Increased plasma levels of competing amino acids, rather than lowered plasma tryptophan levels, are associated with a non-response to treatment in major depression

The Tryptophan Index Is Associated with Risk of Ischemic Stroke: A Community-Based Nested Case-Control Study

BACKGROUND

The relative availability of the essential amino acid tryptophan in the brain, as indicated by the tryptophan index, which is the ratio of tryptophan to its competing amino acids (CAAs) in circulation, has been related to major depression. However, it remains unknown whether tryptophan availability is involved in the pathogenesis of ischemic stroke.

AIMS

We aimed to investigate the relationship between the tryptophan index and the risk of ischemic stroke.

METHODS

We performed a nested case-control study within a community-based cohort in eastern China over the period 2013 to 2018. The analysis included 321 cases of ischemic stroke and 321 controls matched by sex and date of birth. The plasma levels of tryptophan and CAAs, including tyrosine, valine, phenylalanine, leucine, and isoleucine, were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry. Conditional logistic regression analyses were employed to determine incidence rate ratios (IRRs) and their 95% confidence intervals (CIs).

RESULTS

After adjustment for body mass index, current smoking status, educational attainment, physical activity, family history of stroke, hypertension, diabetes, hyperlipidemia, and estimated glomerular filtration rate, an elevated tryptophan index was significantly associated with a reduced risk of ischemic stroke in a dose-response manner (IRR, 0.76; 95% CI, 0.63-0.93, per standard deviation increment). The plasma tryptophan or CAAs were not separately associated with the risk of ischemic stroke.

CONCLUSIONS

The tryptophan index was inversely associated with the risk of ischemic stroke. Our novel observations suggest that the availability of the essential amino acid tryptophan in the brain is involved in the pathogenesis of ischemic stroke.

Mechanisms for the biological activity of Gastrodia elata Blume and its constituents: A comprehensive review on sedative-hypnotic, and antidepressant properties

BACKGROUND

Insomnia and depressive disorder are two common symptoms with a reciprocal causal relationship in clinical practice, which are usually manifested in comorbid form. Several medications have been widely used in the treatment of insomnia and depression, but most of these drugs show non-negligible side effects. Currently, many treatments are indicated for insomnia and depressive symptom, including Chinese herbal medicine such as Gastrodia elata Blume (G. elata), which has excellent sedative-hypnotic and antidepressant effects in clinical and animal studies.

PURPOSE

To summarize the mechanisms of insomnia and depression and the structure-activity mechanism for G. elata to alleviate these symptoms, particularly by hypothalamic-pituitary-adrenal (HPA) axis and intestinal flora, aiming to discover new approaches for the treatment of insomnia and depression.

METHODS

The following electronic databases were searched from the beginning to November 2023: PubMed, Web of Science, Google Scholar, Wanfang Database, and CNKI. The following keywords of G. elata were used truncated with other relevant topic terms, such as depression, insomnia, antidepressant, sedative-hypnotic, neuroprotection, application, safety, and toxicity.

RESULTS

Natural compounds derived from G. elata could alleviate insomnia and depressive disorder, which is involved in monoamine neurotransmitters, inflammatory response, oxidative stress, and gut microbes, etc. Several clinical trials showed that G. elata-derived natural compounds that treat depression and insomnia have significant and safe therapeutic effects, but further well-designed clinical and toxicological studies are needed.

CONCLUSION

G. elata exerts a critical role in treating depression and insomnia due to its multi-targeting properties and fewer side effects. However, more clinical and toxicological studies should be performed to further explore the sedative-hypnotic and antidepressant mechanisms of G. elata and provide more evidence and recommendations for its clinical application. Our review provides an overview of G. elata treating insomnia with depression for future research direction.

Longitudinal association of maternal dietary patterns with antenatal depression: Evidence from the Chinese Pregnant Women Cohort Study

BACKGROUND

Limited evidence to show the longitudinal associations between maternal dietary patterns and antenatal depression (AD) from cohort studies across the entire gestation period.

METHODS

Data came from the Chinese Pregnant Women Cohort Study. The qualitative food frequency questionnaire (Q-FFQ) and Edinburgh Postnatal Depression Scale (EPDS) were used to collect diet and depression data. Dietary patterns were derived by using factor analysis. Generalized estimating equation models were used to analyze the association between diet and AD.

RESULTS

A total of 4139 participants finishing 3-wave of follow-up were finally included. Four constant diets were identified, namely plant-based, animal-protein, vitamin-rich and oily-fatty patterns. The prevalence of depression was 23.89%, 21.12% and 22.42% for the first, second and third trimesters. There were reverse associations of plant-based pattern (OR:0.85, 95%CI:0.75-0.97), animal-protein pattern (OR:0.85, 95%CI:0.74-0.99) and vitamin-rich pattern (OR:0.58, 95%CI:0.50-0.67) with AD, while a positive association between oily-fatty pattern and AD (OR:1.47, 95%CI:1.29-1.68). Except for the plant-based pattern, other patterns had linear trend relationships with AD (P_trend < 0.05). Moreover, a 1-SD increase in vitamin-rich pattern scores was associated with a 20% lower AD risk (OR:0.80, 95%CI:0.76-0.84), while a 1-SD increase in oily-fatty pattern scores was associated with a 19% higher risk (OR:1.19, 95%CI:1.13-1.24). Interactions between dietary patterns and lifestyle habits were observed.

LIMITATIONS

The self-reported Q-FFQ and EPDS may cause recall bias.

CONCLUSIONS

There are longitudinal associations between maternal dietary patterns and antenatal depression. Our findings are expected to provide evidence for a dietary therapy strategy to improve or prevent depression during pregnancy.

The relations between C-reactive protein and trauma exposure, PTSD and depression symptoms, and PTSD psychotherapy treatment response in treatment seeking veterans and service members

While inflammatory markers have been implicated in the link between PTSD and poor health outcomes, there is a paucity of research investigating C-reactive protein (CRP) and psychotherapy treatment response for posttraumatic stress disorder (PTSD). The present study utilized a large, well-characterized sample of veterans and service members (N = 493) engaged in intensive psychotherapy to investigate the associations between CRP, trauma exposure, related variables, and PTSD and depression, as well as investigating if CRP was associated with PTSD psychotherapy treatment response. Bivariate correlation results indicate that CRP was significantly associated with BMI (r = 0.48) and severity of experiences of childhood physical and sexual abuse (r = 0.14 and 0.15, respectively) and was not significantly associated with baseline PTSD total symptom severity, PTSD symptom clusters, or depression symptom severity (rs ranging from -0.03 to 0.04). In multivariate regression models investigating if CRP and related variables were associated with PTSD baseline symptom severity, CRP was not a significant predictor (β = -0.03). Hierarchical linear modeling did not identify CRP as a significant predictor of PTSD psychotherapy outcome. Given that findings indicate that CRP was broadly elevated in this treatment seeking sample but not associated with PTSD and depression symptom severity, results suggest CRP may not be a specific biomarker for PTSD or depression but may be elevated in psychiatric disease more generally.

Dietary patterns in relation to gestational depression and sleep disturbance in Chinese pregnant women

AIM

To investigate the association of dietary patterns with gestational depression and sleep disturbance.

METHODS

Women in early pregnancy were recruited from the Chinese Pregnant Women Cohort Study (CPWCS) through July 25th, 2017 to November 26th, 2018, and eventually 7615 participants were included in this study. The qualitative food frequency questionnaire (Q-FFQ), Edinburgh Postnatal Depression Scale (EPDS), and the Pittsburgh Sleep Quality Index (PSQI) were used to assess dietary, depression and sleep quality during pregnancy, respectively. Dietary patterns were derived by factor analysis. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of each outcome according to quartiles of each dietary pattern.

RESULTS

Five dietary patterns were identified. Participants with the highest quartile in plant-based pattern had a significantly lower likelihood of mental problems (OR: 95% CI for depression: 0.66, 0.55-0.79; sleep disturbance: 0.80, 0.68-0.93); Similar results were observed in vitamin-rich pattern (OR: 95% CI for depression: 0.46, 0.38-0.55; sleep disturbance: 0.76, 0.65-0.89); However, contrary results were found in high-fat pattern (OR: 95% CI for depression: 2.15, 1.25-1.85; sleep disturbance: 1.43, 1.22-1.67); In animal protein-rich pattern, participants with the highest quartile had a decreased likelihood of depression (OR: 0.80, 95% CI: 0.67-0.96). As for bean products pattern, participants with the highest quartile had an increased risk of depression (OR: 1.28, 95% CI:1.06-1.53). Interactions of dietary patterns and lifestyles on mental disorders were observed.

CONCLUSION

Dietary patterns were associated with gestational depression and sleep disturbance. Relevant departments and maternal and child health personnel should conduct health education for pregnant women and guide them to eat properly.

The relation between dietary intakes and psychological disorders in Iranian adults: a population-based study

BACKGROUND

Previous studies showed an association between dietary intakes and psychological disorders. This study aimed to assess the association between dietary intakes and psychiatric disorders in Iran.

METHODS

In this cross sectional research, the data on 9965 adults were extracted from enrollment phase of Yazd Health Study (YaHS); a population-based cohort study on Iranian adults which was conducted during 2014 to 2016. Data on socio-demographic characteristics, tobacco use, history of chronic disease, and dietary assessment were collected using a validated researcher-made questionnaire. Moreover, anthropometric measurement was conducted. Psychological and physical activity assessments were also performed by depression, anxiety and stress scale questionnaire (DASS 21 items) and the short form of the International Physical Activity Questionnaire (IPAQ) respectively. Finally, multiple logistic regression analysis was used to evaluate relation between dietary intakes and psychological disorders.

RESULTS

After adjusting for the confounders, egg (depression: OR = 0.72, 95% CI: 0.52-0.98; anxiety: OR = 0.72, CI: 0.55-0.94), fruits (depression: OR = 0.60, 95% CI: 0.43-0.82; anxiety: OR = 0.70, 95% CI: 0.53-0.91), milk (depression: OR = 0.72, CI: 0.58-0.89; anxiety: OR = 0.73, CI: 0.61-0.87), and yogurt (depression: OR = 0.67, CI: 0.47-0.97; anxiety: OR = 0.54, CI: 0.4-0.73) were found to have protective effects on depression and anxiety. Higher fish consumption was associated with greater depression odds (OR = 1.54, CI: 1.18-2.04). Vegetables' intake had an inverse relationship with anxiety (OR = 0.74, CI = 0.58-0.93) and stress (OR = 0.59, CI: 0.42-0.82). Fruits (OR = 0.6, CI: 0.43-0.85) and milk consumption (OR: 0.61, CI: 0.47-0.77) were found to have protective effects on stress.

CONCLUSIONS

Egg, fruits, milk, yogurt, and vegetables' consumption had an inverse relationship with psychiatric disorders; whereas, higher fish intake was associated with higher depression chance. Further prospective studies are needed to confirm these findings.

Peripheral cytokine levels and response to antidepressant treatment in depression: a systematic review and meta-analysis

Predicting antidepressant treatment response has been a clinical challenge for major depressive disorder (MDD). The inflammation hypothesis of depression suggests that cytokines play a key role in the pathophysiology of MDD and alterations in peripheral cytokine levels are associated with antidepressant treatment outcome. Present meta-analysis aimed to examine the association between baseline peripheral cytokine levels and the response to antidepressant treatment and to evaluate whether changes of cytokine levels were associated with the response to antidepressant treatment in patients with MDD. Human-based studies published in any language in peer-reviewed journals were systematically searched from the PubMed, Embase and Web of Science databases, from inception up to October 2018. The search terms included cytokine, depressive disorder and antidepressant and their synonyms. Case-control or case-case studies reporting on levels of IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, CRP, TNF-α, IFN-γ, GM-CSF, MIP-1α, and Eotaxin-1 in patients with MDD based on validated depression scales both before and after antidepressant treatment were included. Of 7408 identified records, 44 studies met inclusion. Standardized mean differences in each cytokine were evaluated, and random-effects meta-analyses were performed. MDD patients who responded to antidepressant treatment had lower baseline IL-8 levels than the nonresponders (Hedge's g = -0.28; 95%CI, -0.43 to -0.13; P = 0.0003; FDR = 0.004). Antidepressant treatment significantly decreased levels of TNF-α (Hedge's g = 0.60; 95%CI, 0.26-0.94; P = 0.0006; FDR = 0.004) only in responders, and responders showed significantly more decreased TNF-α levels compared with nonresponders (P = 0.046). These findings suggested that alterations in peripheral cytokine levels were associated with antidepressant treatment outcomes in MDD. Further investigations are warranted to elucidate sources of heterogeneity and examine the potentiality of using inflammatory cytokines as novel predictive markers for the pharmacological treatment of MDD.

Tryptophan in health and disease

Tryptophan (TRP), an essential amino acid in mammals, is involved in several physiological processes including neuronal function, immunity, and gut homeostasis. In humans, TRP is metabolized via the kynurenine and serotonin pathways, leading to the generation of biologically active compounds, such as serotonin, melatonin and niacin. In addition to endogenous TRP metabolism, resident gut microbiota also contributes to the production of specific TRP metabolites and indirectly influences host physiology. The variety of physiologic functions regulated by TRP reflects the complex pattern of diseases associated with altered homeostasis. Indeed, an imbalance in the synthesis of TRP metabolites has been associated with pathophysiologic mechanisms occurring in neurologic and psychiatric disorders, in chronic immune activation and in the immune escape of cancer. In this chapter, the role of TRP metabolism in health and disease is presented. Disorders involving the central nervous system, malignancy, inflammatory bowel and cardiovascular disease are discussed.

Egg consumption and prevalence of psychological disorders in adults

PURPOSE

No previous study has examined the associations between egg consumption and prevalence of psychological disorders. The present study was conducted to determine the association between egg consumption and depression in a large sample of Iranian adults.

METHODS

This cross-sectional study was conducted on 3172 adults in Isfahan, Iran. Egg consumption was assessed by using a validated, self-administered, dish-based, semi-quantitative food frequency questionnaire. The Iranian validated version of Hospital Anxiety and Depression Scale was used to screen for anxiety and depression. The Iranian validated version of General Health Questionnaire with 12 items was used to assess psychological distress. Depression, anxiety and psychological distress were defined according to standard criteria.

RESULTS

The mean age of the study participants was 36.5 ± 7.9 years. Depression, anxiety and psychological distress were prevalent among 28.4, 13.6 and 23% of the study subjects, respectively. After controlling for potential confounders, no significant association was observed between egg intake and depression (OR for comparing extreme quartiles: 1.08; 95% CIs 0.80-1.45) and anxiety (OR 0.79; 95% CIs 0.54-1.16), as well as psychological distress (OR 1.03; 95% CIs 0.76-1.41) in the whole population. In men, significant positive associations were observed between egg intake and depression before controlling for BMI (OR 1.68; 95% CIs 1.01-2.80); however, the associations became non-significant after taking BMI into account (OR 1.62; 95% CIs 0.96-2.72).

CONCLUSIONS

We found no significant association between egg intake and psychological disorders. Further studies, in particular of prospective design, are warranted.

Tryptophan-kynurenine and lipid related metabolites as blood biomarkers for first-episode drug-naïve patients with major depressive disorder: An exploratory pilot case-control study

BACKGROUND

Early intervention in depression has been critical to prevent its negative impact including suicide. Recent blood biomarker studies for major depressive disorder (MDD) have suggested that tryptophan-kynurenine and lipid related metabolites are involved in the pathophysiology of MDD. However, there have been limited studies investigating these blood biomarkers in first-episode drug-naïve MDD, which are particularly important for early intervention in depression.

METHODS

As an exploratory pilot case-control study, we examined the above blood biomarkers, and analyzed how these biomarkers are associated with clinical variables in first-episode drug-naïve MDD patients, based on metabolome/lipidome analysis.

RESULTS

Plasma tryptophan and kynurenine levels were significantly lower in MDD group (N = 15) compared to healthy controls (HC) group (N = 19), and plasma tryptophan was the significant biomarker to identify MDD group (area under the curve = 0.740). Lower serum high density lipoprotein-cholesterol (HDL-C) was the predictive biomarker for severity of depression in MDD group (R² = 0.444). Interestingly, depressive symptoms were variously correlated with plasma tryptophan-kynurenine and lipid related metabolites. Moreover, plasma tryptophan-kynurenine metabolites and cholesteryl esters (CEs) were significantly correlated in MDD group, but not in HC group.

LIMITATIONS

This study had small sample size, and we did not use the multiple test correction.

CONCLUSIONS

This is the first study to suggest that not only tryptophan-kynurenine metabolites but also HDL-C and CEs are important blood biomarkers for first-episode drug-naïve MDD patients. The present study sheds new light on early intervention in clinical practice in depression, and further clinical studies especially large-scale prospective studies are warranted.

The importance of nutrition in aiding recovery from substance use disorders: A review

BACKGROUND

Nutrition is a prerequisite for health; yet, there is no special nutritional assessment or guidance for drug and alcohol dependent individuals, despite the fact that their food consumption is often very limited, risking malnutrition. Further, the premise is examined that malnutrition may promote drug seeking and impede recovery from substance use disorders (SUD).

METHOD

A narrative review addressed the relationship between substance use disorders and nutrition, including evidence for malnutrition, as well as their impact on metabolism and appetite regulation. The implications of the biopsychology of addiction and appetite for understanding the role of nutrition in SUD were also considered.

RESULTS

The literature overwhelmingly finds that subjects with alcohol use disorder (AUD) and drug use disorder (DUD) typically suffer from nutrient deficiencies. These nutrient deficiencies may be complicit in the alcoholic myopathy, osteopenia and osteoporosis, and mood disorders including anxiety and depression, observed in AUD and DUD. These same individuals have also been found to have altered body composition and altered hormonal metabolic regulators. Additionally, brain processes fundamental for survival are stimulated both by food, particularly sweet foods, and by substances of abuse, with evidence supporting confusion (addiction transfer) when recovering from SUD between cravings for a substance and craving for food.

CONCLUSION

Poor nutritional status in AUD and DUD severely impacts their physical and psychological health, which may impede their ability to resist substances of abuse and recover their health. This review contributes to a better understanding of interventions that could best support individuals with substance use disorders.