lovato N, Gradisar M. A meta-analysis and model of the relationship between sleep and depression in adolescents: recommendations for future research and clinical practice. Sleep Med Rev 2014; 18:521-9. [PMID: 24857255 DOI: 10.1016/j.smrv.2014.03.006] [Citation(s) in RCA: 343] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
Abstract
The purpose of this review was to quantify the strength of evidence for a directional relationship between sleep disturbance and depression in adolescents. A literature search was conducted to identify research investigating the relationship between sleep disturbance and depression in adolescent samples (12-20 y). Twenty-three studies were identified; 13 explored associations between depression and sleep disturbance; seven examined the prospective role of sleep disturbance in the development of depression; and three investigated the role of adolescent depression in the development of subsequent sleep disturbance. Average weighted mean differences in sleep/depression-related outcome variables were calculated between adolescents with depression, and non-clinical adolescents, or those in remission. Adolescents with depression experienced significantly more wakefulness in bed (sleep onset latency, wake after sleep onset, number of awakenings and sleep efficiency), lighter sleep (more stage 1), and reported more subjective sleep disturbance. Overall effect sizes from longitudinal and treatment studies suggest sleep disturbance acts as a precursor to the development of depression. At follow-up, depressed adolescents had significantly longer sleep onset, more wake after sleep onset, and lower sleep efficiency compared to adolescents who were non-clinical, or had undergone remission. Little support was found for a predictive role of depressive symptoms in the development of sleep disturbance. Based on these findings we propose a model to understand the development of depression from initial sleep disturbance, provide recommendations for clinicians and recommendations for future research.
Collapse
Affiliation(s)
- Nicole Lovato
- School of Psychology, Flinders University, Adelaide, SA, Australia.
| | - Michael Gradisar
- School of Psychology, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
19
|
Arfken CL, Joseph A, Sandhu GR, Roehrs T, Douglass AB, Boutros NN. The status of sleep abnormalities as a diagnostic test for major depressive disorder. J Affect Disord 2014; 156:36-45. [PMID: 24412322 DOI: 10.1016/j.jad.2013.12.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/21/2013] [Accepted: 12/01/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Psychiatry lags other fields in development of diagnostic tests. METHODS A literature review and meta-analysis was conducted to ascertain if polysomnographic abnormalities (REM density, REM latency, sleep efficiency, slow wave sleep, stage 1 and stage 2 sleep) warrant additional effort to develop them into a clinical diagnostic test for major depressive disorder (MDD). The 31 publications meeting inclusion criteria were then classified into one of three progressive steps using guidelines for evaluating the clinical usefulness of a diagnostic test. RESULTS Most of the abnormalities found in MDD patients, when compared to healthy controls, occurred in the expected direction with moderate effect sizes but with substantial publication bias and heterogeneity. Eleven studies compared abnormalities in MDD to other psychiatric disorders (step 2a), and four studies provided data on the sensitivity or specificity of the findings in differentiating among the psychiatric disorders that frequently appear on the same differential diagnostic list as MDD (step 2b). No multicenter trial has been conducted prospectively to test the clinical utility of the diagnostic test (step 3). LIMITATIONS Only published articles in the English language were used. CONCLUSIONS Sleep studies for the detection of MDD appear replicable with a moderate effect size. However, additional step 1 studies are needed to define the sensitivity and specificity. The heterogeneity of sleep recording, scoring techniques, and MDD must also be addressed.
Collapse
Affiliation(s)
- C L Arfken
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48207, USA.
| | - A Joseph
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48207, USA
| | - G R Sandhu
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48207, USA
| | - T Roehrs
- Henry Ford Sleep Disorders & Research Center, Henry Ford Health System & Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48207, USA
| | - A B Douglass
- (c)University of Ottawa, Department of Psychiatry and Royal Ottawa Mental Health Center, Ottawa, ON, Canada
| | - N N Boutros
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48207, USA
| |
Collapse
|
20
|
Kaplow JB, Shapiro DN, Wardecker BM, Howell KH, Abelson JL, Worthman CM, Prossin AR. Psychological and environmental correlates of HPA axis functioning in parentally bereaved children: preliminary findings. J Trauma Stress 2013; 26:233-40. [PMID: 23526635 PMCID: PMC5790317 DOI: 10.1002/jts.21788] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined bereaved children's HPA-axis functioning (cortisol awakening response; CAR) in relation to psychological distress, coping, and surviving parents' grief reactions. Participants included 38 children (20 girls) with recent parental loss (previous 6 months) and 28 of their surviving caregivers (23 women) who were assessed using self-report instruments and in-person, semistructured interviews. Interviews involved discussions about the child's thoughts and feelings related to the loss. Participants provided 3 saliva samples at home (awakening, 30 minutes later, and evening) over 3 successive days, beginning on the day following the interview. Results show a significant relation between dampening of the child's Day 1 CAR and more symptoms of anxiety (r = -.45), depression (r = -.40), posttraumatic stress (r = -.45), and maladaptive grief (r = -.43), as well as higher levels of avoidant coping (r = -.53). Higher levels of parental maladaptive grief were also associated (r = -.47) with a dampening of the child's Day 1 CAR. Our results raise the possibility that blunted CAR may be a result of accumulating allostatic load and/or a result of emotionally challenging events (discussions regarding the deceased) and their subsequent processing (or lack thereof) within the family, which may be particularly stressful for those bereaved children experiencing high levels of psychological distress, avoidant coping, and parental maladaptive grief.
Collapse
Affiliation(s)
- Julie B. Kaplow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | | - Kathryn H. Howell
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - James L. Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Alan R. Prossin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
21
|
Morris MC, Rao U, Garber J. Cortisol responses to psychosocial stress predict depression trajectories: social-evaluative threat and prior depressive episodes as moderators. J Affect Disord 2012; 143:223-30. [PMID: 22858210 PMCID: PMC3489962 DOI: 10.1016/j.jad.2012.05.059] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/07/2012] [Accepted: 05/30/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alterations of hypothalamic-pituitary-adrenal (HPA) function are well-established in adults with current depression. HPA alterations may persist into remission and confer increased risk for recurrence. METHODS A modified version of the Trier Social Stress Test (TSST) was administered at baseline to 32 young adults with remitted major depressive disorder and 36 never-depressed controls. Participants were randomly assigned to either a 'high-stress' condition involving social evaluation or a 'low-stress' control condition. Cortisol concentrations were measured in saliva samples throughout the TSST. Participants were assessed again after 6 months for the occurrence of stressful life events and depressive symptoms/disorders during the follow-up period. RESULTS Participants who exhibited enhanced cortisol reactivity in the low-stress condition showed increases in depressive symptoms over follow-up, after controlling for stressful life events during the follow-up period. Anticipatory stress cortisol and cortisol reactivity each interacted with history of depressive episodes to predict depression trajectories. LIMITATIONS The single TSST administration limits conclusions about whether alterations of cortisol reactivity represent trait-like vulnerability factors or consequences ("scars') of past depression. CONCLUSIONS These results extend previous findings on stress sensitivity in depression and suggest that altered HPA function during remission could reflect an endophenotype for vulnerability to depression recurrence. Findings support interactive models of risk for depression recurrence implicating HPA function, depression history, and sensitivity to minor stressors. Results may have implications for interventions that match treatment approaches to profiles of HPA function.
Collapse
Affiliation(s)
- Matthew C Morris
- Center for Molecular and Behavioral Neuroscience, Meharry Medical College, Nashville, TN 37208, USA.
| | | | | |
Collapse
|
22
|
Shahid A, Khairandish A, Gladanac B, Shapiro C. Peeking into the minds of troubled adolescents: the utility of polysomnography sleep studies in an inpatient psychiatric unit. J Affect Disord 2012; 139:66-74. [PMID: 22410505 DOI: 10.1016/j.jad.2012.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/20/2012] [Accepted: 01/30/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep problems are commonly associated with the primary diagnostic criteria for many psychiatric disorders. Evidence suggests sleep disturbances may precede development of psychiatric disorders and the severity of psychopathology reflects the severity of sleep problems. Polysomnography (PSG) sleep studies in child and adolescent psychiatric populations, a particularly at risk group, has considerable value but has been more elusive requiring further investigation. METHODS We performed a retrospective chart review of PSG sleep studies and psychiatrist evaluations of 106 adolescents aged 7-16 admitted to an involuntary adolescent psychiatric inpatient facility. RESULTS Less than 5% of cases had mild/no sleep problems. Hyperarousal hallmarked this population, and severity of sleep disturbances trends with the severity of psychopathology. Inpatients with multiple psychiatric disorders had greater frequencies of insomnia, decreased sleep efficiency, and arousals from SWS (p<0.05). Inpatient's with self-harm behavior more frequently had elevated sleep onset latency (SOL), reduced efficiency, reduced SWS (p<0.05), increased REM, and reduced REM latency compared to inpatients with dysthymia and/or depression. LIMITATIONS Lacking an a priori hypothesis, this study was explorative and uncontrolled for factors such as medications. This notwithstanding however, analysis indicates the majority of inpatients were taking cocktails that "should" alleviate sleep symptoms suggesting greater associations may prevail in unmedicated populations. CONCLUSIONS This study attests to the potential clinical utility of PSG sleep studies in the management of adolescent psychiatric disorders and contributes to the body of evidence reputing the intimate connection between sleep problems and the development and perpetuation of psychopathology with public health implications.
Collapse
Affiliation(s)
- Azmeh Shahid
- Youthdale Child and Adolescent Sleep Centre, Canada
| | | | | | | |
Collapse
|
23
|
Abstract
Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding its etiology and pathophysiology during this developmental stage is critical for developing effective prevention and intervention strategies. There is considerable evidence of sleep alterations in adult major depressive disorder. However, studies in children and adolescents have not found consistent changes in sleep architecture paralleling adult depression. This review article summarizes sleep polysomnography research in early-onset depression, highlighting the factors associated with variable findings across studies. In addition, potential avenues for future research will be suggested in order to develop more comprehensive theoretical models and interventions for pediatric depression.
Collapse
Affiliation(s)
- Uma Rao
- Center for Molecular and Behavioral Neuroscience, and the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, TN, USADepartment of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA
| |
Collapse
|
24
|
Fulda S, Romanowski CPN, Becker A, Wetter TC, Kimura M, Fenzel T. Rapid eye movements during sleep in mice: high trait-like stability qualifies rapid eye movement density for characterization of phenotypic variation in sleep patterns of rodents. BMC Neurosci 2011; 12:110. [PMID: 22047102 PMCID: PMC3228710 DOI: 10.1186/1471-2202-12-110] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 11/02/2011] [Indexed: 01/13/2023] Open
Abstract
Background In humans, rapid eye movements (REM) density during REM sleep plays a prominent role in psychiatric diseases. Especially in depression, an increased REM density is a vulnerability marker for depression. In clinical practice and research measurement of REM density is highly standardized. In basic animal research, almost no tools are available to obtain and systematically evaluate eye movement data, although, this would create increased comparability between human and animal sleep studies. Methods We obtained standardized electroencephalographic (EEG), electromyographic (EMG) and electrooculographic (EOG) signals from freely behaving mice. EOG electrodes were bilaterally and chronically implanted with placement of the electrodes directly between the musculus rectus superior and musculus rectus lateralis. After recovery, EEG, EMG and EOG signals were obtained for four days. Subsequent to the implantation process, we developed and validated an Eye Movement scoring in Mice Algorithm (EMMA) to detect REM as singularities of the EOG signal, based on wavelet methodology. Results The distribution of wakefulness, non-REM (NREM) sleep and rapid eye movement (REM) sleep was typical of nocturnal rodents with small amounts of wakefulness and large amounts of NREM sleep during the light period and reversed proportions during the dark period. REM sleep was distributed correspondingly. REM density was significantly higher during REM sleep than NREM sleep. REM bursts were detected more often at the end of the dark period than the beginning of the light period. During REM sleep REM density showed an ultradian course, and during NREM sleep REM density peaked at the beginning of the dark period. Concerning individual eye movements, REM duration was longer and amplitude was lower during REM sleep than NREM sleep. The majority of single REM and REM bursts were associated with micro-arousals during NREM sleep, but not during REM sleep. Conclusions Sleep-stage specific distributions of REM in mice correspond to human REM density during sleep. REM density, now also assessable in animal models through our approach, is increased in humans after acute stress, during PTSD and in depression. This relationship can now be exploited to match animal models more closely to clinical situations, especially in animal models of depression.
Collapse
Affiliation(s)
- Stephany Fulda
- Max Planck Institute of Psychiatry, Kraepelinstrasse 2, 80804 Munich, Germany
| | | | | | | | | | | |
Collapse
|
25
|
Spies LA, Margolin G, Susman EJ, Gordis EB. Adolescents' cortisol reactivity and subjective distress in response to family conflict: the moderating role of internalizing symptoms. J Adolesc Health 2011; 49:386-92. [PMID: 21939869 PMCID: PMC3179602 DOI: 10.1016/j.jadohealth.2011.01.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 01/19/2011] [Accepted: 01/24/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Internalizing symptoms have been associated with both higher and blunted cortisol responses in adolescents. Little attention has been paid to subjective experiences of distress in conjunction with internalizing symptoms in hypothalamic-pituitary-adrenal axis responses to laboratory stressors. The present study examines whether adolescents' internalizing symptoms moderate the association between cortisol responses and distress in response to a common stressor in adolescence: family conflict. Differences are also examined between adolescents with current, past only, and no history of internalizing symptoms. METHODS Adolescents (N = 70) discussed areas of conflict with their parents and subsequently reported on distress experienced during the discussion. Baseline and five poststressor saliva samples were collected. Adolescents' internalizing symptoms were assessed concurrently with the discussion and at three previous time-points. RESULTS Internalizing symptoms moderated the association between distress reported by the adolescents and cortisol reactivity in response to family conflict. Adolescents with current and past internalizing symptoms had a blunted cortisol response, whereas adolescents with no history of internalizing symptoms showed greater cortisol reactivity when reporting greater distress. CONCLUSIONS This study expands the understanding of how current and remitted internalizing symptoms are related to adolescents' responses to everyday family conflicts. Adolescents with current and past internalizing symptoms demonstrated a lack of correspondence between psychological and physiological stress, whereas adolescents with no history of internalizing symptoms showed the anticipated correspondence. This study has important implications for understanding the link between internalizing symptoms and adolescents' hypothalamic-pituitary-adrenal functioning in response to common social stressors.
Collapse
Affiliation(s)
| | - Gayla Margolin
- Department of Psychology, University of Southern California
| | | | - Elana B. Gordis
- Department of Psychology, University at Albany, State University of New York.
| |
Collapse
|
26
|
Kessing LV, Willer IS, Knorr U. Volume of the adrenal and pituitary glands in depression. Psychoneuroendocrinology 2011; 36:19-27. [PMID: 20646833 DOI: 10.1016/j.psyneuen.2010.05.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/21/2010] [Accepted: 05/22/2010] [Indexed: 11/17/2022]
Abstract
Numerous studies have shown that the hypothalamic-pituitary-adrenal (HPA) axis is hyperactive in some depressed patients. It is unclear whether such hyperactivity results in changed volumes of the adrenal glands, pituitary gland and hypothalamus. We systematically reviewed all controlled studies on the adrenal or pituitary glands or hypothalamus volume in unipolar depressive disorder published in PubMed 1966 to December 2009. We identified three studies that investigated the volume of the adrenal glands and eight studies that examined the volume of the pituitary gland, but no studies on hypothalamus were found. Two out of three studies found a statistically significant increase in adrenal volume in patients compared to controls. Four out of eight studies found a statistically significant increase in pituitary volume in patients compared to controls. Different methodological problems were identified such as small population samples, different subtypes of depression and insufficient matching of patients and controls. Due to large heterogeneity of study designs and data, it was futile to make a meta-analysis. It is concluded that it remains unclear whether hyperactivity of the HPA axis results in enlarged adrenal and pituitary glands and it is suggested that prospective studies should be conducted with scanning during successive depressive episodes and periods of remission.
Collapse
Affiliation(s)
- Lars Vedel Kessing
- Department of Psychiatry, University of Copenhagen, Rigshospitalet, Denmark.
| | | | | |
Collapse
|
27
|
Tyrka AR, Kelly MM, Graber JA, DeRose L, Lee JK, Warren MP, Brooks-Gunn J. Behavioral adjustment in a community sample of boys: links with basal and stress-induced salivary cortisol concentrations. Psychoneuroendocrinology 2010; 35:1167-77. [PMID: 20223598 PMCID: PMC2922420 DOI: 10.1016/j.psyneuen.2010.02.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 11/20/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been observed in association with internalizing symptoms and is thought to be involved in the pathogenesis of depression and some anxiety disorders. This study examined basal and stress-induced cortisol concentrations in relation to internalizing and externalizing symptoms in a racially mixed community sample of 102 8-11-year-old boys. Afternoon basal cortisol concentrations were positively correlated with measures of internalizing behavior problems, social problems, and emotionality. Greater change in cortisol across a home-visit challenge task was also significantly associated with internalizing behaviors and social problems, as well as attention and thought problems. The implications of these findings and how they may relate to the pathogenesis of emotional and behavioral problems are discussed.
Collapse
Affiliation(s)
- Audrey R. Tyrka
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI,Address Correspondence to: Audrey R. Tyrka, M.D., Ph.D., Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906. TEL: (401) 455-6520. FAX: (401) 455-6534.
| | - Megan M. Kelly
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Julia A. Graber
- Department of Psychology, University of Florida, Gainesville, FL
| | - Laura DeRose
- Department of Developmental Psychology, Adelphi University, Garden City, NY
| | - Janet K. Lee
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI
| | | | - Jeanne Brooks-Gunn
- College of Physicians & Surgeons, Columbia University, NY, NY,National Center for Children and Families, Teachers College, Columbia University, NY, NY
| |
Collapse
|
28
|
Abstract
OBJECTIVE The study examined whether cortisol measures are associated with the clinical course of depression in adolescents. Furthermore, the study evaluated whether the relationship between cortisol and clinical course is moderated by environmental stress and/or social support. METHOD Fifty-five adolescents with depression (age range 13-18 years) were recruited. In addition to a systematic diagnostic assessment, information was obtained on environmental stress and social support. Urinary free cortisol measures were collected on three consecutive nights during the index episode. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period, documenting recovery from the index depressive episode and recurrent episodes. Information on environmental stress and social support also was gathered during each follow-up assessment. RESULTS Consistent with prior reports, the majority of adolescents (92.2%) recovered from the initial depressive episode. A substantial proportion of the recovered youth (42.6%) experienced a subsequent episode during the follow-up period. Higher cortisol levels were associated with a longer time to recovery from the index depressive episode. The effect of cortisol on recovery was moderated by social support. The combination of elevated cortisol and recent stressful experiences predicted recurrence, whereas a higher level of social support was protective against recurrence. CONCLUSIONS These data, in conjunction with prior literature, suggest that depression reflects an underlying neurobiological vulnerability that may predispose individuals with high vulnerability to chronic, recurrent episodes. Psychosocial factors, independently or in combination with an underlying neurobiological vulnerability, also play an important role in determining the clinical course of depression.
Collapse
|
29
|
Rao U, Hammen CL, London ED, Poland RE. Contribution of hypothalamic-pituitary-adrenal activity and environmental stress to vulnerability for smoking in adolescents. Neuropsychopharmacology 2009; 34:2721-32. [PMID: 19693006 PMCID: PMC2784160 DOI: 10.1038/npp.2009.112] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although tobacco smoking, which has been linked to depression, is a major public health problem, little is known about the neurobiological factors that confer vulnerability to smoking in youngsters and the effects of adolescent smoking on the course of depression. This study examined whether hypothalamic-pituitary-adrenal (HPA) activity and stressful life experiences are related to smoking behavior in depressed and non-depressed adolescents, and whether smoking predicts a worsening course of depression. Smoking history and stressful experiences were assessed in 151 adolescents (48 with no personal or family history of psychiatric disorder, 48 with no psychiatric history, but at high risk for depression by virtue of parental depression, and 55 with current major depressive disorder). Evening salivary cortisol and nocturnal urinary-free cortisol were measured for three consecutive evenings. The participants were then followed at regular intervals for up to 5 years to assess smoking history, clinical course of depression and stressful experiences during the follow-up period. Increased evening/night-time cortisol levels were associated with both initiation and persistence of smoking during follow-up. Stressful life experiences further increased the risk for smoking in depressed as well as non-depressed youth. Smoking was also associated with a higher frequency of depressive episodes during follow-up. A model that included stressful experiences and cortisol levels reduced the contribution of smoking per se to depression. High evening/night-time cortisol level appears to be a vulnerability marker for smoking in adolescents, with stressful experiences further increasing the risk for smoking in vulnerable youth. High evening/night-time cortisol levels and stressful experiences accounted, at least partially, for the association between depressive illness and smoking behavior.
Collapse
Affiliation(s)
- Uma Rao
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390-9101, USA.
| | | | | | | |
Collapse
|
30
|
Lofthouse N, Gilchrist R, Splaingard M. Mood-related sleep problems in children and adolescents. Child Adolesc Psychiatr Clin N Am 2009; 18:893-916. [PMID: 19836695 DOI: 10.1016/j.chc.2009.04.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sleep problems are an essential part of the current diagnostic criteria for depressive and bipolar disorders in children and adolescents. Whereas many studies have reported subjective sleep problems in youth with depression or bipolar disorder, except for reduced rapid eye movement latency associated with depression, few objective mood-related sleep abnormalities have been consistently identified. Recent technologic advances, such as spectral EEG and actigraphy, hold promise for revealing additional objective disturbances. There are presently few evidence-based published practice recommendations for mood-related sleep problems in youth. In this article, the authors chronologically review research on the phenomenology and treatment of sleep difficulties in youth with depressive and bipolar disorders and present research-based and clinically guided recommendations for the assessment and treatment of these problems.
Collapse
Affiliation(s)
- Nicholas Lofthouse
- Department of Psychiatry, The Ohio State University, 1670 Upham Drive, Columbus, OH 43210, USA.
| | | | | |
Collapse
|
31
|
Lopez-Duran NL, Kovacs M, George CJ. Hypothalamic-pituitary-adrenal axis dysregulation in depressed children and adolescents: a meta-analysis. Psychoneuroendocrinology 2009; 34:1272-83. [PMID: 19406581 PMCID: PMC2796553 DOI: 10.1016/j.psyneuen.2009.03.016] [Citation(s) in RCA: 295] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 03/09/2009] [Accepted: 03/24/2009] [Indexed: 01/03/2023]
Abstract
Research findings on the hypothalamic-pituitary-adrenal (HPA) axis and pediatric depression reflect a variety of methodological approaches that tap different facets of HPA-axis functions. Partly owing to the methodological heterogeneity of studies, descriptive reviews of this area have produced inconsistent conclusions. Therefore, we conducted formal meta-analyses of pertinent studies in order to advance our understanding of HPA-axis dysregulation in pediatric depression. We examined: (a) 17 published studies of HPA-axis response to the dexamethasone suppression test (DST) in depressed youth (DST; N=926) and (b) 17 studies of basal HPA-axis functioning (N=1332). We also examined descriptively studies that used corticotropin-releasing hormone (CRH) infusion, and those that used psychological probes of the HPA-axis. The global standardized mean effect size difference in HPA-axis response to the DST between depressed and non-depressed youth was 0.57, z=4.18, p<0.01. The global standardized mean difference effect size in basal HPA-axis functioning was 0.20, z=4.53, p<0.01. Age, sex, timing of sampling, dexamethasone dosage, or type of control group was not a significant source of variability for the DST or basal studies. In addition, when compared to non-depressed peers, depressed youth have a normative response to CRH infusion but an overactive response to psychological stressors. In conclusion, the HPA-axis system tends to be dysregulated in depressed youth, as evidenced by atypical responses to the DST, higher baseline cortisol values, and an overactive response to psychological stressors. This pattern of dysregulation suggests anomalies within the axis's negative feedback system and CRH production, but intact pituitary and adrenal sensitivity.
Collapse
Affiliation(s)
- Nestor L. Lopez-Duran
- Send all correspondence to Nestor L. Lopez-Duran Ph.D. University of Pittsburgh. Western Psychiatric Institute and Clinic. 3811 O'Hara St. Pittsburgh, PA 15213. Telephone 1.412.246.5714. Fax: 1.412.246.5455.
| | | | | |
Collapse
|
32
|
Rao U, Chen LA. Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2009. [PMID: 19432387 PMCID: PMC2766280 DOI: 10.31887/dcns.2009.11.1/urao] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding the disorder during this developmental stage is critical for determining its etiology and course, as well as for deveiopinq effective intervention straieqies. This paper summarizes current knoviedqe reqardinq the etiology, phenomenoiogy, correlates, natural course, and consequences of unipolar depression in children and adolescents. Using adult depression as a framevork, the unique aspects of childhood and adolescence are considered in order to better understand depression within a developmental context. The data suggest that the clinical presentation, correlates, and natural course of depression are remarkably similar across the lifespan. There are, however, important developmental differences. Specifically, the familial and psychological context in which depression develops in youngsters is associated with variability in the frequency and nature of depressive symptoms and comorbid conditions among children and adolescents. Maturational differences have also been identified in the neurobiological correlates of depression. These developmental differences may be associated with the observed variability in clinical response to treatment and longitudinal course. Characterization of the developmental differences will be helpful in developing more specific and effective interventions for youngsters, thereby allowing them to reach their full potential as adults.
Collapse
Affiliation(s)
- Uma Rao
- Department of Psychiatry, the University of Texas Southwestern Medical Center, Dallas, Texas 75390-9101, USA.
| | | |
Collapse
|
33
|
Abstract
Previous work has demonstrated reliable electroencephalographic (EEG) sleep and hypothalamic-pituitary-adrenal (HPA) changes associated with adult major depressive disorder. These changes might be evident before clinical manifestation of the illness in at-risk persons. The aim of the study was to identify depression-related EEG sleep and HPA changes in healthy adolescents at high risk for depression, and to examine the relationship between EEG sleep (or HPA) changes and the onset of depression. Forty-eight adolescent volunteers with no personal history of a psychiatric illness, including depression, but who were at high risk for developing depression by virtue of parental depression (high-risk group), and 48 adolescent volunteers with no personal or family history of a psychiatric disorder (normal controls) were recruited. EEG sleep and HPA measures were collected on three consecutive evenings and nights at baseline. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period. Compared with normal controls, adolescents at high risk for depression had shorter latency to rapid eye movement (REM) sleep, increased phasic REM sleep, more REM sleep and elevated nocturnal urinary-free cortisol (NUFC) excretion at baseline. Shorter REM latency, higher REM density and elevated NUFC (measured at baseline) were associated with the development of depression during follow-up. The findings that REM sleep abnormalities and elevated HPA activity occur before the onset of depression in at-risk adolescents suggest that these variables serve as vulnerability markers for the illness.
Collapse
Affiliation(s)
- Uma Rao
- Department of Psychiatry, the University of Texas Southwestern Medical Center, Dallas, TX 75390-9101, USA.
| | | | | |
Collapse
|
34
|
Friedman NP, Corley RP, Hewitt JK, Wright KP. Individual differences in childhood sleep problems predict later cognitive executive control. Sleep 2009; 32:323-33. [PMID: 19294952 PMCID: PMC2647786 DOI: 10.1093/sleep/32.3.323] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVE To determine whether individual differences in developmental patterns of general sleep problems are associated with 3 executive function abilities-inhibiting, updating working memory, and task shifting-in late adolescence. PARTICIPANTS 916 twins (465 female, 451 male) and parents from the Colorado Longitudinal Twin Study. MEASUREMENTS AND RESULTS Parents reported their children's sleep problems at ages 4 years, 5 y, 7 y, and 9-16 y based on a 7-item scale from the Child-Behavior Checklist; a subset of children (n = 568) completed laboratory assessments of executive functions at age 17. Latent variable growth curve analyses were used to model individual differences in longitudinal trajectories of childhood sleep problems. Sleep problems declined over time, with approximately 70% of children having > or = 1 problem at age 4 and approximately 33% of children at age 16. However, significant individual differences in both the initial levels of problems (intercept) and changes across time (slope) were observed. When executive function latent variables were added to the model, the intercept did not significantly correlate with the later executive function latent variables; however, the slope variable significantly (P < 0.05) negatively correlated with inhibiting (r = -0.27) and updating (r = -0.21), but not shifting (r = -0.10) abilities. Further analyses suggested that the slope variable predicted the variance common to the 3 executive functions (r = -0.29). CONCLUSIONS Early levels of sleep problems do not seem to have appreciable implications for later executive functioning. However, individuals whose sleep problems decrease more across time show better general executive control in late adolescence.
Collapse
Affiliation(s)
- Naomi P Friedman
- Institute for Behavioral Genetics, University of Colorado at Boulder Boulder CO 80309, USA.
| | | | | | | |
Collapse
|
35
|
Rao U, Poland RE. Electroencephalographic sleep and hypothalamic-pituitary-adrenal changes from episode to recovery in depressed adolescents. J Child Adolesc Psychopharmacol 2008; 18:607-13. [PMID: 19108665 PMCID: PMC2672202 DOI: 10.1089/cap.2008.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The study examined electroencephalographic (EEG) sleep and hypothalamic-pituitary-adrenal (HPA) changes associated with depressive episode and during recovery in adolescent depression. METHODS Sixteen adolescents with major depressive disorder and 16 volunteers with no personal or family history of psychiatric disorder participated in a three-night EEG sleep protocol along with nocturnal urinary free cortisol (NUFC). Depressed subjects also were restudied during stable remission from the depressive episode. RESULTS Compared with controls, depressed adolescents had significantly reduced sleep efficiency, shorter latency to rapid eye movement (REM) sleep, increased phasic REM sleep, and elevated NUFC excretion. Among depressed subjects, EEG sleep values did not change significantly from episode to remission. NUFC excretion reduced significantly during remission from the depressive episode. CONCLUSIONS The findings that EEG sleep measures are independent of clinical state, whereas HPA variables are state dependent, suggest that sleep and HPA measures make a differential contribution to our understanding of the pathophysiology and prognosis of mood disorders in adolescent patients.
Collapse
Affiliation(s)
- Uma Rao
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9101, USA.
| | | |
Collapse
|
36
|
Goodyer IM. Emanuel Miller Lecture: early onset depressions--meanings, mechanisms and processes. J Child Psychol Psychiatry 2008; 49:1239-56. [PMID: 19120706 DOI: 10.1111/j.1469-7610.2008.01964.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depressive syndromes in children and adolescents constitute a serious group of mental disorders with considerable risk for recurrence. A more precise understanding of aetiology is necessary to improve treatment and management. METHODS Three neuroactive agents are purported to be involved in the aetiology of these disorders: serotonin, brain-derived neurotrophic factor and cortisol. A literature review was conducted to determine their contributions to the emergence of unipolar depressions in the adolescent years. RESULTS Serotonin, brain-derived neurotrophic factor and cortisol may operate in concert within two distinct functional frameworks: atypical early epigenesis arising in the first few years of life and resulting in the formation of a vulnerable neuronal network involving in particular the amygdala and ventral prefrontal cortex. Individuals with this vulnerability are likely to show impaired mood regulation when faced with environmental demands during adolescence and over the subsequent decades; and acquired neuroendangerment, a pathological brain process leading to reduced synaptic plasticity, in particular in the hippocampus and perhaps the nucleus accumbens and ventral tegmentum. This may result in motivational, cognitive and behavioural deficits at any point in the lifespan most apparent at times of environmental demand. CONCLUSIONS The characteristics, course and outcome of a depressive episode may depend on the extent of the involvement of both atypical early neurogenesis and acquired neuroendangerment.
Collapse
Affiliation(s)
- Ian M Goodyer
- Developmental Psychiatry Section, Department of Psychiatry, University of Cambridge, UK.
| |
Collapse
|
37
|
Shirtcliff EA, Essex MJ. Concurrent and longitudinal associations of basal and diurnal cortisol with mental health symptoms in early adolescence. Dev Psychobiol 2008; 50:690-703. [PMID: 18726897 PMCID: PMC2660275 DOI: 10.1002/dev.20336] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent biosocial theories postulate that both biological risk and the social context influence the development of mental health problems [Boyce and Ellis (2005) Development and Psychopathology, 17(2), 271-301]. Guided by this framework, we examined whether basal cortisol and its diurnal rhythm were associated with mental health symptoms in early adolescence. Because cross-sectional and longitudinal investigations sometimes reveal different cortisol-mental health associations, we examined the association both concurrently and longitudinally when children transition to middle school, a time which entails a major change in social context from single to multiple teachers, classrooms, and sets of classmates. Salivary cortisol was measured three times a day (waking, afternoon, and bedtime) across 3 days when adolescents were 5th graders. Mental health was measured when adolescents were in 5th and 7th grades, just before and after the transition to middle school. To deal with the substantial comorbidity of internalizing and externalizing symptoms at this developmental stage, mental health measures distinguished overall symptom severity from the preponderance of internalizing versus externalizing symptoms (i.e., directionality). A three-level Hierarchical Linear Model was used to extract basal cortisol and its diurnal rhythm separate from the day-to-day and within-the-day fluctuations in cortisol in response to daily experiences. Results were specific to symptom severity, suggesting that cortisol is a nonspecific risk factor for mental health symptoms in young adolescents. At 5th grade, low basal cortisol was associated with concurrent symptom severity. However, longitudinally, it was adolescents with high cortisol at 5th grade who were at risk for increasing mental health symptoms by 7th grade. Flat diurnal rhythms in 5th grade were related to levels of symptom severity at both 5th and 7th grades. Considering the change in social context, as defined by the transition to middle school, helped resolve seemingly inconsistent evidence that both hypo- and hyper-arousal were associated with mental health symptoms in early adolescence.
Collapse
Affiliation(s)
- Elizabeth A Shirtcliff
- Department of Psychology, University of New Orleans, 2006 Geology/Psychology Bldg, New Orleans, LA 70148, USA.
| | | |
Collapse
|
38
|
Incorporating hypothalamic-pituitary-adrenal axis measures into preventive interventions for adolescent depression: are we there yet? Dev Psychopathol 2008; 20:975-1001. [PMID: 18606040 DOI: 10.1017/s0954579408000461] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis is a robust correlate of major depression in adults, and to a lesser extent, in adolescents. Premorbid differences in HPA axis function have been found to prospectively predict the onset of adolescent depression. To what extent might our knowledge of HPA axis function in adolescents with, or at risk for, depression, help guide efforts to prevent depression in this age group? We review evidence regarding the role of the HPA axis in the development of adolescent depression, and examine whether and which HPA axis measures might be useful in guiding prevention efforts as (a) as a criterion by which to select youth at risk for depression, (b) as a predictor of which youth will be most responsive to prevention efforts, and (c) as an indicator of whether prevention/intervention efforts are working. We conclude that our current understanding of the HPA axis, and its measurement, in adolescent depression are not sufficiently precise to be of immediate practical use in improving prevention efforts. Incorporating HPA axis measures into prevention studies, however, would be immensely useful in clarifying the role of the HPA axis in adolescent depression, such that future prevention efforts might more confidently rely on HPA axis information.
Collapse
|
39
|
Van den Bergh BRH, Van Calster B, Pinna Puissant S, Van Huffel S. Self-reported symptoms of depressed mood, trait anxiety and aggressive behavior in post-pubertal adolescents: Associations with diurnal cortisol profiles. Horm Behav 2008; 54:253-7. [PMID: 18499109 DOI: 10.1016/j.yhbeh.2008.03.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Revised: 03/14/2008] [Accepted: 03/28/2008] [Indexed: 01/20/2023]
Abstract
The association between self-reported symptoms and diurnal cortisol profiles was studied in post-puberty adolescents (29 boys and 29 girls, M(age)=15.06 years). The adolescents completed the Children's Depression Inventory, State Trait Anxiety Inventory, and an Aggressive behavior scale. The diurnal cortisol profile was derived from three saliva samples, collected at awakening, noon and evening on a week-end day. Univariate repeated measurement regressions revealed that depressed mood and trait anxiety were strongly and aggressive behavior was weakly related to the diurnal cortisol profile: greater emotional distress was associated with flatter diurnal cortisol profiles. Multivariate analysis, however, revealed that only trait anxiety made an independent contribution. Further analyses suggested that trait anxiety was related to elevated evening cortisol rather than to decreased awakening cortisol and that from a trait anxiety score of 38 onwards, high anxious adolescents show clearly higher evening cortisol than low anxious adolescents. These data suggest that anxiety disorder co-morbidity might explain some of the differences in HPA-axis function among depressed patients.
Collapse
Affiliation(s)
- B R H Van den Bergh
- Section Pediatric Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands.
| | | | | | | |
Collapse
|
40
|
Felder-Puig R, Scherzer C, Baumgartner M, Ortner M, Aschenbrenner C, Bieglmayer C, Voigtländer T, Panzer-Grümayer ER, Tissing WJE, Koper JW, Steinberger K, Nasel C, Gadner H, Topf R, Dworzak M. Glucocorticoids in the treatment of children with acute lymphoblastic leukemia and hodgkin's disease: a pilot study on the adverse psychological reactions and possible associations with neurobiological, endocrine, and genetic markers. Clin Cancer Res 2008; 13:7093-100. [PMID: 18056188 DOI: 10.1158/1078-0432.ccr-07-0902] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We did a controlled study to assess adverse psychological reactions (APR) associated with high-dose glucocorticoid therapy and tried to detect somatic correlates for the observed reactions. PATIENTS AND METHODS Our study included 37 patients with acute lymphoblastic leukemia (ALL) and 11 patients with Morbus Hodgkin (MH) disease, who were treated with high-dose glucocorticoid therapy, and 26 control patients with other types of malignancies. APRs were assessed with a standardized measure via parent-report. Patients with ALL and MH were further analyzed for signs of neuronal cell death in the cerebrospinal fluid, polymorphisms of the glucocorticoid receptor gene, as well as cortisol, adrenocorticorticotropic hormone, and dehydroepiandrosterone sulfate blood levels. RESULTS Fifty-four percent of ALL, 36% of MH, and 23% of control patients developed APR in the first few weeks of therapy. Approximately 3.5 months later, the majority of patients with ALL showed no APR, similar to control patients. Patients demonstrating a higher, nonsuppressible secretion of cortisol and/or adrenocorticorticotropic hormone during glucocorticoid therapy were found to be more likely to develop APR. No sign of neuronal cell destruction and no correlation of APR with specific glucocorticoid receptor polymorphisms were found. CONCLUSION Our results suggest that the development of APR due to glucocorticoid therapy is measurable and correlates with hormonal reaction patterns.
Collapse
|
41
|
Forbes EE, Bertocci MA, Gregory AM, Ryan ND, Axelson DA, Birmaher B, Dahl RE. Objective sleep in pediatric anxiety disorders and major depressive disorder. J Am Acad Child Adolesc Psychiatry 2008; 47:148-155. [PMID: 18176336 PMCID: PMC2674333 DOI: 10.1097/chi.0b013e31815cd9bc] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine objective and subjective sleep problems in early-onset anxiety and depression. METHOD Children and adolescents (46% female, ages 7 to 17 years) with anxiety disorders (n = 24), major depressive disorder (MDD) without comorbid anxiety disorders (n = 128), or no history of psychiatric disorder (n = 101) spent two consecutive nights in a sleep laboratory and completed self-reports of sleep quality. RESULTS On objective measures, the anxiety group exhibited more awakenings than the MDD group, less slow-wave sleep than the control or MDD group, and greater night 2 sleep latency than the MDD or control group. The anxiety group exhibited no decrease in rapid eye movement latency from the first night to the second. The MDD group exhibited less time awake than the control group and less stage 1 sleep than the anxiety or control group. On subjective measures, young people with anxiety reported greater sleep latency on the second night and no decrease in sleep latency. Age was covaried in analyses. CONCLUSIONS Findings provide objective and subjective evidence of sleep disturbance in children and adolescents with anxiety disorders and replicate findings of limited objective sleep disturbance in those with MDD. Sleep problems are an important consideration when treating young people with anxiety.
Collapse
Affiliation(s)
- Erika E Forbes
- All of the authors are with the University of Pittsburgh, except Dr. Gregory, who is with Goldsmiths College, London University..
| | - Michele A Bertocci
- All of the authors are with the University of Pittsburgh, except Dr. Gregory, who is with Goldsmiths College, London University
| | - Alice M Gregory
- All of the authors are with the University of Pittsburgh, except Dr. Gregory, who is with Goldsmiths College, London University
| | - Neal D Ryan
- All of the authors are with the University of Pittsburgh, except Dr. Gregory, who is with Goldsmiths College, London University
| | - David A Axelson
- All of the authors are with the University of Pittsburgh, except Dr. Gregory, who is with Goldsmiths College, London University
| | - Boris Birmaher
- All of the authors are with the University of Pittsburgh, except Dr. Gregory, who is with Goldsmiths College, London University
| | - Ronald E Dahl
- All of the authors are with the University of Pittsburgh, except Dr. Gregory, who is with Goldsmiths College, London University
| |
Collapse
|
42
|
Abstract
Disturbed sleep is one of the hallmark signs of depression. After successful treatment, many of these signs disappear; however, changes in rapid eye movement (REM) sleep may persist and even predict recurrence of depression. High-risk studies have established these alterations to be not only biological scars but true endophenotypes for depression. REM sleep changes are mediated by the noradrenergic, serotonergic, and cholinergic systems and are under strong genetic control. REM sleep has a crucial role for brain maturation and is inhibited during ontogeny. Lack of this inhibition may predispose an individual to depression. Findings regarding the CREB gene support REM sleep's role in depression. The combination of psychopathology and neurobiological measures, such as REM sleep parameters, will help to improve genetic studies and therefore increase the knowledge of relevant pathways for depression. This could facilitate development of preventive and therapeutic measures.
Collapse
|
43
|
|
44
|
Pfeffer CR, Altemus M, Heo M, Jiang H. Salivary cortisol and psychopathology in children bereaved by the september 11, 2001 terror attacks. Biol Psychiatry 2007; 61:957-65. [PMID: 17137565 DOI: 10.1016/j.biopsych.2006.07.037] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 06/14/2006] [Accepted: 07/28/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies suggest that stressful events increase risk for childhood anxiety and depression and hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This prospective longitudinal study evaluated relationships among severe psychosocial stress, psychiatric morbidity, and HPA axis function in children. METHODS Forty-five children (mean age: 8.9 +/- 2.9 years) suffering parent death from September 11, 2001 terror attacks and 34 nonbereaved children (mean age: 9.3 +/- 2.5 years) were evaluated prospectively at 6-month intervals in this 2-year study. Assessments involved diagnostic interviews (Child Schedule for Affective Disorders and Schizophrenia [K-SADS]) for psychopathology and 3 days of baseline salivary cortisol and a salivary dexamethasone suppression test for HPA axis function. RESULTS Bereaved children, but not nonbereaved children, had significantly increased rates of psychiatric disorders involving anxiety disorders, especially posttraumatic stress disorder (PTSD), after September 11, 2001 compared with retrospective assessments before September 11, 2001. Morning (AM) and 4:00 pm baseline cortisol were significantly and persistently higher for bereaved than nonbereaved children. Compared with bereaved children without psychopathology, bereaved children with PTSD had significantly lower 4:00 pm baseline cortisol and significantly greater 4:00 pm cortisol suppression. Children with generalized anxiety disorder had significantly less AM cortisol suppression than children without psychopathology. CONCLUSIONS Children bereaved by sudden, unexpected parent death had persistent psychological dysfunction and HPA axis dysregulation in this study.
Collapse
Affiliation(s)
- Cynthia R Pfeffer
- Department of Psychiatry, Weill Medical College of Cornell University, New York, 10605 USA.
| | | | | | | |
Collapse
|
45
|
Gottesmann C, Gottesman I. The neurobiological characteristics of rapid eye movement (REM) sleep are candidate endophenotypes of depression, schizophrenia, mental retardation and dementia. Prog Neurobiol 2007; 81:237-50. [PMID: 17350744 DOI: 10.1016/j.pneurobio.2007.01.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 12/14/2006] [Accepted: 01/10/2007] [Indexed: 01/23/2023]
Abstract
Animal models are a promising method to approach the basic mechanisms of the neurobiological disturbances encountered in mental disorders. Depression is characterized by a decrease of REM sleep latency and an increase of rapid eye movement density. In schizophrenia, electrophysiological, tomographic, pharmacological and neurochemical activities are all encountered during REM sleep. Mental retardation and dementia are characterized by rather specific REM sleep disturbances. Identification of the genetic support for these abnormalities (endophenotypes) encountered during REM sleep could help to develop specific treatments.
Collapse
Affiliation(s)
- Claude Gottesmann
- Département des Sciences de la Vie, Faculté des Sciences, Université de Nice-Sophia Antipolis, 22 parc Lubonis, 06000 Nice, France.
| | | |
Collapse
|
46
|
Psychophysiological States: the Ultradian Dynamics of Mind–Body Interactions. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2007. [DOI: 10.1016/s0074-7742(07)80001-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
|
47
|
Young EA, Ribeiro SC. Sex differences in the ACTH response to 24H metyrapone in depression. Brain Res 2006; 1126:148-55. [PMID: 16824495 DOI: 10.1016/j.brainres.2006.05.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 05/14/2006] [Indexed: 11/18/2022]
Abstract
Increased hypothalamic-pituitary-adrenal (HPA) axis activation has been observed in major depression. Increased corticotropin-releasing hormone (CRH) is hypothesized to drive corticotropin (ACTH) secretion leading to increased ACTH and cortisol secretion throughout 24H. Contradicting data exist as to whether the increased drive is present throughout the day or is restricted to the late afternoon and evening. To determine if increased HPA axis activation occurs during a specific circadian phase or is found throughout the 24H, we studied 26 healthy drug-free depressed patients and 26 healthy age- and sex-matched control subjects under metyrapone inhibition of cortisol synthesis for 24H beginning at 4 PM. Blood was drawn every 10 min for 24H and assayed for ACTH and cortisol. Gender differences in response to metyrapone were seen in both patients and controls. Depressed women demonstrated increased ACTH concentrations between 4 PM and 10 PM compared to control women. Maximal ACTH response over time was identical between depressed and control women. Depressed men demonstrated significantly decreased ACTH secretion between 4 and 10 PM as well as decreased maximal ACTH response compared to control men or depressed women. These data support an increased evening CRH drive in depressed women, but overall decreased CRH drive in depressed men.
Collapse
Affiliation(s)
- Elizabeth A Young
- Department of Psychiatry, The University of Michigan, MI 48109-0720, USA.
| | | |
Collapse
|
48
|
MacMaster FP, Russell A, Mirza Y, Keshavan MS, Taormina SP, Bhandari R, Boyd C, Lynch M, Rose M, Ivey J, Moore GJ, Rosenberg DR. Pituitary volume in treatment-naïve pediatric major depressive disorder. Biol Psychiatry 2006; 60:862-6. [PMID: 16876142 DOI: 10.1016/j.biopsych.2006.04.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 01/30/2006] [Accepted: 04/13/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prior pilot investigation identified a larger pituitary gland volume (PGV) in pediatric patients with major depressive disorder (MDD) compared with healthy pediatric control subjects that was most prominent in boys with MDD. In this independent sample, we focus on gender differences in pituitary volume in a larger sample of pediatric patients with MDD. METHODS Volumetric magnetic resonance imaging studies were conducted in 35 psychotropic drug-naïve children (15 boys, 20 girls), ages 8-17 years, and 35 case-matched healthy control subjects. RESULTS The MDD boys had larger PGV (19%) compared with male control subjects. No significant diagnostic group differences in pituitary volume were observed in girls. Healthy boys had significantly smaller PGV (27%) than healthy girls, whereas MDD boys did not differ from girls with MDD. Nonfamilial (without a family history of mood disorder) boys with MDD had significantly larger PGV (35%) than male healthy control subjects and tended to have a larger PGV (27%) than familial (at least one first-degree relative with MDD) boys with MDD. Boys with familial MDD did not differ from control subjects. CONCLUSIONS These findings provide new evidence of increased pituitary volume in psychotropic-naïve pediatric patients with MDD that seems to be more prominent in male patients with nonfamilial MDD.
Collapse
Affiliation(s)
- Frank P MacMaster
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, Michigan 48201, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Zalsman G, Oquendo MA, Greenhill L, Goldberg PH, Kamali M, Martin A, Mann JJ. Neurobiology of depression in children and adolescents. Child Adolesc Psychiatr Clin N Am 2006; 15:843-68, vii-viii. [PMID: 16952764 DOI: 10.1016/j.chc.2006.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article reviews classical and updated studies of the neurobiology of depressive disorders in children and adolescents. Most studies of childhood and adolescent depression and suicide have followed up the observations and methods used in studies in adults. These studies include neuroendocrine studies, which particularly look at the hypothalamic-pituitary-adrenal axis, the serotonergic system, peripheral blood and cerebrospinal fluid biologic markers, genetics, gene-environment interactions and sleep studies, and neuroimaging and postmortem studies, although in these areas the number of studies is limited.
Collapse
Affiliation(s)
- Gil Zalsman
- Department of Psychiatry, Division of Neuroscience, Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
PURPOSE OF REVIEW Sleep undergoes substantial changes during adolescence and suicide risk begins to increase during this period as well. This review focuses on recent literature on the relationship between sleep and suicidal behavior and proposes directions for future research. RECENT FINDINGS Adolescent sleep is characterized by widespread sleep restriction, irregular sleep schedules, daytime sleepiness, and elevated risk for sleep disturbances. More research on adolescent sleep and psychosocial impairment, psychiatric disorders, and suicidal behavior has been conducted. Suicidal psychiatric patients had more sleep disturbances including insomnia, hypersomnia, or nightmares than nonsuicidal patients. Shorter rapid eye movement latency and increased rapid eye movement activity have been noted to be a marker of suicidality in psychiatric patients. Epidemiological studies have demonstrated that insomnia, nightmares, and sleep insufficiency are associated with elevated risk for suicide. Although the link between insomnia and suicidal behavior appears to be mediated by depression, existing data suggest an independent predictive role of nightmares in future suicidal behavior. SUMMARY Sleep loss or disturbances are likely to signal an increased risk of future suicidal action in adolescents. Large-scale prospective studies and neurobiological studies are needed for a better understanding of the complex relationship between sleep, psychopathology, and youth suicidal behavior.
Collapse
Affiliation(s)
- Xianchen Liu
- Department of Psychiatry, University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, USA.
| | | |
Collapse
|