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Juruena MF, Gadelrab R, Cleare AJ, Young AH. Epigenetics: A missing link between early life stress and depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110231. [PMID: 33383101 DOI: 10.1016/j.pnpbp.2020.110231] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/06/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
Research has suggested a relationship between early life stress, and depression in particular longer episodes of depression with treatment resistant outcomes. However, the underlying mechanisms for this association remain poorly understood. Molecular studies indicate that, in general, the hereditary character of psychiatric disorders are polygenic, multifactorial and highly complex, with innumerable low-effect genetic variants interacting with each other. In addition, the importance of the environment and its interaction with genes has pointed to a fundamental role of epigenetic mechanisms in psychiatric disorders, such as methylation of deoxyribonucleic acid (DNA), alterations, histone actions and regulation of gene expression by non-coding ribonucleic acids (RNAs). This article provides an overview of the interplay of epigenetics, the HPA axis, early life stress and the development of depression. Advances in our knowledge of epigenetics in the context of early life stress and depression provide a new understanding of the genetic influence on psychopathology and could lead to the identification of new targets for clinical intervention.
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Affiliation(s)
- Mario F Juruena
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust (SLaM), UK.
| | | | - Anthony J Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust (SLaM), UK
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust (SLaM), UK
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Pan X, Kaminga AC, Wen SW, Wang Z, Wu X, Liu A. The 24-hour urinary cortisol in post-traumatic stress disorder: A meta-analysis. PLoS One 2020; 15:e0227560. [PMID: 31918435 PMCID: PMC6952249 DOI: 10.1371/journal.pone.0227560] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 12/20/2019] [Indexed: 01/09/2023] Open
Abstract
Objective Previous studies found inconsistent results on the relationship between post-traumatic stress disorder (PTSD) and concentrations of 24-hour (24-h) urinary cortisol. This study performed a systematic review and meta-analysis to summarize previous findings on this relationship. Methods We searched in the databases of Web of Science, PubMed, Embase, and Psyc-ARTICLES for articles published before September 2018. We used the random-effects model with restricted maximum-likelihood estimator to synthesize the effect sizes by calculating the standardized mean difference (SMD) and assessing its significance. Results Six hundred and nineteen articles were identified from the preceding databases and 20 of them were included in the meta-analysis. Lower concentrations of 24-h urinary cortisol were observed in patients with PTSD when compared with the controls (SMD = -0.49, 95%CI [-0.91; -0.07], p = 0.02). Subgroup analysis revealed that the concentrations of 24-h urinary cortisol were lower in PTSD patients than in the controls for studies that included female participants or studies that included participants from the United States of America. Conclusions Overall, decreased levels of 24-h urinary cortisol were linked with the pathophysiology of PTSD. Nonetheless, more studies should be conducted to validate the molecular underpinnings of urine cortisol degeneration in PTSD.
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Affiliation(s)
- Xiongfeng Pan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Atipatsa C Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
| | - Shi Wu Wen
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Zhipeng Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaoli Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Masafi S, Saadat SH, Tehranchi K, Olya R, Heidari M, Malihialzackerini S, Jafari M, Rajabi E. Effect of Stress, Depression and Type D Personality on Immune System in the Incidence of Coronary Artery Disease. Open Access Maced J Med Sci 2018; 6:1533-1544. [PMID: 30159090 PMCID: PMC6108813 DOI: 10.3889/oamjms.2018.217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/08/2018] [Accepted: 07/18/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND: Psychoneuroimmunology (PNI) is the study of the interaction between psychological processes and the nervous and immune systems of the human body. The impact of psychological factors on the immune system and the role of this system in Coronary Artery Disease (CAD) are confirmed. Coronary Heart Disease (CHD) is arisen due to the failure of blood and oxygen to the heart tissues. AIM: The present study aimed to describe psychoneuroimmunological processes which contribute to CAD and CHD progression. METHOD: Such psychological risk factors like stress, depression and type D personality were investigated here. Psychoneuroimmunological pathways of all three mentioned risk factors were described for CAD. RESULTS: The studies review indicated that stress could be accompanied with myocardial ischemia and help to rupture. The depression involves in the transfer of stable atherosclerotic plaque to unstable, and type D personality is effective in the initial stages of a CAD. CONCLUSION: As more information on cardiovascular immunity becomes available, this will provide a better understanding and thus act as the foundation for the potential development of new treatment strategies for treatment of cardiovascular disorders.
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Affiliation(s)
- Saideh Masafi
- Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran
| | - Seyed Hassan Saadat
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Katayoun Tehranchi
- Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran
| | - Roohollah Olya
- Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran
| | - Mostafa Heidari
- Department of Psychology, Saveh Branch, Islamic Azad University, Saveh, Iran
| | - Saied Malihialzackerini
- Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran
| | - Mahdi Jafari
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Rajabi
- Shahid Beheshty University of Medical Science, Tehran, Iran
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Effect of age and sex on plasma cortisol and dehydroepiandrosterone concentrations in the dog (Canis familiaris). Res Vet Sci 2014; 96:33-8. [DOI: 10.1016/j.rvsc.2013.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 07/23/2013] [Accepted: 10/26/2013] [Indexed: 11/24/2022]
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Affiliation(s)
- V S Rotenberg
- Department of Psychiatry, Tel Aviv University, Tel Aviv, Israel.
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Braquehais MD, Oquendo MA, Baca-García E, Sher L. Is impulsivity a link between childhood abuse and suicide? Compr Psychiatry 2010; 51:121-9. [PMID: 20152291 DOI: 10.1016/j.comppsych.2009.05.003] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 04/27/2009] [Accepted: 05/19/2009] [Indexed: 01/13/2023] Open
Abstract
Childhood abuse and neglect are known to affect psychological states through behavioral, emotional, and cognitive pathways. They increase the risk of having psychiatric diseases in adulthood and have been considered risk factors for suicidal behavior in all diagnostic categories. Early, prolonged, and severe trauma is also known to increase impulsivity, diminishing the capacity of the brain to inhibit negative actions and to control and modulate emotions. Many neurobiological studies hold that childhood maltreatment may lead to a persistent failure of the inhibitory processes ruled mainly by the frontal cortex over a fear-motivated hyperresponsive limbic system. Multiple neurotransmitters and hormones are involved in the stress response, but, to our knowledge, the two major biological consequences of the chronic exposure to trauma are the hypofunction of the serotonergic system and changes in the hypothalamic-pituitary-adrenal axis function. Some of these findings overlap with the neurobiological features of impulsivity and of suicidal behavior. Impulsivity has also been said to be both a consequence of trauma and a risk factor for the development of a pathological response to trauma. Thus, we suggest that impulsivity could be one of the links between childhood trauma and suicidal behavior. Prevention of childhood abuse could significantly reduce suicidal behavior in adolescents and adults, in part, through a decrease in the frequency of impulsive behaviors in the future.
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Sher L. A model of suicidal behavior in war veterans with posttraumatic mood disorder. Med Hypotheses 2009; 73:215-9. [DOI: 10.1016/j.mehy.2008.12.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 12/07/2008] [Accepted: 12/10/2008] [Indexed: 12/16/2022]
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Carpenter LL, Carvalho JP, Tyrka AR, Wier LM, Mello AF, Mello MF, Anderson GM, Wilkinson CW, Price LH. Decreased adrenocorticotropic hormone and cortisol responses to stress in healthy adults reporting significant childhood maltreatment. Biol Psychiatry 2007; 62:1080-7. [PMID: 17662255 PMCID: PMC2094109 DOI: 10.1016/j.biopsych.2007.05.002] [Citation(s) in RCA: 401] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 04/25/2007] [Accepted: 05/02/2007] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preclinical research findings suggest that exposure to stress and concomitant hypothalamus-pituitary-adrenal (HPA) axis activation during early development can have permanent and potentially deleterious effects. A history of early-life abuse or neglect appears to increase risk for mood and anxiety disorders. Abnormal HPA response to stress challenge has been reported in adult patients with major depressive disorder and posttraumatic stress disorder. METHODS Plasma adrenocorticotropin hormone (ACTH) and cortisol reactivity to the Trier Social Stress Test were examined in healthy adults (n = 50) without current psychopathology. Subjects with a self-reported history of moderate to severe childhood maltreatment (MAL) (n = 23) as measured by the Childhood Trauma Questionnaire were compared with subjects without such a history (CTL) (n = 27). RESULTS Compared with CTLs, MAL subjects exhibited significantly lower cortisol and ACTH baseline-to-peak deltas. A significant group effect was seen in the (repeated measures) cortisol response to the stress challenge, reflecting lower concentrations among MAL subjects. A significant group x time effect characterized the relatively blunted ACTH response of the MAL group. Emotional neglect (-.34, p = .02) and sexual abuse (.31, p = .03) strongly predicted maximal cortisol release. CONCLUSIONS In adults without diagnosable psychopathology, childhood maltreatment is associated with diminished HPA axis response to a psychosocial stressor. Possible explanations for the finding are discussed.
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Affiliation(s)
- Linda L Carpenter
- Mood Disorders Research Program, Butler Hospital, Brown Medical School, Providence, Rhode Island 02906, USA
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Grant MM, Friedman ES, Haskett RF, Riso LP, Thase ME. Urinary free cortisol levels among depressed men and women: differential relationships to age and symptom severity? Arch Womens Ment Health 2007; 10:73-8. [PMID: 17294357 DOI: 10.1007/s00737-007-0171-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 01/13/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Preclinical and clinical models of depression suggest sex differences may be mediated at least in part, by differences in hormonal modulation of hypothalamic-pituitary-adrenal (HPA) axis activity. Unraveling the consequences of moderating influences from the effect of sexual dimorphism will be vital to elaborating models of pathophysiology. METHODS The current study investigated urinary free cortisol (UFC) among younger adults with mild to moderate major depressive disorder to clarify the relationship with potential demographic and clinical moderators. RESULTS Male patients had higher mean UFC levels than female patients. Moreover, significant interactions between age and severity were found among men, but not women. In contrast to prior findings, neither age nor severity effects on UFC levels were found among female patients. LIMITATIONS Conclusions from the current study are limited by the absence of cortisol data from matched controls. Thus it was not possible to disentangle sex differences in baseline physiology from that of pathophysiological differences tied specifically to depression. CONCLUSIONS Despite several methodological limitations, the interactions between sex and both age and severity in this large sample of depressed patients are suggestive of differential pathophysiology for regulation of UFC excretion, and could reflect a neuroprotective effect for estrogen among younger depressed women.
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Affiliation(s)
- M M Grant
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Goy-Thollot I, Decosne-Junot C, Bonnet JM. Influence of aging on adrenal responsiveness in a population of eleven healthy beagles. Res Vet Sci 2006; 82:195-201. [PMID: 17011003 DOI: 10.1016/j.rvsc.2006.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 07/24/2006] [Accepted: 07/25/2006] [Indexed: 11/20/2022]
Abstract
The present study aimed at investigating the effects of aging on the adrenal cortex response of cortisol and aldosterone in dogs. A population of healthy adult Beagles was evaluated twice at a five-year interval. At each evaluation, plasma basal cortisol and aldosterone, cortisol and aldosterone following ACTH-stimulation, sodium, and potassium concentrations and arterial blood pressure were measured. We observed significantly (p<0.05) greater sodium, urea and creatinine concentrations with aging. Nevertheless urea and creatinine remained within our laboratory reference ranges. This study showed a highly significant age-related elevation of basal cortisol (p<0.01). Inversely, both aldosterone following ACTH-stimulation levels and difference between aldosterone following ACTH-stimulation and basal aldosterone values plummeted significantly (p<0.01) with aging. In conclusion, the evaluation of the adrenal cortex function in dogs should take in consideration the age of the individuals.
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Affiliation(s)
- Isabelle Goy-Thollot
- SIAMU, Small Animal Sciences Department, Ecole Nationale Vétérinaire de Lyon, 1, avenue Bourgelat, 69280 Marcy l'Etoile, UMR-MA 103, France.
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Almedom AM, Teclemichael T, Romero LM, Alemu Z. Postnatal salivary cortisol and sense of coherence (SOC) in Eritrean mothers. Am J Hum Biol 2005; 17:376-9. [PMID: 15849703 DOI: 10.1002/ajhb.20127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This pilot study explores possible physiological correlates of maternal sense of coherence (SOC) by looking at salivary cortisol levels in Eritrean mothers during the immediate pre- and postnatal period. Samples of pre- and postnatal resting whole saliva were obtained from 19 mothers and from 31 controls in Ghinda. Radioimmunoassay results revealed no differences between prenatal and control concentrations of salivary cortisol, but postnatal levels were significantly lower (P < 0.014). Mothers who delivered in hospital had significantly higher SOC scores compared to those who opted for home birth (P < 0.045). This difference was particularly pronounced in the comprehensibility subscale of the SOC scores (P < 0.037). Moreover, mothers with higher comprehensibility scores showed significantly lower postnatal cortisol levels (P < 0.017). No associations were found between cortisol and age or parity. The implications of these findings for maternity health service policy and practice in Eritrea are considered.
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Affiliation(s)
- Astier M Almedom
- Tufts University, Biology Department, 165 Packard Avenue, Medford, Massachusetts 02155, USA.
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Abstract
Many studies have demonstrated the role of psychosocial and behavioural risk factors in the aetiology and pathogenesis of cardiovascular disorders. Recently, a new personality construct, the type D or 'distressed' personality, has been proposed. Type D behaviour is characterized by the joint tendency to experience negative emotions and to inhibit these emotions while avoiding social contacts with others. The observation that cardiac patients with type D personality are at increased risk for cardiovascular morbidity and mortality underlines the importance of examining both acute (e.g. major depression) and chronic (e.g. certain personality features) factors in patients at risk for coronary events. Both type D dimensions (negative affectivity and social inhibition) are associated with greater cortisol reactivity to stress. Elevated cortisol may be a mediating factor in the association between type D personality and the increased risk for coronary heart disease and, possibly, other medical disorders. Studies of the effect of age on hypothalamic-pituitary-adrenal (HPA) function in healthy humans have produced inconsistent results. This may relate to a different prevalence of type D individuals in study samples (i.e. some type D individuals may have alterations within the HPA axis that are similar to HPA axis changes in depressed patients). Further studies of the psychological and biological features of type D individuals may help develop treatment approaches to improve the psychological and physical health of individuals with type D personality.
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Affiliation(s)
- L Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Sher L, Oquendo MA, Galfalvy HC, Zalsman G, Cooper TB, Mann JJ. Higher cortisol levels in spring and fall in patients with major depression. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29:529-34. [PMID: 15866354 DOI: 10.1016/j.pnpbp.2005.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple lines of evidence suggest that there are seasonal effects on mood and behavior, and that these effects are related to serotonergic and hypothalamic-pituitary-adrenal (HPA) function. This study sought to determine whether there is a seasonal effect on clinical parameters, baseline cortisol and prolactin levels, and cortisol and prolactin responses to fenfluramine administration in subjects with major depression. METHODS In all, 136 subjects with major depression entered the study. Sixty-two subjects who had a major depressive episode (MDE) in Spring or in Fall (the Spring/Fall group) were compared to 74 subjects who had MDE in Winter or in Summer (the Winter/Summer group). Demographic and clinical parameters were assessed and recorded. Clinical parameters included depression, aggression, impulsivity, hopelessness, hostility, and current suicide ideation rating scales, suicide attempt status, and number and maximum lethality of suicide attempts. Cortisol and prolactin levels were drawn before fenfluramine administration and hourly for 5 h thereafter. Cortisol and prolactin levels were computed as the area under the curve of hourly cortisol measurements. RESULTS Baseline cortisol levels were significantly higher in the Spring/Fall group compared to the Winter/Summer group (14.1+/-4.5 ng/ml vs. 12.5+/-4.4 ng/ml, df=132, t=2.16, p=0.03). There were no seasonal effects on baseline prolactin levels, or post-challenge cortisol and prolactin levels. CONCLUSIONS The Spring/Fall group and the Winter/Summer group may represent different subtypes of major depression. Future studies need to both confirm our results and elucidate the mechanism of the circannual effect on biological function in depressed patients. The results of our study underline the importance of considering seasonality in psychobiology.
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Affiliation(s)
- Leo Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Sher L. The role of endogenous opioids in the placebo effect in post-traumatic stress disorder. Complement Med Res 2005; 11:354-9. [PMID: 15604626 DOI: 10.1159/000082817] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The concept of the placebo effect has received a considerable attention over the past several decades. The placebo effect has been observed in different psychiatric disorders, including post-traumatic stress disorder (PTSD), a chronic and severe disorder precipitated by exposure to a psychologically distressing event. The placebo response rates in patients with PTSD range from 19% to 62%. A considerable number of research publications suggest that endogenous opioids are involved in the mechanisms of the placebo effect. Endogenous opioid peptides play an important role in stress response and in the pathophysiology of PTSD. Therefore, endogenous opioids may be involved in the neurobiology of the placebo effect in PTSD. Possibly, the endogenous opioid system mediates the effect of placebo on all 3 PTSD symptom clusters (re-experiencing symptoms, avoidance and numbing, and physiologic arousal). The placebo effect-related activation of the endogenous opioid system may result in an improvement in intrusive symptomatology and symptoms of increased arousal because the administration of exogenous opioids improve these symptoms. The placebo effect-related activation of the endogenous opioid system may have a mood-enhancing effect, and, consequently, diminish avoidance and numbing. Multiple neurotransmitter and neuroendocrine pathways may be involved in the mechanisms of the placebo effect in PTSD. Further studies of the neurobiology of the placebo effect on patients with PTSD and other psychiatric disorders may produce interesting and important results.
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Affiliation(s)
- L Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Sher L, Oquendo MA, Li S, Burke AK, Grunebaum MF, Zalsman G, Huang YY, Mann JJ. Higher cerebrospinal fluid homovanillic acid levels in depressed patients with comorbid posttraumatic stress disorder. Eur Neuropsychopharmacol 2005; 15:203-9. [PMID: 15695066 DOI: 10.1016/j.euroneuro.2004.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Accepted: 09/15/2004] [Indexed: 11/19/2022]
Abstract
Major depression and posttraumatic stress disorder (PTSD) are often comorbid, resulting in more impairment compared than with either diagnosis alone. Both major depression and PTSD are thought to be associated with monoamine transmitter abnormalities. This study compared clinical features and cerebrospinal fluid (CSF) monoamine metabolites in drug-free depressed subjects with a current major depressive episode (MDE) without comorbid PTSD, subjects with a current MDE and comorbid PTSD, and healthy volunteers. Depressed subjects with comorbid PTSD had higher CSF homovanillic acid (HVA) levels compared with depressed subjects without comorbid PTSD or healthy volunteers. Higher HVA was present after adjustment for sex, lifetime aggression severity and depression scores, alcoholism, tobacco smoking, comorbid cluster B personality disorder, reported childhood abuse, and psychosis. We found no group difference in CSF 5-hydroxyindolacetic acid (5-HIAA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels. Higher dopaminergic activity may contribute to alterations in memory and other cognitive functions, anhedonia, and hypervigilance observed in PTSD.
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Affiliation(s)
- Leo Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, 1051 Riverside Drive, Suite 2917, Box 42, New York, NY 10032, USA.
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Sher L. Posttraumatic mood disorder: a new concept. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:127-8. [PMID: 15807233 DOI: 10.1177/070674370505000215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sher L. The concept of post-traumatic mood disorder. Med Hypotheses 2005; 65:205-10. [PMID: 15922089 DOI: 10.1016/j.mehy.2005.03.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 03/24/2005] [Indexed: 11/30/2022]
Abstract
Post-traumatic stress disorder (PTSD) is frequently comorbid with depression. A number of studies have been conducted to compare individuals suffering from comorbid PTSD and depression with individuals suffering from PTSD alone or depression alone. Comorbidity of PTSD and depression is associated with more severe symptoms as well as higher levels of disability compared to individuals with PTSD alone. A severity of overall symptoms is three to fivefold greater in subjects with comorbid PTSD and depression compared to those with PTSD alone. The comorbid group is five times more likely to manifest functional impairment compared to those diagnosed with PTSD alone. Patients with comorbid PTSD and depression have higher depression, impulsivity, and hostility scores and are significantly more likely to make a suicide attempt compared to subjects with depression alone. Depressed subjects with comorbid PTSD tend towards earlier age of first hospitalization and a higher number of hospitalizations compared to depressed individuals without comorbid PTSD. Lower affinity of alpha-2 adrenoreceptors and higher plasma tyrosine availability to the brain are associated with comorbid PTSD and depression, but not with PTSD alone. Individuals with comorbid PTSD and depression do not exhibit the classic rapid eye movement sleep architectural modifications associated with depression, despite the fact that several other psychophysiological indices of dysphoria are detectable in their sleep. In fenfluramine challenge studies, depressed patients with comorbid PTSD have lower plasma cortisol compared to depressed patients without comorbid PTSD. Cortisol levels increase with age and the number of previous major depressive episodes is a predictor of the cortisol response to fenfluramine administration in depressed patients without PTSD, but not in depressed patients with comorbid PTSD. Depressed subjects with comorbid PTSD have higher cerebrospinal fluid homovanillic acid levels compared with depressed subjects without comorbid PTSD. Thus, studies suggest that patients suffering from comorbid PTSD and depression differ clinically and biologically from individuals with PTSD alone or depression alone. It is possible that some or all individuals diagnosed with comorbid PTSD and depression have a separate psychobiological condition that can be termed "post-traumatic mood disorder". Future clinical and neurobiological studies may not only advance our understanding of the role of environmental and genetic factors in the etiology and pathogenesis of stress-related disorders, but also be useful in refining conceptions of stress-related disorders themselves and possible approaches to the treatment of these conditions.
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Affiliation(s)
- Leo Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Suite 2917 Box 42, New York, NY 10032, United States.
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Sher L. Wernicke-Korsakoff syndrome and alcohol-induced persistent dementia. Aust N Z J Psychiatry 2004; 38:976-7. [PMID: 15555036 DOI: 10.1080/j.1440-1614.2004.01499.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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