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Chae WR, Baumert J, Nübel J, Brasanac J, Gold SM, Hapke U, Otte C. Associations between individual depressive symptoms and immunometabolic characteristics in major depression. Eur Neuropsychopharmacol 2023; 71:25-40. [PMID: 36966710 DOI: 10.1016/j.euroneuro.2023.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 05/29/2023]
Abstract
Inflammation and metabolic dysregulations are likely to underlie atypical, energy-related depressive symptoms such as appetite and sleep alterations. Indeed, increased appetite was previously identified as a core symptom of an immunometabolic subtype of depression. The aim of this study was 1) to replicate the associations between individual depressive symptoms and immunometabolic markers, 2) to extend previous findings with additional markers, and 3) to evaluate the relative contribution of these markers to depressive symptoms. We analyzed data from 266 persons with major depressive disorder (MDD) in the last 12 months from the German Health Interview and Examination Survey for Adults and its mental health module. Diagnosis of MDD and individual depressive symptoms were determined by the Composite International Diagnostic Interview. Associations were analyzed using multivariable regression models, adjusting for depression severity, sociodemographic/behavioral variables, and medication use. Increased appetite was associated with higher body mass index (BMI), waist circumference (WC), insulin, and lower high-density lipoprotein. In contrast, decreased appetite was associated with lower BMI, WC, and fewer metabolic syndrome (MetS) components. Insomnia was associated with higher BMI, WC, number of MetS components, triglycerides, insulin, and lower albumin, while hypersomnia was associated with higher insulin. Suicidal ideation was associated with higher number of MetS components, glucose, and insulin. None of the symptoms were associated with C-reactive protein after adjustment. Appetite alterations and insomnia were most important symptoms associated with metabolic markers. Longitudinal studies should investigate whether the candidate symptoms identified here are predicted by or predict the development of metabolic pathology in MDD.
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Affiliation(s)
- Woo Ri Chae
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany.
| | - Jens Baumert
- Robert-Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
| | - Julia Nübel
- Robert-Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
| | - Jelena Brasanac
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan M Gold
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Medical Department, Section Psychosomatic Medicine, Hindenburgdamm 30, 12203 Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulfert Hapke
- Robert-Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
| | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
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2
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Is depression the missing link between inflammatory mediators and cancer? Pharmacol Ther 2022; 240:108293. [PMID: 36216210 DOI: 10.1016/j.pharmthera.2022.108293] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
Patients with cancer are at greater risk of developing depression in comparison to the general population and this is associated with serious adverse effects, such as poorer quality of life, worse prognosis and higher mortality. Although the relationship between depression and cancer is now well established, a common underlying pathophysiological mechanism between the two conditions is yet to be elucidated. Existing theories of depression, based on monoamine neurotransmitter system dysfunction, are insufficient as explanations of the disorder. Recent advances have implicated neuroinflammatory mechanisms in the etiology of depression and it has been demonstrated that inflammation at a peripheral level may be mirrored centrally in astrocytes and microglia serving to promote chronic levels of inflammation in the brain. Three major routes to depression in cancer in which proinflammatory mediators are implicated, seem likely. Activation of the kynurenine pathway involving cytokines, increases tryptophan catabolism, resulting in diminished levels of serotonin which is widely acknowledged as being the hallmark of depression. It also results in neurotoxic effects on brain regions thought to be involved in the evolution of major depression. Proinflammatory mediators also play a crucial role in impairing regulatory glucocorticoid mediated feedback of the hypothalamic-pituitary-adrenal axis, which is activated by stress and considered to be involved in both depression and cancer. The third route is via the glutamatergic pathway, whereby glutamate excitotoxicity may lead to depression associated with cancer. A better understanding of the mechanisms underlying these dysregulated and other newly emerging pathways may provide a rationale for therapeutic targeting, serving to improve the care of cancer patients.
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Liu T, Wang G, Zhang X, Liu X, Liang Z, Ren X, Yan D, Zhang W. B serum proteome profiles revealed dysregulated proteins and mechanisms associated with insomnia patients: A preliminary study. Front Integr Neurosci 2022; 16:936955. [PMID: 35958162 PMCID: PMC9360785 DOI: 10.3389/fnint.2022.936955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Insomnia is a clinical problem of significant public health importance; however, the underlying pathogenesis of this disorder is not comprehensively understood. Methods To identify potential treatment targets and unfold one of the gaps that were involved in insomnia pathological mechanisms, we employed a tandem mass tag-based (TMT) quantitative proteomics technology to detect differentially expressed proteins (DEPs) in serum from patients with insomnia and controls. DEPs were further analyzed by bioinformatics platforms. In addition, parallel reaction monitoring (PRM) was used to verify the TMT results. Results Patients with insomnia had poorer sleep quality compared with healthy controls. A total of 106 DEPs were identified among patients with insomnia and controls. They were mainly enriched in immune and inflammation-related biological functions and signaling pathways. Using the protein–protein interaction network, we screened the 10 most connected proteins as key DEPs. We predicted that four key DEPs were subject to targeted regulation by natural compounds of herbs. Eight key DEPs were validated using PRM in an additional 15 patients with insomnia and 15 controls, and the results also supported the experimental findings. Conclusion We identified aberrantly expressed proteins in insomnia that may be involved in the immune-inflammatory response. The 10 key DEPs screened may be potential targets for insomnia, especially FN1, EGF, HP, and IGF1. The results of this study will broaden our understanding of the pathological mechanisms of insomnia and provide more possibilities for pharmacotherapy.
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Affiliation(s)
- Tao Liu
- Traditional Chinese Medicine Hospital Affiliated with Xinjiang Medical University, Ürümqi, China
- Postdoctoral Workstation of Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China
| | - Guanying Wang
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xingping Zhang
- Traditional Chinese Medicine Hospital Affiliated with Xinjiang Medical University, Ürümqi, China
- College of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, China
- *Correspondence: Xingping Zhang,
| | - Xin Liu
- College of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, China
| | - Zhengting Liang
- College of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, China
| | - Xiaojuan Ren
- Xinjiang Urumqi Traditional Chinese Medicine Hospital, Ürümqi, China
| | - Deqi Yan
- College of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, China
| | - Wenhui Zhang
- College of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, China
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4
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Armstrong LE, Bergeron MF, Lee EC, Mershon JE, Armstrong EM. Overtraining Syndrome as a Complex Systems Phenomenon. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 1:794392. [PMID: 36925581 PMCID: PMC10013019 DOI: 10.3389/fnetp.2021.794392] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/13/2021] [Indexed: 12/29/2022]
Abstract
The phenomenon of reduced athletic performance following sustained, intense training (Overtraining Syndrome, and OTS) was first recognized more than 90 years ago. Although hundreds of scientific publications have focused on OTS, a definitive diagnosis, reliable biomarkers, and effective treatments remain unknown. The present review considers existing models of OTS, acknowledges the individualized and sport-specific nature of signs/symptoms, describes potential interacting predisposing factors, and proposes that OTS will be most effectively characterized and evaluated via the underlying complex biological systems. Complex systems in nature are not aptly characterized or successfully analyzed using the classic scientific method (i.e., simplifying complex problems into single variables in a search for cause-and-effect) because they result from myriad (often non-linear) concomitant interactions of multiple determinants. Thus, this review 1) proposes that OTS be viewed from the perspectives of complex systems and network physiology, 2) advocates for and recommends that techniques such as trans-omic analyses and machine learning be widely employed, and 3) proposes evidence-based areas for future OTS investigations, including concomitant multi-domain analyses incorporating brain neural networks, dysfunction of hypothalamic-pituitary-adrenal responses to training stress, the intestinal microbiota, immune factors, and low energy availability. Such an inclusive and modern approach will measurably help in prevention and management of OTS.
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Affiliation(s)
| | - Michael F. Bergeron
- Sport Sciences and Medicine and Performance Health, WTA Women’s Tennis Association, St. Petersburg, FL, United States
| | - Elaine C. Lee
- Human Performance Laboratory, University of Connecticut, Storrs, CT, United States
| | - James E. Mershon
- Department of Energy and Renewables, Heriot-Watt University, Stromness, United Kingdom
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McFarland DC, Riba M, Grassi L. Clinical Implications of Cancer Related Inflammation and Depression: A Critical Review. Clin Pract Epidemiol Ment Health 2021; 17:287-294. [PMID: 35444703 PMCID: PMC8985467 DOI: 10.2174/1745017902117010287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 09/07/2021] [Accepted: 10/01/2021] [Indexed: 12/27/2022]
Abstract
Background: Neuropsychiatric symptoms are problematic in cancer settings. In addition to poor quality of life, depression is associated with worsened survival. Patients who develop depression that responds to treatment have the same cancer-related survival as those patients who never had depression. Although depression in patients with cancer is common, it is often unrecognized, untreated, or at best, undertreated. There remains untapped potential for underlying cancer-related biology associated with depression to help clinicians correctly identify depressed cancer patients and orchestrate appropriate treatments to address cancer-related depression. Biologically, inflammation has been most vigorously described in its association with depression in otherwise healthy patients and to a significant extent in patients with medical illness. This association is especially relevant to patients with cancer since so many aspects of cancer induce inflammation. In addition to cancer itself, its treatments (e.g., surgery, radiation, chemotherapy, and systemic therapies) and associated factors (e.g., smoking, obesity, aging) are all associated with increased inflammation that can drive immunological changes in the brain followed by depression. This critical review investigates the relationship between depression and cancer-related inflammation. It investigates several hypotheses that support these relationships in cancer patients. Special attention is given to the data that support certain inflammatory markers specific to both cancer and depression, the neurobiological mechanisms by which inflammation can impact neurotransmitters and neurocircuits in the brain, and the data addressing interventions that reduce inflammation and depression in cancer patients, and future directions.
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MacLellan A, Fureix C, Polanco A, Mason G. Can animals develop depression? An overview and assessment of ‘depression-like’ states. BEHAVIOUR 2021. [DOI: 10.1163/1568539x-bja10132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Describing certain animal behaviours as ‘depression-like’ or ‘depressive’ has become common across several fields of research. These typically involve unusually low activity or unresponsiveness and/or reduced interest in pleasure (anhedonia). While the term ‘depression-like’ carefully avoids directly claiming that animals are depressed, this narrative review asks whether stronger conclusions can be legitimate, with animals developing the clinical disorder as seen in humans (cf., DSM-V/ICD-10). Here, we examine evidence from animal models of depression (especially chronically stressed rats) and animals experiencing poor welfare in conventional captive conditions (e.g., laboratory mice and production pigs in barren environments). We find troubling evidence that animals are indeed capable of experiencing clinical depression, but demonstrate that a true diagnosis has yet to be confirmed in any case. We thus highlight the importance of investigating the co-occurrence of depressive criteria and discuss the potential welfare and ethical implications of animal depression.
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Affiliation(s)
- Aileen MacLellan
- Department of Integrative Biology, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - Carole Fureix
- Bristol Veterinary School, University of Bristol, Langford, UK
| | - Andrea Polanco
- Department of Integrative Biology, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - Georgia Mason
- Department of Integrative Biology, University of Guelph, Guelph, ON, Canada N1G 2W1
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7
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Haghighatdoost F, Feizi A, Esmaillzadeh A, Keshteli AH, Roohafza H, Afshar H, Adibi P. The MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) and Mediterranean Diets are differently associated with psychosomatic complaints profile in adults: Results from SEPAHAN Cross-sectional study. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2020. [DOI: 10.3233/mnm-200426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: In spite of an obvious association between diet and mental health, there is only few report regarding the association between diet and psychosomatic complaints. OBJECTIVE: To investigate the association of the Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet with psychosomatic complaints profile in comparison with the Mediterranean diet (aMED). METHODS: In this cross-sectional study on 2818 Isfahanian adults, a validated dish-based food frequency questionnaire was used to assess dietary intakes. Psychosomatic complaints profile was evaluated through a self-administered Persian validated questionnaire by using exploratory factor analysis. RESULTS: After controlling for potential confounders, individuals in the highest quintile of the MIND diet had lower risk for experiencing psychological (odds ratio (OR) = 0.60, 95% confidence interval (CI): 0.42, 0.86; P trend < 0.0001), and pharyngeal-respiratory (OR = 0.57, 95% CI: 0.41, 0.79; P = 0.002). The association for neuro-skeletal complaints was marginally significant (OR = 0.66, 95% CI: 0.43, 1.03; P = 0.093). The aMED diet tended to lower gastrointestinal complaints (OR = 0.68, 95% CI: 0.46, 1.01; P = 0.062). CONCLUSION: The MIND diet was inversely associated with different psychosomatic complaints risk, but no evidence of such an association for the MED diet was observed.
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Affiliation(s)
- Fahimeh Haghighatdoost
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Biostatistics and Epidemiology Department, School of Health and Psychosomatic research center, Isfahan University of Medical Sciences, Isfahan, Iran
- Cardiac rehabilitation research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ammar Hassanzadeh Keshteli
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac rehabilitation research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Afshar
- Psychosomatic Research Center and Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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8
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Maes M, Sirivichayakul S, Kanchanatawan B, Carvalho AF. In schizophrenia, psychomotor retardation is associated with executive and memory impairments, negative and psychotic symptoms, neurotoxic immune products and lower natural IgM to malondialdehyde. World J Biol Psychiatry 2020; 21:383-401. [PMID: 32031479 DOI: 10.1080/15622975.2019.1701203] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: Stable-phase schizophrenia comprises two distinct entities namely Major Neuro-Cognitive Psychosis (MNP) and simple NP (SNP), which are defined by neuroimmune and neurocognitive abnormalities.Methods: This study investigates associations of psychomotor retardation (PMR), clinical and biomarker characteristics of schizophrenia. We recruited 40 healthy controls and 79 schizophrenia patients and measured IgA responses to tryptophan catabolites (TRYCATs), IgM to malondialdehyde and nitroso (NO)-cysteinyl, CCL-11, an immune activation index based on cytokine levels, and motor screening task (MOT) scores.Results: PMR differentiated schizophrenia from controls and MNP from SNP. In addition, PMR was strongly associated with impairments in executive functions and episodic and semantic memory, psychotic, hostility, excitation, mannerism and negative (PHEMN) symptoms. Around 50% of the variance in PMR was predicted by the cumulative effects of the immune activation index, CCL-11, TRYCATs, NO-Cysteinyl and natural IgM. PRM can reliably be combined with PHEMN symptoms, memory and executive impairments into one latent vector reflecting overall severity of schizophrenia.Conclusions: PMR is a key psychopathological feature of schizophrenia mainly MNP. In addition, PMR may be driven by deficits in the compensatory immune-regulatory system and increased production of neurotoxic immune products, namely TRYCATs, IgM to NO-cysteinyl, and CCL-11, an endogenous cognition deteriorating chemokine.
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Affiliation(s)
- Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.,IMPACT Strategic Research Center, Deakin University, Geelong, Australia
| | | | | | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Duarte-Silva E, Macedo D, Maes M, Peixoto CA. Novel insights into the mechanisms underlying depression-associated experimental autoimmune encephalomyelitis. Prog Neuropsychopharmacol Biol Psychiatry 2019; 93:1-10. [PMID: 30849414 DOI: 10.1016/j.pnpbp.2019.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 02/07/2023]
Abstract
Multiple Sclerosis (MS) is a chronic autoimmune disease characterized by neuroinflammation, demyelination and neuroaxonal degeneration affecting >2 million people around the world. MS is often accompanied by psychiatric comorbidities such as major depressive disorder (MDD), which presents a lifetime prevalence of around 50% in MS patients. Experimental Autoimmune Encephalomyelitis (EAE) is an animal model extensively used to study MS. EAE mimics the autoimmune nature of MS, as well as its inflammatory and demyelinating mechanisms also presenting predictive validity. There are important similarities between EAE and MS-associated depression (MSD). The mechanisms shared by these disorders include peripheral inflammation, neuroinflammation, mitochondrial dysfunctions, oxidative stress, nitrosative stress, lowered antioxidant defenses, increased bacterial translocation into the systemic circulation, and microglial pathology. Although the role of the immune-inflammatory system in MDD has been established in the 1990's, only few studies addressed immune pathways as a major determinant of depressive-like behavior in EAE. Therefore, in the present study we aimed at revising the current literature on EAE as an animal model to investigate the comorbidity between MS and MDD. In this regard, we revised the current literature on behavioral alterations in EAE, the possible mechanisms involved in this comorbidity and the potential and limitations of using this animal model to study depressive-like behavior.
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Affiliation(s)
- Eduardo Duarte-Silva
- Laboratory of Ultrastructure, Aggeu Magalhães Institute (IAM), Recife, PE, Brazil; Postgraduate Program in Biosciences and Biotechnology for Health (PPGBBS), Oswaldo Cruz Foundation (FIOCRUZ-PE)/Aggeu Magalhães Institute (IAM), Recife, PE, Brazil.
| | - Danielle Macedo
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; National Institute for Translational Medicine (INCT-TM, CNPq), Ribeirão Preto, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Christina Alves Peixoto
- Laboratory of Ultrastructure, Aggeu Magalhães Institute (IAM), Recife, PE, Brazil; Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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10
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Kozlowska K, Chung J, Cruickshank B, McLean L, Scher S, Dale RC, Mohammad SS, Singh-Grewal D, Prabhuswamy MY, Patrick E. Blood CRP levels are elevated in children and adolescents with functional neurological symptom disorder. Eur Child Adolesc Psychiatry 2019; 28:491-504. [PMID: 30143887 DOI: 10.1007/s00787-018-1212-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/03/2018] [Indexed: 01/09/2023]
Abstract
There is accumulating evidence that patients with functional neurological symptom disorder (FND) show activation of multiple components of the stress system-the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and brain regions involved in arousal- and emotion-processing. This study aims to examine whether the immune-inflammatory component of the stress system is also activated. C-reactive protein (CRP) blood titre levels were measured in 79 children and adolescents with FND. CRP values ≥ 2 mg/L suggest low-grade inflammation. CRP values > 10 mg/L suggest a disease process. Sixty-six percent of subjects (n = 52) had CRP titres ≥ 2 mg/L. The upward shift in the distribution of CRP levels suggested low-grade inflammation (median CRP concentration was 4.60 mg/L, with 75th and 90th percentiles of 6.1 and 10.3 mg/L, respectively). Elevated CRP titres were not explained by sex, pubertal status, BMI, or medical factors. Confounder analyses suggested that history of maltreatment (χ2 = 2.802, df = 1, p = 0.094, φ = 0.190; β = 2.823, p = 0.04) and a diagnosis of anxiety (χ2 = 2.731, df = 1, p = 0.098, φ = 0.187; β = 4.520, p = 0.061) contributed to elevated CRP levels. Future research will need to identify the origins and locations of immune cell activation and the pathways and systems contributing to their activation and modulation. Because functional activity in neurons and glial cells-the brain's innate effector immune cells-is tightly coupled, our finding of elevated CRP titres suggests activation of the immune-inflammatory component of the brain's stress system. A more direct examination of inflammation-related molecules in the brain will help clarify the role of immune-inflammatory processes in FND.
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Affiliation(s)
- Kasia Kozlowska
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia. .,Brain Dynamics Centre, Westmead Institute of Medical Research, Westmead, NSW, Australia. .,Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.
| | - Jason Chung
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia
| | - Bronya Cruickshank
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Loyola McLean
- Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Building 112, Cumberland Hospital Campus, Parramatta BC, Locked Bag 7118, Parramatta, NSW, 2124, Australia.,Brain and Mind Centre, and Discipline of Psychiatry, University of Sydney Medical School, Sydney, NSW, Australia
| | - Stephen Scher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,McLean Hospital, Belmont, MA, USA.,Discipline of Psychiatry, University of Sydney Medical School, Sydney, NSW, Australia
| | - Russell C Dale
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Movement Disorder and Clinical Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Shekeeb S Mohammad
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Davinder Singh-Grewal
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Department of Rheumatology, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Discipline of Child and Maternal Health, University of New South Wales, Sydney, NSW, Australia
| | - Mukesh Yajaman Prabhuswamy
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Ellis Patrick
- School of Mathematics and Statistics, University of Sydney, F07 - Carslaw Building, Sydney, NSW, 2006, Australia.,Westmead Institute for Medical Research, Sydney, NSW, Australia
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Wu H, Denna TH, Storkersen JN, Gerriets VA. Beyond a neurotransmitter: The role of serotonin in inflammation and immunity. Pharmacol Res 2019; 140:100-114. [DOI: 10.1016/j.phrs.2018.06.015] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/01/2018] [Accepted: 06/17/2018] [Indexed: 12/16/2022]
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12
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Pathogen-Host Defense in the Evolution of Depression: Insights into Epidemiology, Genetics, Bioregional Differences and Female Preponderance. Neuropsychopharmacology 2017; 42:5-27. [PMID: 27629366 PMCID: PMC5143499 DOI: 10.1038/npp.2016.194] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/28/2016] [Accepted: 09/08/2016] [Indexed: 12/25/2022]
Abstract
Significant attention has been paid to the potential adaptive value of depression as it relates to interactions with people in the social world. However, in this review, we outline the rationale of why certain features of depression including its environmental and genetic risk factors, its association with the acute phase response and its age of onset and female preponderance appear to have evolved from human interactions with pathogens in the microbial world. Approaching the relationship between inflammation and depression from this evolutionary perspective yields a number of insights that may reveal important clues regarding the origin and epidemiology of the disorder as well as the persistence of its risk alleles in the modern human genome.
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13
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Yang RR, Lu BC, Li T, Du YF, Wang X, Jia YX. The relationship between high-sensitivity C-reactive protein at admission and post stroke depression: a 6-month follow-up study. Int J Geriatr Psychiatry 2016; 31:231-9. [PMID: 26042821 DOI: 10.1002/gps.4315] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/08/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE A large body of evidence suggests that stroke and depression are accompanied by activation of inflammatory pathways. Thus, the primary purpose of this study was to assess the high-sensitivity C-reactive protein (Hs-CRP) to the presence of post stroke depression (PSD). METHODS Two hundred and twenty-six ischemic stroke patients admitted to the hospital within the first 24 hours after stroke onset were consecutively recruited and followed up for 6 months. Clinical information was collected. Serum Hs-CRP levels were measured at baseline. Based on the symptoms, diagnoses of depression were made in accordance with DSM-IV criteria for depression at 6-month after stroke. RESULTS At 6-month, ninety-five patients (42.0%) showed depression at 6 months after admission and in 69 patients (30.5%) this depression was classified as major. In the 69 patients with major depression, our results showed significantly higher Hs-CRP levels (1.54[IQR, 0.79-2.27]mg/dL vs. 0.43[IQR, 0.31-1.27]mg/dL, P<0.0001) at admission than patients without major depression. After adjusting for NIHSS on admission and all other recorded confounders, Hs-CRP still was an independent predicator of PSD with an adjusted OR of 1.339 (95% CI, 1.231-1.456; P<0.001). Further, in our study, we found that an increased risk of PSD was associated with serum Hs-CRP levels ≥0.85mg/dL (adjusted OR 7.830, 95% CI: 4.193-14.620) after adjusting for above recorded confounders. CONCLUSION Elevated Hs-CRP serum levels at admission was found to be associated with depression 6-month after stroke, suggesting that these alterations might participate in the pathophysiology of depression symptoms in stroke patients.
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Affiliation(s)
- Rui-Rui Yang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong province, PR China
| | - Bo-Cheng Lu
- Department of Neurology, Qilu Shihua Central Hospital, Zibo, Shandong province, PR China
| | - Tao Li
- Department of Neurosurgery, the Zhangqiu People's Hospital of Shandong, Jinan, Shandong province, PR China
| | - Yi-Feng Du
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong province, PR China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong province, PR China
| | - Yan-Xia Jia
- Radiological Department, Jining No. 1 People's Hospital, Jining, Shandong province, PR China
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Adzic M, Djordjevic J, Mitic M, Brkic Z, Lukic I, Radojcic M. The contribution of hypothalamic neuroendocrine, neuroplastic and neuroinflammatory processes to lipopolysaccharide-induced depressive-like behaviour in female and male rats: Involvement of glucocorticoid receptor and C/EBP-β. Behav Brain Res 2015; 291:130-139. [DOI: 10.1016/j.bbr.2015.05.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/15/2015] [Accepted: 05/17/2015] [Indexed: 12/22/2022]
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Tang CZ, Zhang YL, Wang WS, Li WG, Shi JP. Serum Levels of High-sensitivity C-Reactive Protein at Admission Are More Strongly Associated with Poststroke Depression in Acute Ischemic Stroke than Homocysteine Levels. Mol Neurobiol 2015; 53:2152-60. [PMID: 25941076 DOI: 10.1007/s12035-015-9186-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/22/2015] [Indexed: 12/26/2022]
Abstract
Inflammatory processes have fundamental roles in depression. The primary purpose of this study was to assess the serum levels of high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (HCY) at admission to the presence of poststroke depression (PSD). From December 2012 to December 2013, first-ever acute ischemic stroke patients who were admitted to the hospital within the first 24 h after stroke onset were consecutively recruited and followed up for 6 months. Serum levels of Hs-CRP and HCY were tested at admission. Based on the symptoms, diagnoses of depression were made in accordance with DSM-IV criteria for depression at 6 months after stroke. Ninety-five patients (42.0%) showed depression (major + minor) at 6 months after admission, and in 69 patients (30.5%), this depression was classified as major. In the 69 patients with major depression, our results showed significantly higher Hs-CRP and HCY levels at admission than patients without major depression. After adjusting all other possible covariates, Hs-CRP and HCY still were independent predicators of PSD with adjusted OR of 1.332 (95% CI, 1.230-1.452; P < 0.001) and 1.138 (95% CI, 1.072-1.274; P < 0.001), respectively. The area under the receiver operating characteristic curve values of Hs-CRP and HCY were 0.765 (95% CI, 0.701-0.9825) and 0.684 (95% CI, 0.610-0.757) for PSD, respectively. The prognostic accuracy of combined model (HCY and Hs-CRP) was higher compared to those biomarkers alone and other markers. Elevated serum levels of Hs-CRP and HCY at admission were found to be associated with depression 6 months after stroke, suggesting that these alterations might participate in the pathophysiology of depression symptoms in stroke patients.
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Affiliation(s)
- Chao-Zhi Tang
- Laboratory of Molecular Medicine, College of Life Science, Henan Normal University, No.46, Jianshedong Road, Xinxiang, Henan Province, 453007, People's Republic of China
| | - Yu-Ling Zhang
- Laboratory of Molecular Medicine, College of Life Science, Henan Normal University, No.46, Jianshedong Road, Xinxiang, Henan Province, 453007, People's Republic of China
| | - Wen-Sheng Wang
- Laboratory of Molecular Medicine, College of Life Science, Henan Normal University, No.46, Jianshedong Road, Xinxiang, Henan Province, 453007, People's Republic of China.
| | - Wei-Guo Li
- Laboratory of Molecular Medicine, College of Life Science, Henan Normal University, No.46, Jianshedong Road, Xinxiang, Henan Province, 453007, People's Republic of China
| | - Ji-Peng Shi
- The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan Province, People's Republic of China
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Xue QL, Guralnik JM, Beamer BA, Fried LP, Chaves PHM. Monitoring 6-month trajectory of grip strength improves the prediction of long-term change in grip strength in disabled older women. J Gerontol A Biol Sci Med Sci 2015; 70:367-73. [PMID: 25167868 PMCID: PMC4400523 DOI: 10.1093/gerona/glu149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/27/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study aims to assess the degree and heterogeneity of decline in grip strength in the short term (6 months) and the clinical relevance of short-term decline to long-term decline (2.5 years) in grip strength in disabled older women. METHODS Eighty-four community-dwelling disabled women aged 65 years or older were evaluated on a weekly basis over 6 months, followed by an additional five semi-annual visits for a total follow-up of 3 years. The study outcome is maximum isometric handgrip strength in the nondominant hand. Linear random effects models were used to characterize population- as well as individual-level change in grip strength over time. RESULTS In the weekly assessments over the initial 6 months, individual-level short-term change in grip strength was detectable (mean = -0.12 kg/month; p = .06), heterogeneous (range: -2.03 ± 0.95 kg/month), and independent of absolute grip strength at baseline (mean = 18.4 kg). Additionally, among women with grip strength greater than 16.7 kg at baseline, the long-term rate of decline in grip strength was accelerated by 0.15 kg/year (p = .014) for every 0.5 standard deviation (0.25 kg/month) increase in the short-term rate of decline. The baseline absolute grip strength, however, was not significantly associated with the long-term rate of decline (correlation = -0.36, p = .105). CONCLUSIONS Our findings suggest that short-term change in grip strength is detectable and meaningful for disabled older women and it is the individual's past trajectory of grip strength relative to her current strength level, not her current absolute strength per se, that is important for predicting future strength decline.
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Affiliation(s)
- Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Jack M Guralnik
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brock A Beamer
- Baltimore VA medical Center Geriatric Research Education and Clinical Centers and the Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, New York, New York
| | - Paulo H M Chaves
- Benjamin Leon Family Center for Geriatric Research and Education, Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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Subbotskaya NV, Sarmanova ZV, Barkhatova AN, Kliushnik TP, Tiganov AS. Clinical and immunological correlations in endogenous depression. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:49-53. [DOI: 10.17116/jnevro20151154149-53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Effects of indole-3-carbinol on clonidine-induced neurotoxicity in rats: Impact on oxidative stress, inflammation, apoptosis and monoamine levels. Neurotoxicology 2014; 44:48-57. [DOI: 10.1016/j.neuro.2014.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/02/2014] [Accepted: 05/19/2014] [Indexed: 01/26/2023]
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Karaoulanis SE, Rizouli KA, Rizoulis AA, Angelopoulos NV. Lack of association of acute phase response proteins with hormone levels and antidepressant medication in perimenopausal depression. BMC Psychiatry 2014; 14:164. [PMID: 24894416 PMCID: PMC4084572 DOI: 10.1186/1471-244x-14-164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/19/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Major depression is associated with higher plasma levels of positive acute-phase proteins, as well as with lower plasma levels of negative acute-phase proteins. The aim of this study is to examine the levels of acute-phase response proteins and whether these levels are influenced by reproductive hormones and antidepressant medication in the perimenopausal depression. METHODS Sixty-five women (age range: 40-58 years old) participated in this study. All women were in the perimenopausal phase. The diagnosis of depression was made through a psychiatric interview and with the aid of Hamilton Depression Rating Scale 17 (HAM-D 17). The acute-phase response proteins, such as haptoglobin (HP), transferrine (TRf), α1-antitrypsin, complement protein 3 (C3), complement protein 4 (C4) and C-reactive protein (CRP) and the reproductive hormones, for example follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), were analyzed using standard laboratory methods. Pearson's correlations were applied to evaluate the relationship between acute-phase proteins and hormones. RESULTS Perimenopausal women were divided into three groups. The first group consisted of normal controls, the second one involved depressed perimenopausal women, who were taking selective serotonin reuptake inhibitors (SSRIs), and the third one included depressed women that were not treated with SSRIs. Depressed women in perimenopause, when being compared to non-depressed women, did not differ as to serum levels of acute-phase proteins. There was a positive correlation between HP and E2 in depressed perimenopausal women, who were not taking SSRIs. CONCLUSIONS The lack of association between acute-phase proteins and depressive mood mentioned in this study does not support previous findings in patients with major depression. This negative finding in perimenopausal depression indicates either the absence or a more complex nature of the interactions between acute-phase proteins, low-grade inflammation and depression. The hormonal profile of women is a part of this complexity, because it seems that in perimenopause the hormonal changes are accompanied by changes of acute-phase response proteins. Particularly, in perimenopausal depression, there is an interaction between HP and E2. Therefore, it seems that perimenopause is a period of a woman's life during which hormonal, immune and metabolic changes occur and interact with each other making women vulnerable to depression.
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Affiliation(s)
- Sokratis E Karaoulanis
- Department of Psychiatry, University Hospital of Larissa, University of Thessalia, Mezourlo, Larissa, P,O, Box 41110, Greece.
| | - Katerina A Rizouli
- Department of Immunology, University Hospital of Larissa, University of Thessalia, Larissa, Greece
| | - Andreas A Rizoulis
- Department of Endocrinology, University Hospital of Larissa, University of Thessalia, Larissa, Greece
| | - Nikiforos V Angelopoulos
- Department of Psychiatry, University Hospital of Larissa, University of Thessalia, Mezourlo, Larissa, P.O. Box 41110, Greece
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Anderson G, Berk M, Maes M. Biological phenotypes underpin the physio-somatic symptoms of somatization, depression, and chronic fatigue syndrome. Acta Psychiatr Scand 2014; 129:83-97. [PMID: 23952563 DOI: 10.1111/acps.12182] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Somatization is a symptom cluster characterized by 'psychosomatic' symptoms, that is, medically unexplained symptoms, and is a common component of other conditions, including depression and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This article reviews the data regarding the pathophysiological foundations of 'psychosomatic' symptoms and the implications that this has for conceptualization of what may more appropriately be termed physio-somatic symptoms. METHOD This narrative review used papers published in PubMed, Scopus, and Google Scholar electronic databases using the keywords: depression and chronic fatigue, depression and somatization, somatization and chronic fatigue syndrome, each combined with inflammation, inflammatory, tryptophan, and cell-mediated immune (CMI). RESULTS The physio-somatic symptoms of depression, ME/CFS, and somatization are associated with specific biomarkers of inflammation and CMI activation, which are correlated with, and causally linked to, changes in the tryptophan catabolite (TRYCAT) pathway. Oxidative and nitrosative stress induces damage that increases neoepitopes and autoimmunity that contribute to the immuno-inflammatory processes. These pathways are all known to cause physio-somatic symptoms, including fatigue, malaise, autonomic symptoms, hyperalgesia, intestinal hypermotility, peripheral neuropathy, etc. CONCLUSION Biological underpinnings, such as immune-inflammatory pathways, may explain, at least in part, the occurrence of physio-somatic symptoms in depression, somatization, or myalgic encephalomyelitis/chronic fatigue syndrome and thus the clinical overlap among these disorders.
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Impact of sleep complaints and depression outcomes among participants in the standard medical intervention and long-term exercise study of exercise and pharmacotherapy for depression. J Nerv Ment Dis 2014; 202:167-71. [PMID: 24469530 DOI: 10.1097/nmd.0000000000000085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine the effects of exercise and sertraline on disordered sleep in patients with major depressive disorder (MDD). Methods The Standard Medical Intervention and Long-term Exercise study randomized the patients with MDD (n = 202) to one of four arms: a) supervised exercise, b) home-based exercise, c) sertraline therapy, and d) placebo pill. Sleep disturbance was assessed with three sleep-related items from the Hamilton Rating Scale for Depression (HAM-D) before and after 4 months of treatment. The patients were followed for 12 months to assess the prognostic value of sleep disturbance on MDD relapse and recovery.Results Comparison of the active treatment and placebo groups showed no treatment differences in HAM-D sleep complaints after 4 months (p = 0.758). However, residual insomnia symptoms after treatment were strongly associated with elevated depressive symptoms assessed by the HAM-D after 4 months (β = 0.342, p < 0.0001) and MDD relapse (odds ratio, 1.55; 95% confidence interval, 1.15-2.10; p = 0.004) assessed at 1-year follow-up (16 months after randomization). Neither exercise nor sertraline was associated with greater improvements in sleep disturbance compared with the placebo controls. However, residual symptoms of insomnia after successful treatment of MDD predicted relapse, highlighting the clinical importance of addressing insomnia in patients with MDD.
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Rybka J, Kędziora-Kornatowska K, Banaś-Leżańska P, Majsterek I, Carvalho LA, Cattaneo A, Anacker C, Kędziora J. Interplay between the pro-oxidant and antioxidant systems and proinflammatory cytokine levels, in relation to iron metabolism and the erythron in depression. Free Radic Biol Med 2013; 63:187-94. [PMID: 23707456 DOI: 10.1016/j.freeradbiomed.2013.05.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 12/14/2022]
Abstract
As there is strong evidence for inflammation and oxidative stress in depression, the aim of this study was to elucidate the relationship between oxidative imbalance and cellular immune response and to ask whether these processes are linked with iron metabolism in depressed patients. Blood was collected from patients diagnosed with recurrent depressive disorder (n=15) and from healthy controls (n=19). Whole-blood reduced glutathione (GSH), erythrocyte superoxide dismutase (SOD-1), glutathione peroxidase (GPx-1), glutathione reductase, malondialdehyde (MDA), and methemoglobin (MetHb) and plasma H₂O₂ were assayed spectrophotometrically. The serum heme oxygenase 1 (HO-1), cytokine, neopterin, and iron statuses were measured by ELISA. DNA damage was analyzed by comet assay. Serum concentrations of ferritin and soluble transferrin receptor were assayed by ELISA. MetHb saturation was analyzed spectrophotometrically in red blood cell hemolysate. The erythron variables were measured using a hematological analyzer. We observed a significant decrease in GPx-1 and SOD-1 activities and decreased levels of HO-1 and GSH in depressed patients compared to controls. Conversely, compared with controls, we found increased concentrations of MDA and H₂O₂ and more DNA damage in depressed patients. Furthermore, the levels of the proinflammatory cytokine interleukin-6 and of neopterin were increased in depressed patients along with decreased hemoglobin and hematocrit. A strong association between antioxidant defense, cytokine levels, and iron homeostasis was also revealed. These findings show that depression is associated with increased oxidative stress, inflammation, and restrictions on the available iron supply for red blood cell production. Furthermore, decreased antioxidant defense correlates with an increased cellular inflammatory response, whereas both concur with erythron and iron status, the latter explained by significant canonical correlations with the set of free radical scavenging enzymes and proinflammatory enzymes. The strong links between immune function, oxidative stress, and iron homeostasis suggest the presence of a self-sustaining multipathway mechanism that may progressively worsen, i.e., throughout accumulation of oxidative damage, producing the functional and structural consequences associated with depression. Hence, identifying viable therapeutic strategies to tackle oxidative stress and accompanying physiological disturbances, including inflammation and anemia, of chronic disease provides more opportunities for the treatment and, ultimately, prevention of depression.
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Affiliation(s)
- Joanna Rybka
- Department of Biochemistry, Collegium Medicum UMK, 85-092 Bydgoszcz, Poland.
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Hurley LL, Tizabi Y. Neuroinflammation, neurodegeneration, and depression. Neurotox Res 2013; 23:131-44. [PMID: 22895696 PMCID: PMC3751583 DOI: 10.1007/s12640-012-9348-1] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 07/26/2012] [Accepted: 07/30/2012] [Indexed: 12/19/2022]
Abstract
Neurodegeneration and depression are two common co-morbid conditions, particularly within the aging population. Research has linked neuroinflammation as a major contributing factor to both of these diseases. The key to neuroinflammation effects on neurodegeneration and depression appears to lie within the dysregulation of the control and release of pro- and anti-inflammatory cytokines. This can come from an internal or external insult to the system, or from changes in the individual due to aging that culminate in immune dysregulation. The need to reduce neuroinflammation has led to extensive research into neuroprotectants. We discuss the efficacy found with nicotine, alcohol, resveratrol, curcumin, and ketamine. Our main focus will be on what research tells us about the connections between neuroinflammation, neurodegeneration, and depression, and the hope that neuroprotectants research gives people suffering from neurodegeneration and depression stemming from neuroinflammation. We will conclude by making suggestions for future research in this area.
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Affiliation(s)
- Laura L. Hurley
- Department of Pharmacology, College of Medicine, Howard University, Washington, DC 20059
| | - Yousef Tizabi
- Department of Pharmacology, College of Medicine, Howard University, Washington, DC 20059
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Abstract
INTRODUCTION Depression is associated with inflammation, Th1 and Th17 responses, oxidative and nitrosative stress (O&NS), autoimmune responses against neoantigenic determinants, and neuroprogression (i.e., neurodegeneration, impaired plasticity and reduced neurogenesis). These pathways involve increased monocytic activation and interleukin-1 (IL-1) levels. AREAS COVERED This review will highlight the putative role of IL-1 in depression and the potential use of IL-1 signaling blockade as a treatment of depression. Electronic databases, i.e., Scopus, PUBMED and Google Scholar were employed using keywords: depression, depressive-like, interleukin-1, and interleukin-1 receptor antagonist (IL-1RA). EXPERT OPINION Ample studies show that depression is accompanied by increased levels of IL-1 and IL-1RA, which attenuates the pro-inflammatory activities of IL-1. In some, but not all studies, antidepressant treatment decreased IL-1β levels. In translational models, IL-1β administration elicits depressive-like behaviors, neuroinflammation and neuroprogression, whereas treatment with IL-1RA yields antidepressant-like effects and attenuates neuroprogression. Anakinra, an IL-1RA, targets not only IL-1 signaling, but also Th1, Th17, O&NS and neuroprogressive pathways and therefore may be advanced to clinical Phase-II trials in depression due to medical conditions associated with an elevated IL-1/IL-1RA ratio.
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Maes M, Berk M, Goehler L, Song C, Anderson G, Gałecki P, Leonard B. Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways. BMC Med 2012; 10:66. [PMID: 22747645 PMCID: PMC3391987 DOI: 10.1186/1741-7015-10-66] [Citation(s) in RCA: 403] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 06/29/2012] [Indexed: 12/21/2022] Open
Abstract
It is of considerable translational importance whether depression is a form or a consequence of sickness behavior. Sickness behavior is a behavioral complex induced by infections and immune trauma and mediated by pro-inflammatory cytokines. It is an adaptive response that enhances recovery by conserving energy to combat acute inflammation. There are considerable phenomenological similarities between sickness behavior and depression, for example, behavioral inhibition, anorexia and weight loss, and melancholic (anhedonia), physio-somatic (fatigue, hyperalgesia, malaise), anxiety and neurocognitive symptoms. In clinical depression, however, a transition occurs to sensitization of immuno-inflammatory pathways, progressive damage by oxidative and nitrosative stress to lipids, proteins, and DNA, and autoimmune responses directed against self-epitopes. The latter mechanisms are the substrate of a neuroprogressive process, whereby multiple depressive episodes cause neural tissue damage and consequent functional and cognitive sequelae. Thus, shared immuno-inflammatory pathways underpin the physiology of sickness behavior and the pathophysiology of clinical depression explaining their partially overlapping phenomenology. Inflammation may provoke a Janus-faced response with a good, acute side, generating protective inflammation through sickness behavior and a bad, chronic side, for example, clinical depression, a lifelong disorder with positive feedback loops between (neuro)inflammation and (neuro)degenerative processes following less well defined triggers.
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Affiliation(s)
- Michael Maes
- Maes Clinics @ TRIA, Piyavate Hospital, 998 Rimklongsamsen Road, Bangkok 10310, Thailand.
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Euteneuer F, Schwarz MJ, Hennings A, Riemer S, Stapf T, Selberdinger V, Rief W. Psychobiological aspects of somatization syndromes: contributions of inflammatory cytokines and neopterin. Psychiatry Res 2012; 195:60-5. [PMID: 21864915 DOI: 10.1016/j.psychres.2011.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 06/30/2011] [Accepted: 07/21/2011] [Indexed: 02/09/2023]
Abstract
Previous research suggests a dysregulation of immune-to-brain communication in the pathophysiology of somatization syndromes (multiple somatoform symptoms). We compared blood levels of the inflammatory markers tumor necrosis factor-alpha (TNF-α), interleukin-1 receptor antagonist (IL-1ra), interleukin-6 (IL-6) and neopterin between 23 patients with somatization syndromes (Somatoform Symptom Index-8, SSI-8), 23 age- and sex-matched healthy controls and 23 patients with major depression. No group differences were found for IL-1ra and IL-6. While TNF-α was increased in both clinical groups, neopterin was only increased in somatization syndromes. Correlational analyses revealed that neopterin tended to be related to somatoform pain complaints in patients with somatization syndromes. This study is the first to demonstrate increased levels of TNF-α and neopterin in patients with somatization syndromes without a diagnosis of depression, which may support a role of immune alterations in somatization syndromes. Neopterin is a reliable indicator for interferon-γ (IFN-γ) which was identified as the only cytokine that induces significant production of neopterin. Considering recent research indicating that IFN-γ can lead to increased neuronal responsiveness and body perceptions by reducing inhibitory tone in the dorsal horn, the observed association between somatization syndromes and neopterin might support the idea of central sensitization in the pathogenesis of somatoform symptoms.
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Affiliation(s)
- Frank Euteneuer
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Germany.
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Son YJ, Kim G. The Relationship between Obesity, Self-esteem and Depressive Symptoms of Adult Women in Korea. ACTA ACUST UNITED AC 2012. [DOI: 10.7570/kjo.2012.21.2.89] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Youn-Jung Son
- Department of Nursing, College of Medicine, Soonchunhyang University, Korea
| | - GiYon Kim
- Department of Nursing, Yonsei University Wonju College of Medicine, Korea
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Leonard B, Maes M. Mechanistic explanations how cell-mediated immune activation, inflammation and oxidative and nitrosative stress pathways and their sequels and concomitants play a role in the pathophysiology of unipolar depression. Neurosci Biobehav Rev 2011; 36:764-85. [PMID: 22197082 DOI: 10.1016/j.neubiorev.2011.12.005] [Citation(s) in RCA: 595] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 11/24/2011] [Accepted: 12/10/2011] [Indexed: 12/17/2022]
Abstract
This paper reviews that cell-mediated-immune (CMI) activation and inflammation contribute to depressive symptoms, including anhedonia; anxiety-like behaviors; fatigue and somatic symptoms, e.g. illness behavior or malaise; and mild cognitive impairment (MCI). These effects are in part mediated by increased levels of pro-inflammatory cytokines (PICs), e.g. interleukin-1 (IL-1), IL-6 and tumor necrosis factor (TNF)α, and Th-1-derived cytokines, such as IL-2 and interferon (IFN)γ. Moreover, new pathways, i.e. concomitants and sequels of CMI activation and inflammation, were detected in depression: (1) Induction of indoleamine 2,3-dioxygenase (IDO) by IFNγ and some PICs is associated with depleted plasma tryptophan, which may interfere with brain 5-HT synthesis, and increased production of anxiogenic and depressogenic tryptophan catabolites. (2) Increased bacterial translocation may cause depression-like behaviors by activating the cytokine network, oxidative and nitrosative stress (O&NS) pathways and IDO. (3) Induction of O&NS causes damage to membrane ω3 PUFAs, functional proteins, DNA and mitochondria, and autoimmune responses directed against intracellular molecules that may cause dysfunctions in intracellular signaling. (4) Decreased levels of ω3 PUFAs and antioxidants, such as coenzyme Q10, glutathione peroxidase or zinc, are associated with an increased inflammatory potential; more oxidative damage; the onset of specific symptoms; and changes in the expression or functions of brain 5-HT and N-methyl-d-aspartate receptors. (5) All abovementioned factors cause neuroprogression, that is a combination of neurodegeneration, neuronal apoptosis, and lowered neurogenesis and neuroplasticity. It is concluded that depression may be the consequence of a complex interplay between CMI activation and inflammation and their sequels/concomitants which all together cause neuroprogression that further shapes the depression phenotype. Future research should employ high throughput technologies to collect genetic and gene expression and protein data from patients with depression and analyze these data by means of systems biology methods to define the dynamic interactions between the different cell signaling networks and O&NS pathways that cause depression.
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Affiliation(s)
- Brian Leonard
- Pharmacology Department, National University of Ireland, Galway, Ireland
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Cizza G, Requena M, Galli G, de Jonge L. Chronic sleep deprivation and seasonality: implications for the obesity epidemic. J Endocrinol Invest 2011; 34:793-800. [PMID: 21720205 PMCID: PMC3297412 DOI: 10.3275/7808] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sleep duration has progressively fallen over the last 100 years while obesity has increased in the past 30 years. Several studies have reported an association between chronic sleep deprivation and long-term weight gain. Increased energy intake due to sleep loss has been listed as the main mechanism. The consequences of chronic sleep deprivation on energy expenditure have not been fully explored. Sleep, body weight, mood and behavior are subjected to circannual changes. However, in our modern environment seasonal changes in light and ambient temperature are attenuated. Seasonality, defined as cyclic changes in mood and behavior, is a stable personality trait with a strong genetic component. We hypothesize that the attenuation in seasonal changes in the environment may produce negative consequences, especially in individuals more predisposed to seasonality, such as women. Seasonal affective disorder, a condition more common in women and characterized by depressed mood, hypersomnia, weight gain, and carbohydrate craving during the winter, represents an extreme example of seasonality. One of the postulated functions of sleep is energy preservation. Hibernation, a phenomenon characterized by decreased energy expenditure and changes in the state of arousal, may offer useful insight into the mechanisms behind energy preservation during sleep. The goals of this article are to: a) consider the contribution of changes in energy expenditure to the weight gain due to sleep loss; b) review the phenomena of seasonality, hibernation, and their neuroendocrine mechanisms as they relate to sleep, energy expenditure, and body weight regulation.
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Affiliation(s)
- G Cizza
- Section on Neuroendocrinology of Obesity, NIDDK, Bethesda, MD, USA.
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Mamdani F, Berlim MT, Beaulieu MM, Labbe A, Merette C, Turecki G. Gene expression biomarkers of response to citalopram treatment in major depressive disorder. Transl Psychiatry 2011; 1:e13. [PMID: 22832429 PMCID: PMC3309465 DOI: 10.1038/tp.2011.12] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There is significant variability in antidepressant treatment outcome, with ∼30-40% of patients with major depressive disorder (MDD) not presenting with adequate response even following several trials. To identify potential biomarkers of response, we investigated peripheral gene expression patterns of response to antidepressant treatment in MDD. We did this using Affymetrix HG-U133 Plus2 microarrays in blood samples, from untreated individuals with MDD (N=63) ascertained at a community outpatient clinic, pre and post 8-week treatment with citalopram, and used a regression model to assess the impact of gene expression differences on antidepressant response. We carried out technical validation of significant probesets by quantitative reverse transcriptase PCR and conducted central nervous system follow-up of the most significant result in post-mortem brain samples from 15 subjects who died during a current MDD episode and 11 sudden-death controls. A total of 32 probesets were differentially expressed according to response to citalopram treatment following false discovery rate correction. Interferon regulatory factor 7 (IRF7) was the most significant differentially expressed gene and its expression was upregulated by citalopram treatment in individuals who responded to treatment. We found these results to be concordant with our observation of decreased expression of IRF7 in the prefrontal cortex of MDDs with negative toxicological evidence for antidepressant treatment at the time of death. These findings point to IRF7 as a gene of interest in studies investigating genomic factors associated with antidepressant response.
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Affiliation(s)
- F Mamdani
- McGill Group for Suicide Studies and Depressive Disorders Program, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - M T Berlim
- McGill Group for Suicide Studies and Depressive Disorders Program, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - M-M Beaulieu
- McGill Group for Suicide Studies and Depressive Disorders Program, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - A Labbe
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - C Merette
- Centre de Recherche Université Laval Robert-Giffard, Quebec City, Quebec, Canada
| | - G Turecki
- McGill Group for Suicide Studies and Depressive Disorders Program, Douglas Mental Health University Institute, Montréal, Quebec, Canada,McGill Group for Suicide Studies, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Verdun, Montréal, Quebec H4H 1R3, Canada. E-mail:
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Erdem M, Celik C, Cayci T, Ozdemir B, Kurt YG, Akgul EO, Yaman H, Balikci A, Uzun O. Serum haptoglobin levels in patients with melancholic and nonmelancholic major depression. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:944-7. [PMID: 21256177 DOI: 10.1016/j.pnpbp.2011.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Major depression (MD) is accompanied by systemic immune activation or an inflammatory response with the involvement of phagocytic cells, T cell activation, B cell proliferation, and an acute phase response with increased levels of positive and decreased levels of negative acute-phase proteins. In this study, we aimed to determine any differences in serum haptoglobin (Hp) concentrations among patients with melancholic and nonmelancholic MD and the healthy controls. METHODS This study involved 125 male patients who were admitted to the Department of Psychiatry, Gulhane Military Medical Academy (GMMA), in Ankara, Turkey. They were diagnosed with MD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and agreed to participate in the study. The melancholic group consisted of 37 patients and the nonmelancholic group had 45 patients. A healthy control group of 40 subjects was selected from the staff of GMMA. These subjects had not had any lifetime psychiatric diagnosis or psychiatric treatment in their medical histories. Peripheral venous blood samples were obtained from the patients and the control group for a complete blood count, routine biochemistry, and the detection of serum Hp levels. RESULTS There was no statistically significant difference among the melancholic MD, the nonmelancholic MD, and the healthy control groups in terms of age, level of education, and gender. Serum Hp concentrations are significantly higher in melancholic patients as compared with non-melancholic depressed patients and controls. However, there was no statistically significant difference between the nonmelancholic MD and the control group in terms of Hp concentrations. CONCLUSION The results of this study are important in terms of showing different serum Hp concentrations in patients with melancholic and nonmelancholic MD.
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Affiliation(s)
- Murat Erdem
- Gulhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
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Depression is an inflammatory disease, but cell-mediated immune activation is the key component of depression. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:664-75. [PMID: 20599581 DOI: 10.1016/j.pnpbp.2010.06.014] [Citation(s) in RCA: 368] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 01/07/2023]
Abstract
The first findings that depression is characterized by cell-mediated immune activation and inflammation were published between 1990-1993 (Maes et al.). Recently, it was reported that--based on meta-analysis results--depression is an inflammatory disorder because the plasma levels of two cytokines are increased, i.e. interleukin-(IL)-6 and tumor necrosis factor-α (TNFα). The same meta-analysis found that plasma IL-2 and interferon-(IFN)γ levels are not altered in depression, suggesting that there is no T cell activation in that illness. The present paper reviews the body of evidence that depression is accompanied by cell-mediated immune activation. The findings include: increased serum levels of the soluble IL-2 receptor (sIL-2R) and the sCD8 molecule; increased numbers and percentages of T cells bearing T cell activation markers, such as CD2+CD25+, CD3+CD25+, and HLA-DR+; increased stimulated production of IFNγ; higher neopterin and sTNFR-1 or sTNFR-2 levels; induction of indoleamine 2,3-dioxygenase (IDO) with lowered levels of plasma tryptophan and increased levels of tryptophan catabolites along the IDO pathway (TRYCATs); and glucocorticoid resistance in immune cells. Interferon-α (IFNα)-based immunotherapy shows that baseline and IFNα-induced activation of T cells, IDO activity and TRYCAT formation are related to the development of IFNα-induced depressive symptoms. Animal models of depression show that a cell-mediated immune response is related to the development of depression-like behavior. Antidepressants and mood stabilizers suppress different aspects of cell-mediated immunity and rather specifically target IFNγ production. This review shows that inflammation and cell-mediated immune activation are key factors in depression.
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Maes M. An intriguing and hitherto unexplained co-occurrence: Depression and chronic fatigue syndrome are manifestations of shared inflammatory, oxidative and nitrosative (IO&NS) pathways. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:784-94. [PMID: 20609377 DOI: 10.1016/j.pnpbp.2010.06.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/19/2010] [Accepted: 06/26/2010] [Indexed: 12/17/2022]
Abstract
There is a significant 'comorbidity' between depression and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Depressive symptoms frequently occur during the course of ME/CFS. Fatigue and somatic symptoms (F&S), like pain, muscle tension, and a flu-like malaise, are key components of depression. At the same time, depression and ME/CFS show major clinical differences, which allow to discriminate them with a 100% accuracy. This paper aims to review the shared pathways that underpin both disorders and the pathways that discriminate them. Numerous studies have shown that depression and ME/CFS are characterized by shared aberrations in inflammatory, oxidative and nitrosative (IO&NS) pathways, like systemic inflammation and its long-term sequels, including O&NS-induced damage to fatty acids, proteins and DNA; dysfunctional mitochondria; lowered antioxidant levels, like zinc and coenzyme Q10; autoimmune responses to neoepitopes formed by O&NS; lowered omega-3 polyunsaturated fatty acid levels; and increased translocation of gram-negative bacteria. Some IO&NS-related pathways, like the induction of indoleamine 2-3-dioxygenase, neurodegeneration and decreased neurogenesis, are more specific to depression, whereas other pathways, like the 2'-5' oligoadenylate synthetase/RNase L pathway, are specific to ME/CFS. Most current animal models of depression, e.g. those induced by cytokines, are not reminiscent of human depression but reflect a mixture of depressive and F&S symptoms. The latter symptoms, sometimes called sickness behavior, differ from depression and ME/CFS because the former is a (sub)acute response to infection-induced pro-inflammatory cytokines that aims to enhance recovery, whereas the latter are characterized by long-term sequels in multiple IO&NS pathways. Depression and ME/CFS are not 'comorbid' disorders, but should be regarded as 'co-associated disorders' that are clinical manifestations of shared pathways.
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Affiliation(s)
- Michael Maes
- Maes Clinics @ TRIA, 998 Rimklongsamsen Road, Bangkok 10310, Thailand.
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Maes M, Twisk FNM. Chronic fatigue syndrome: Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways. BMC Med 2010; 8:35. [PMID: 20550693 PMCID: PMC2901228 DOI: 10.1186/1741-7015-8-35] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 06/15/2010] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In a recently published paper, Harvey and Wessely put forward a 'biopsychosocial' explanatory model for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is proposed to be applicable to (chronic) fatigue even when apparent medical causes are present. METHODS Here, we review the model proposed by Harvey and Wessely, which is the rationale for behaviourally oriented interventions, such as cognitive behaviour therapy (CBT) and graded exercise therapy (GET), and compare this model with a biological model, in which inflammatory, immune, oxidative and nitrosative (IO&NS) pathways are key elements. DISCUSSION Although human and animal studies have established that the pathophysiology of ME/CFS includes IO&NS pathways, these abnormalities are not included in the model proposed by Harvey and Wessely. Activation of IO&NS pathways is known to induce fatigue and somatic (F&S) symptoms and can be induced or maintained by viral and bacterial infections, physical and psychosocial stressors, or organic disorders such as (auto)immune disorders. Studies have shown that ME/CFS and major depression are both clinical manifestations of shared IO&NS pathways, and that both disorders can be discriminated by specific symptoms and unshared or differentiating pathways. Interventions with CBT/GET are potentially harmful for many patients with ME/CFS, since the underlying pathophysiological abnormalities may be intensified by physical stressors. CONCLUSIONS In contrast to Harvey and Wessely's (bio)psychosocial model for ME/CFS a bio(psychosocial) model based upon IO&NS abnormalities is likely more appropriate to this complex disorder. In clinical practice, we suggest physicians should also explore the IO&NS pathophysiology by applying laboratory tests that examine the pathways involved.
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Affiliation(s)
- Michael Maes
- Maes Clinics @ TRIA, Piyavate Hospital, Bangkok, Thailand.
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Rief W, Hennings A, Riemer S, Euteneuer F. Psychobiological differences between depression and somatization. J Psychosom Res 2010; 68:495-502. [PMID: 20403510 DOI: 10.1016/j.jpsychores.2010.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 02/02/2010] [Accepted: 02/02/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND Comorbidity studies have shown that depression and somatization (multiple somatoform symptoms) often overlap. Therefore it has been suggested to classify at least some patients with somatization syndromes under the category of depressive disorders. We wanted to investigate whether psychobiological investigations confirm the lumping of somatization and depression, or whether psychobiological pathways favor distinguishing these disorders. METHOD An overview is presented summarizing psychobiological studies including patients with depression and/or somatization-associated syndromes. We focus on the following topics: heritability, polymorphisms in special candidate genes, immune activation, hypothalamic-pituitary-adrenal (HPA) axis reactivity, serotonergic pathways, monoamino acids, and fatty acid concentrations. RESULTS Immunological activation seems to be associated with specific features of somatoform disorders, namely, sickness behavior and pain thresholds. Genetic factors can also contribute to somatic complaints, e.g., via serotonergic pathways, HPA-axis response, immune activation, and other biological systems that contribute to the self-description of not being healthy. Some results indicate that psychobiological aspects of depression and somatization overlap in part (e.g., the relevance of serotonergic pathways), but there is clearly more evidence for discrepancies of psychobiological pathways in depression and somatization (e.g., the relevance of proinflammatory immune processes; HPA-axis activity; monoamino acid availability; omega-3-concentration; the role of triallelic subtypes of 5-HTTLPR). CONCLUSION Many psychobiological pathways act differently in depression and somatization. These differences in psychobiology favor the distinction of these syndromes in classification approaches.
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Affiliation(s)
- Winfried Rief
- Division of Clinical Psychology and Psychotherapy, University of Marburg, D-35032 Marburg, Germany.
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Maes M, Yirmyia R, Noraberg J, Brene S, Hibbeln J, Perini G, Kubera M, Bob P, Lerer B, Maj M. The inflammatory & neurodegenerative (I&ND) hypothesis of depression: leads for future research and new drug developments in depression. Metab Brain Dis 2009; 24:27-53. [PMID: 19085093 DOI: 10.1007/s11011-008-9118-1] [Citation(s) in RCA: 642] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 10/28/2008] [Indexed: 12/27/2022]
Abstract
Despite extensive research, the current theories on serotonergic dysfunctions and cortisol hypersecretion do not provide sufficient explanations for the nature of depression. Rational treatments aimed at causal factors of depression are not available yet. With the currently available antidepressant drugs, which mainly target serotonin, less than two thirds of depressed patients achieve remission. There is now evidence that inflammatory and neurodegenerative (I&ND) processes play an important role in depression and that enhanced neurodegeneration in depression may-at least partly-be caused by inflammatory processes. Multiple inflammatory-cytokines, oxygen radical damage, tryptophan catabolites-and neurodegenerative biomarkers have been established in patients with depression and these findings are corroborated by animal models of depression. A number of vulnerability factors may predispose towards depression by enhancing inflammatory reactions, e.g. lower peptidase activities (dipeptidyl-peptidase IV, DPP IV), lower omega-3 polyunsaturated levels and an increased gut permeability (leaky gut). The cytokine hypothesis considers that external, e.g. psychosocial stressors, and internal stressors, e.g. organic inflammatory disorders or conditions, such as the postpartum period, may trigger depression via inflammatory processes. Most if not all antidepressants have specific anti-inflammatory effects, while restoration of decreased neurogenesis, which may be induced by inflammatory processes, may be related to the therapeutic efficacy of antidepressant treatments. Future research to disentangle the complex etiology of depression calls for a powerful paradigm shift, i.e. by means of a high throughput-high quality screening, including functional genetics and genotyping microarrays; established and novel animal and ex vivo-in vitro models for depression, such as new transgenic mouse models and endophenotype-based animal models, specific cell lines, in vivo and ex vivo electroporation, and organotypic brain slice culture models. This screening will allow to: 1) discover new I&ND biomarkers, both at the level of gene expression and the phenotype; and elucidate the underlying molecular I&ND pathways causing depression; and 2) identify new therapeutic targets in the I&ND pathways; develop new anti-I&ND drugs for these targets; select existing anti-I&ND drugs or substances that could augment the efficacy of antidepressants; and predict therapeutic response by genetic I&ND profiles.
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Affiliation(s)
- Michael Maes
- Clinical Research Center for Mental Health, Olmenlaan 9, Antwerp Wilrijk 2610, Belgium.
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Inflammatory and oxidative and nitrosative stress pathways underpinning chronic fatigue, somatization and psychosomatic symptoms. Curr Opin Psychiatry 2009; 22:75-83. [PMID: 19127706 DOI: 10.1097/yco.0b013e32831a4728] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this paper is to review recent findings on inflammatory and oxidative and nitrosative stress (IO&NS) pathways in chronic fatigue and somatization disorder. RECENT FINDINGS Activation of IO&NS pathways is the key phenomenon underpinning chronic fatigue syndrome (CFS): intracellular inflammation, with an increased production of nuclear factor kappa beta (NFkappabeta), cyclo-oxygenase-2 (COX-2) and inducible NO synthase (iNOS); and damage caused by O&NS to membrane fatty acids and functional proteins. These IO&NS pathways are induced by a number of trigger factors, for example psychological stress, strenuous exercise, viral infections and an increased translocation of LPS from gram-bacteria (leaky gut). The 'psychosomatic' symptoms experienced by CFS patients are caused by intracellular inflammation (aches and pain, muscular tension, fatigue, irritability, sadness, and the subjective feeling of infection); damage caused by O&NS (aches and pain, muscular tension and fatigue); and gut-derived inflammation (complaints of irritable bowel). Inflammatory pathways (monocytic activation) are also detected in somatizing disorder. SUMMARY 'Functional' symptoms, as occurring in CFS and somatization, have a genuine organic cause, that is activation of peripheral and central IO&NS pathways and gut-derived inflammation. The development of new drugs, aimed at treating those disorders, should target these IO&NS pathways.
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Kawamoto R, Kajiwara T, Oka Y, Takagi Y. Self-reported depressive state can be a predictor of engagement in work by community-dwelling elderly 2 years later. Geriatr Gerontol Int 2003. [DOI: 10.1046/j.1444-1586.2003.00050.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Frank MG, Wieseler Frank JL, Hendricks SE, Burke WJ, Johnson DR. Age at onset of major depressive disorder predicts reductions in NK cell number and activity. J Affect Disord 2002; 71:159-67. [PMID: 12167512 DOI: 10.1016/s0165-0327(01)00395-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been associated with altered immunologic parameters including reductions in natural killer cell activity (NKCA). It remains largely unknown, however, whether alterations in immune function characterize homogeneous sub-groups of MDD. The present study addressed the question of whether age at onset of index episode and/or duration of the present episode of MDD predicted alterations in NKCA and NK cell number. METHODS Participants met DSM-IV criteria for MDD. Age at onset of MDD, duration of the present episode, demographics, and comorbidity were obtained by SCID for all subjects (n = 36). Severity and symptom pattern of MDD was assessed by the Hamilton Depression Rating Scale. NKCA was measured using a standard chromium-release cytotoxicity assay and NK number assessed by flow cytometry. RESULTS Age at onset of MDD significantly predicted variance in NK cell number and NKCA. Consistent with previous studies, sleep disturbance and psychomotor retardation possessed significant explanatory power for variance in NK cell number and NKCA, respectively. LIMITATIONS Measures of age at onset of MDD and duration of the present episode were obtained by self-report and thus recall bias may attenuate the reliability of the present findings. The present study design also precludes conclusions regarding the temporal association between alterations in NK cells and MDD. CONCLUSIONS We propose that immunologic alterations, characterized by a suppression of NKCA and NK cell number concomitant with proinflammatory processes, may constitute an immunologic phenotype unique to early-age-onset depression and may be salient factors in the pathogenesis of depression.
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Affiliation(s)
- Matthew G Frank
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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Armstrong LE, VanHeest JL. The unknown mechanism of the overtraining syndrome: clues from depression and psychoneuroimmunology. Sports Med 2002; 32:185-209. [PMID: 11839081 DOI: 10.2165/00007256-200232030-00003] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
When prolonged, excessive training stresses are applied concurrent with inadequate recovery, performance decrements and chronic maladaptations occur. Known as the overtraining syndrome (OTS), this complex condition afflicts a large percentage of athletes at least once during their careers. There is no objective biomarker for OTS and the underlying mechanism is unknown. However, it is not widely recognised that OTS and clinical depression [e.g. major depression (MD)] involve remarkably similar signs and symptoms, brain structures, neurotransmitters, endocrine pathways and immune responses. We propose that OTS and MD have similar aetiologies. Our examination of numerous shared characteristics offers insights into the mechanism of OTS and encourages testable experimental hypotheses. Novel recommendations are proposed for the treatment of overtrained athletes with antidepressant medications, and guidelines are provided for psychological counselling.
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Affiliation(s)
- Lawrence E Armstrong
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, Connecticut 06269-1110, USA
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Sammut S, Bethus I, Goodall G, Muscat R. Antidepressant reversal of interferon-alpha-induced anhedonia. Physiol Behav 2002; 75:765-72. [PMID: 12020742 DOI: 10.1016/s0031-9384(02)00677-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Interferon-alpha(IFN-alpha) is used clinically in the treatment of several pathologies such as hepatitis C and various cancers. The positive therapeutic potential is however often limited by negative secondary effects which include major depression, one of the cardinal symptoms of which is anhedonia which has been operationalized as a decreased sensitivity to rewards (inability to experience pleasure). Previous studies have demonstrated the existence of anhedonia in rats following an acute injection of IFN-alpha at doses corresponding to those used in clinical applications. If this previously demonstrated anhedonia is indeed part of a depression syndrome in rats, this behavioural symptom should be reversible by the administration of antidepressants. The objective of the present experiment was to determine whether two commonly used antidepressants (desipramine and fluoxetine) were effective in ameliorating IFN-alpha-induced anhedonia in rats. The experiment consisted of two phases. In the first, the effects of daily systemic injections of 104 units/kg of IFN-alpha (or vehicle) were evaluated with the three-bottle (1%, 8%, and 32%) sucrose-consumption test. In the second phase of the experiment, in addition to continued injections of IFN-, different groups received daily injections of desipramine (7.5 mg/kg ip), fluoxetine (7.5 mg/kg ip), or vehicle. The IFN-alpha injections during Phase 1 resulted in clear anhedonia, as expressed by increased consumption of the 32% solution and decreased consumption of 1% over the 33 days of this phase. After 15 days of antidepressant treatments, 32% sucrose consumption returned to baseline values. We have therefore confirmed that IFN-alpha-induced anhedonia is susceptible to reversal following chronic antidepressant treatment and thus it may appear timely to consider the prophylactic use of such in particular patients prescribed IFN in the clinic.
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Affiliation(s)
- Stephen Sammut
- Department of Biomedical Sciences, Laboratory of Behavioural Neuroscience, University of Malta, Msida.
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Corcos M, Guilbaud O, Hjalmarsson L, Chambry J, Jeammet P. Cytokines and depression: an analogic approach. Biomed Pharmacother 2002; 56:105-10. [PMID: 12000135 DOI: 10.1016/s0753-3322(01)00156-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
A growing body of evidence suggests that major depressive disorders may be accompanied by immune dysfunction and more particularly by an enhanced production of pro-inflammatory cytokines. The possible involvement of cytokines in depressive illness are based upon an analogic model. Pro-inflammatory cytokines are known to induce behavioral effects, and neuro-endocrine and immune activation similar to those observed in depression; these can be alleviated by antidepressant treatment. In this paper, we review research literature on the links between depressive illness and cytokine production and address further questions on this cytokine pathway. Further research is needed to see whether cytokines sustain specific depressive syndromes or whether cytokines induce depressive-like symptoms.
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Affiliation(s)
- M Corcos
- Department of Adolescent and Young Adult Psychiatry, Pr Jeammet, Institut Mutualiste Montsouris, Paris, France.
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Rothermundt M, Arolt V, Peters M, Gutbrodt H, Fenker J, Kersting A, Kirchner H. Inflammatory markers in major depression and melancholia. J Affect Disord 2001; 63:93-102. [PMID: 11246085 DOI: 10.1016/s0165-0327(00)00157-9] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is evidence that patients with major depression (MD) also suffer an inflammatory immune reaction. However, the results remain ambiguous. This could be due to the psychiatrically heterogeneous patient samples investigated in many published studies. Since melancholic depression is psychopathologically and possibly etiologically different from non-melancholic MD, we focused on investigating immune parameters in these two subgroups. METHODS 43 in-patients suffering from acute major depression were diagnosed, sub-classified according to DSM IV criteria, and compared to 43 matched healthy controls. Cell counts were determined by morphology, and acute phase proteins [c-reactive protein (CRP), alpha(2)-macroglobulin (A2M), haptoglobin (HP)] were measured by laser nephelometry. Cytokine production (IL-1beta) upon mitogen stimulation was measured by ELISA in a whole blood assay. RESULTS Non-melancholic patients showed increased monocyte counts and A2M serum concentrations in the acute stage of disease and after 2 and 4 weeks of treatment. Melancholic patients demonstrated a decreased monocyte count upon admission and after 4 weeks of treatment. HP levels and IL-1beta production were unchanged in all studied subjects. LIMITATIONS Medication of the patients varied. The differentiation between melancholic and non-melancholic depression was performed clinically and was not performed using any standardized instrument. CONCLUSION Melancholic and non-melancholic patients show different immune patterns. This differentiation might clarify immunological findings in MD and point towards etiological factors that are involved in the development of various subtypes of MD.
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Affiliation(s)
- M Rothermundt
- Department of Psychiatry and Psychotherapy, Westfaelische Wilhelms-University, Albert-Schweitzer-Strasse 11, D-48129 Muenster, Germany.
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Abstract
The specific symptoms of depression associated with increased mortality in the depressed elderly are poorly known. The aim of this paper is to analyse the individual depressive symptoms measured by the Zung Self Rated Depression Scale (ZSDS) and the Hamilton Rating Scale for Depression (HRSD) in association with mortality among depressed elderly subjects. The population consisted of 169 depressed (DSM-III criteria) aged (65+ years) persons from a Finnish epidemiological research project. The follow-up for deaths continued for about 6 years. When age, sex, smoking, physical health and functional abilities were taken into account, dissatisfaction, weight loss and gastrointestinal symptoms (anorexia and constipation) predicted mortality together with high age and poor physical health. Weight loss was related to an increased risk of death, specifically in the depressed. Dissatisfaction and gastrointestinal symptoms were more general markers of increased mortality.
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Affiliation(s)
- T Pulska
- University of Oulu, Department of Public Health Science and General Practice and Oulu University Hospital, Unit of General Practice, Oulu, Finland.
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Rantanen T, Penninx BW, Masaki K, Lintunen T, Foley D, Guralnik JM. Depressed mood and body mass index as predictors of muscle strength decline in old men. J Am Geriatr Soc 2000; 48:613-7. [PMID: 10855595 DOI: 10.1111/j.1532-5415.2000.tb04717.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study depressed mood as a predictor of strength decline within body weight categories over a 3-year follow-up period. DESIGN A prospective cohort study over 3 years. SETTING Honolulu, Hawaii. PARTICIPANTS The subjects were 2275 men participating in the Honolulu Heart Program with an average age of 77.1 years (range 71-92 years), who were not cognitively impaired at baseline (Exam 4), and who participated in maximal hand grip strength measurements at baseline and 3 years later (Exam 5). MEASUREMENTS Hand grip strength was measured using a dynamometer. Depressive symptoms were studied using an 11-item version of Center for Epidemiologic Studies Depression Scale with 9 as a cutoff. Body weight categories were formed on the basis of body mass index (BMI) (BMI = weight/height2; underweight: BMI < 20; normal weight: BMI 20-24.99, overweight: BMI > or = 25). MAIN RESULTS At baseline, 9.4% of the participants were rated as having depressed mood. The mean individual strength change over 3 years was - 6.9% (standard deviation 14.0). Steep strength decline was determined as losing > or = 14% (lowest quartile). The proportions of those with steep strength decline in the groups based on combined distributions of BMI and depressed mood were: underweight/ depressed (n = 22) 41%, underweight/not depressed (n = 200) 28%, normal weight/depressed (n = 127) 30%, normal weight/not depressed (n = 1181) 25%, overweight/depressed (n = 55) 31%, overweight/not depressed (n = 675, referent) 21%. After adjusting for baseline strength, age, height, sociodemographic variables and diseases, the odds ratio for steep strength decline was more than four times greater among those who were depressed and underweight, and twice as great among people who were depressed and normal weight compared with those who were nondepressed and overweight. The risks of nondepressed under- and normal weight people and depressed overweight people did not differ from the reference group. CONCLUSIONS Depressed mood was associated with increased risk of steep strength decline, in particular in older men with low body weight. Low body weight in combination with depressed mood may be an indicator of frailty or severe disease status that leads to accelerated strength loss and disability.
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Affiliation(s)
- T Rantanen
- Epidemiology, Demography and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
Overtraining syndrome (OTS) is a condition wherein an athlete is training excessively, yet performance deteriorates. This is usually accompanied by mood/behavior changes and a variety of biochemical and physiological alterations. Presently, there is no global hypothesis to account for OTS. The present paper will attempt to provide a unifying paradigm that will integrate previous research under the rubric of the cytokine hypothesis of overtraining. It is argued that high volume/intensity training, with insufficient rest, will produce muscle and/or skeletal and/or joint trauma. Circulating monocytes are then activated by injury-related cytokines, and in turn produce large quantities of proinflammatory IL-1beta, and/or IL-6, and/or TNF-alpha, producing systemic inflammation. Elevated circulating cytokines then co-ordinate the whole-body response by: a) communicating with the CNS and inducing a set of behaviors referred to as "sickness" behavior, which involves mood and behavior changes that support resolution of systemic inflammation: b) adjusting liver function, to support the up-regulation of gluconeogenesis, as well as de novo synthesis of acute phase proteins, and a concomitant hypercatabolic state; and c) impacting on immune function. Theoretically, OTS is viewed as the third stage of Selye's general adaptation syndrome, with the focus being on recovery/survival, and not adaptation, and is deemed to be "protective," occurring in response to excessive physical/physiological stress. Recommendations are made for potential markers of OTS, based on a systemic inflammatory condition.
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Affiliation(s)
- L L Smith
- Department of Health, Leisure, and Exercise Science, Appalachian State University, Boone, NC 28608, USA
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Maes M. Major depression and activation of the inflammatory response system. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1999; 461:25-46. [PMID: 10442165 DOI: 10.1007/978-0-585-37970-8_2] [Citation(s) in RCA: 386] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M Maes
- Clinical Research Center for Mental Health (CRC-MH) Antwerp, Belgium.
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Abstract
BACKGROUND Patients with affective disorders show evidence of increased positive acute phase proteins (e.g., C-reactive protein [CRP], alpha-1-acid glycoprotein, haptoglobin) and decreased negative acute phase proteins (e.g., albumin, transferrin [TFN]). CRP reductions have been reported to be greater in patients who later respond to lithium augmentation, and these patients also demonstrate higher CRP levels on the failed antidepressant, prior to the addition of lithium. However, association of such systemic immune changes with affective subtypes, mood state, psychotropic medications, age and gender has not been extensively explored. METHODS The present study assessed levels of CRP and TFN in 79 bipolar I, 24 bipolar II, and 46 unipolar depressed outpatients in comparison to 22 healthy controls. RESULTS Patients on lithium monotherapy were significantly less likely to demonstrate elevated CRP, and a similar trend was noted in those patients taking lithium in combination with an antidepressant. The frequency of elevated CRP levels did not significantly vary for different psychotropic medications, affective subgroups, or mood states. TFN levels were not influenced by diagnosis, affective state or psychotropic medications. LIMITATIONS Due to the retrospective nature of this analysis, the affective subgroups were heterogeneous with regard to medications and affective state, and differed significantly in age. Due to limitations in subgroup sample size, significant effects of clinical variables may have been masked by interactions of medications, age, affective subtype, and mood state. CONCLUSIONS The results imply that lithium may play a role in normalizing systemic immune activation associated with depression. Whether such immune changes may be restricted to lithium-responsive subgroups deserves further evaluation.
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Affiliation(s)
- M Hornig
- Laboratory for Neurovirology, University of California-Irvine, 92697-4292, USA
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