1
|
Sultan AA, Karthikeyan S, Grigorian A, Kennedy KG, Mio M, MacIntosh BJ, Goldstein BI. Cerebral blood flow in relation to peripheral endothelial function in youth bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2024; 135:111087. [PMID: 39004332 DOI: 10.1016/j.pnpbp.2024.111087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Anomalous cerebral blood flow (CBF) is evident in bipolar disorder (BD), however the extent to which CBF reflects peripheral vascular function in BD is unknown. This study investigated endothelial function, an index of early atherosclerosis and cardiovascular disease risk, in relation to CBF among youth with BD. METHODS Participants included 113 youth, 13-20 years old (66 BD; 47 healthy controls [HC]). CBF was measured using arterial spin labeling with 3T MRI. Region of interest analyses (ROI; global grey matter, middle frontal gyrus, anterior cingulate cortex, temporal cortex, caudate) were undertaken alongside voxel-wise analyses. Reactive hyperemia index (RHI), a measure of endothelial function, was assessed non-invasively via pulse amplitude tonometry. General linear models were used to examine RHI and RHI-by-diagnosis associations with CBF, controlling for age, sex, and body mass index. Bonferroni correction for multiple comparisons was used for ROI analyses, such that the significance level was divided by the number of ROIs (α = 0.05/5 = 0.01). Cluster-extent thresholding was used to correct for multiple comparisons for voxel-wise analyses. RESULTS ROI findings were not significant after correction. Voxel-wise analyses found that higher RHI was associated with lower left thalamus CBF in the whole group (p < 0.001). Additionally, significant RHI-by-diagnosis associations with CBF were found in three clusters: left intracalcarine cortex (p < 0.001), left thalamus (p < 0.001), and right frontal pole (p = 0.006). Post-hoc analyses showed that in each cluster, higher RHI was associated with lower CBF in BD, but higher CBF in HC. CONCLUSION We found that RHI was differentially associated with CBF in youth with BD versus HC. The unanticipated association of higher RHI with lower CBF in BD could potentially reflect a compensatory mechanism. Future research, including prospective studies and experimental designs are warranted to build on the current findings.
Collapse
Affiliation(s)
- Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sudhir Karthikeyan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Physical Sciences, Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
2
|
Kim E, Sinco BR, Zhao J, Fang Y, Cunningham C, Frank E, Sen S, Bohnert A, Hughes TM. Duration of New-Onset Depressive Symptoms During Medical Residency. JAMA Netw Open 2024; 7:e2418082. [PMID: 38904957 PMCID: PMC11193122 DOI: 10.1001/jamanetworkopen.2024.18082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/20/2024] [Indexed: 06/22/2024] Open
Abstract
Importance The implications of new-onset depressive symptoms during residency, particularly for first-year physicians (ie, interns), on the long-term mental health of physicians are unknown. Objective To examine the association between and persistence of new-onset and long-term depressive symptoms among interns. Design, Setting, and Participants The ongoing Intern Health Study (IHS) is a prospective annual cohort study that assesses the mental health of incoming US-based resident physicians. The IHS began in 2007, and a total of 105 residency programs have been represented in this national study. Interns enrolled sequentially in annual cohorts and completed follow-up surveys to screen for depression using the 9-item Patient Health Questionnaire-9 (PHQ-9) throughout and after medical training. The data were analyzed from May 2023 to March 2024. Exposure A positive screening result for depression, defined as an elevated PHQ-9 score of 10 or greater (indicating moderate to severe depression) at 1 or more time points during the first postgraduate year of medical training (ie, the intern year). Main Outcomes and Measures The main outcomes assessed were mean PHQ-9 scores (continuous) and proportions of physicians with an elevated PHQ-9 score (≥10; categorical or binary) at the time of the annual follow-up survey. To account for repeated measures over time, a linear mixed model was used to analyze mean PHQ-9 scores and a generalized estimating equation (GEE) was used to analyze the binary indicator for a PHQ-9 score of 10 or greater. Results This study included 858 physicians with a PHQ-9 score of less than 10 before the start of their internship. Their mean (SD) age was 27.4 (9.0) years, and more than half (53.0% [95% CI, 48.5%-57.5%]) were women. Over the follow-up period, mean PHQ-9 scores did not return to the baseline level assessed before the start of the internship in either group (those with a positive depression screen as interns and those without). Among interns who screened positive for depression (PHQ-9 score ≥10) during their internship, mean PHQ-9 scores were significantly higher at both 5 years (4.7 [95% CI, 4.4-5.0] vs 2.8 [95% CI, 2.5-3.0]; P < .001) and 10 years (5.1 [95% CI, 4.5-5.7] vs 3.5 [95% CI, 3.0-4.0]; P < .001) of follow-up. Furthermore, interns with an elevated PHQ-9 score (≥10) demonstrated a higher likelihood of meeting this threshold during each year of follow-up. Conclusions and Relevance In this cohort study of IHS participants, a positive depression screening result during the intern year had long-term implications for physicians, including having persistently higher mean PHQ-9 scores and a higher likelihood of meeting this threshold again. These findings underscore the pressing need to address the mental health of physicians who experience depressive symptoms during their training and to emphasize the importance of interventions to sustain the health of physicians throughout their careers.
Collapse
Affiliation(s)
- Erin Kim
- University of Michigan Medical School, Ann Arbor
| | - Brandy R. Sinco
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Joan Zhao
- University of Michigan Medical School, Ann Arbor
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Yu Fang
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Carrie Cunningham
- Department of Surgery, Massachusetts General Hospital, Boston
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Elena Frank
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Srijan Sen
- University of Michigan Medical School, Ann Arbor
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Amy Bohnert
- University of Michigan Medical School, Ann Arbor
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Center for Clinical Management and Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Tasha M. Hughes
- University of Michigan Medical School, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor
| |
Collapse
|
3
|
Harris R, Kavaliotis E, Drummond SPA, Wolkow AP. Sleep, mental health and physical health in new shift workers transitioning to shift work: Systematic review and meta-analysis. Sleep Med Rev 2024; 75:101927. [PMID: 38626702 DOI: 10.1016/j.smrv.2024.101927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 04/18/2024]
Abstract
This systematic review and meta-analysis (PROSPERO registration CRD42022309827) aimed to describe how shift work impacts new workers' sleep, mental health, and physical health during the transition to shift work and to consolidate information regarding predictors of shift work tolerance (SWT) during this transition period. Inclusion criteria included: new shift workers; sleep, mental health, or physical health outcomes; prospective study design with the first timepoint assessing workers within three months of starting shift work; and written in English. Searches from six databases returned 12,172 articles as of August 2023. The final sample included 48 papers. Publication quality and risk of bias was assessed using the critical appraisal skills program. Forty-five studies investigated longitudinal changes in sleep, mental health, or physical health outcomes and 29 studies investigated predictors of SWT (i.e., better sleep, mental and physical health). Sleep and mental health outcomes worsened following the onset of shift work, while physical health did not significantly change. Pre-shift work mental health, sleep, and work characteristics predicted SWT later in workers' careers. Shift work adversely impacts new workers' sleep and mental health early in their career, and interventions before beginning shift work are needed to promote better SWT.
Collapse
Affiliation(s)
- Rachael Harris
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia
| | - Eleni Kavaliotis
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia
| | - Alexander P Wolkow
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia.
| |
Collapse
|
4
|
Darling AM, Richey RE, Akins JD, Saunders EFH, Matthew Brothers R, Greaney JL. Cerebrovascular reactivity is blunted in young adults with major depressive disorder: The influence of current depressive symptomology. J Affect Disord 2021; 295:513-521. [PMID: 34509066 PMCID: PMC8667006 DOI: 10.1016/j.jad.2021.08.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In middle-aged adults with depression, cerebral vasodilatory reactivity is blunted; however, this has not been examined in treatment-naïve young adults with major depressive disorder (MDD). We tested the hypothesis that cerebrovascular reactivity would be blunted in young adults (18-30 yrs) with MDD compared to healthy non-depressed adults (HA) and would be attenuated to a greater extent in adults with symptomatic MDD (sMDD) compared to adults with MDD in remission (euthymic MDD; eMDD). METHODS Sixteen adults with MDD [21±3yrs; n = 8 sMDD (6 women); n = 8 eMDD (5 women)] and 14 HA (22±3yrs; 9 women) participated. End-tidal carbon dioxide concentration (PETCO2; capnograph), beat-to-beat mean arterial pressure (MAP; finger photoplethysmography), middle cerebral artery blood velocity (MCAv; transcranial Doppler ultrasound), and internal carotid artery (ICA) diameter and blood velocity (Doppler ultrasound) were continuously measured during baseline and rebreathing-induced hypercapnia. Cerebrovascular reactivity was calculated as the relative increase in vascular conductance during hypercapnia. RESULTS In adults with MDD, cerebrovascular reactivity in the MCA (∆39±9 HA vs. ∆31±13% MDD, p = 0.04), but not the ICA (∆36±24 HA vs. ∆34±18% MDD, p = 0.84), was blunted compared to HA. In the MCA, cerebrovascular reactivity was reduced in adults with sMDD compared to adults with eMDD (∆36±11 eMDD vs. ∆25±13% sMDD, p = 0.02). LIMITATIONS The cross-sectional nature approach limits conclusions regarding the temporal nature of this link. CONCLUSION These data indicate that MCA cerebrovascular reactivity is blunted in young adults with MDD and further modulated by current depressive symptomology, suggesting that the management of depressive symptomology may secondarily improve cerebrovascular health.
Collapse
Affiliation(s)
- Ashley M Darling
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Rauchelle E Richey
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States; Department of Integrative Physiology, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - John D Akins
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, United States
| | - R Matthew Brothers
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Jody L Greaney
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States.
| |
Collapse
|
5
|
Associations between increased circulating endothelial progenitor cell levels and anxiety/depressive severity, cognitive deficit and function disability among patients with major depressive disorder. Sci Rep 2021; 11:18221. [PMID: 34521977 PMCID: PMC8440504 DOI: 10.1038/s41598-021-97853-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 05/31/2021] [Indexed: 12/11/2022] Open
Abstract
The association of major depressive disorder (MDD) with cardiovascular diseases (CVDs) through endothelial dysfunction is bidirectional. Circulating endothelial progenitor cells (cEPCs), essential for endothelial repair and function, are associated with risks of various CVDs. Here, the relationship of cEPC counts with MDD and the related clinical presentations were investigated in 50 patients with MDD and 46 healthy controls. In patients with MDD, a battery of clinical domains was analysed: depressed mood with Hamilton Depression Rating Scale (HAMD) and Montgomery–Åsberg Depression Rating Scale (MADRS), anxiety with Hamilton Anxiety Rating Scale (HAMA), cognitive dysfunction and deficit with Digit Symbol Substitution Test (DSST) and Perceived Deficits Questionnaire-Depression (PDQ-D), somatic symptoms with Depressive and Somatic Symptom Scale (DSSS), quality of life with 12-Item Short Form Health Survey (SF-12) and functional disability with Sheehan Disability Scale (SDS). Immature and mature cEPC counts were measured through flow cytometry. Increased mature and immature cEPC counts were significantly associated with higher anxiety after controlling the confounding effect of systolic blood pressure, and potentially associated with more severe depressive symptoms, worse cognitive performance and increased cognitive deficit, higher social disability, and worse mental health outcomes. Thus, cEPCs might have pleiotropic effects on MDD-associated symptoms and psychosocial outcomes.
Collapse
|
6
|
Yang N, Sun S, Duan G, Lv K, Liang C, Zhang L, Yu J, Tang Y, Lu G. Advances of Endothelial Progenitor Cells in the Development of Depression. Front Cell Neurosci 2021; 15:608656. [PMID: 34421539 PMCID: PMC8375291 DOI: 10.3389/fncel.2021.608656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/23/2021] [Indexed: 12/27/2022] Open
Abstract
Depression is a major psychological disease of human beings. With the severity of depression, it elevates the risk of cardiovascular disease (CVD), especially acute coronary syndrome (ACS), resulting in serious harm to human health. The number of endothelial progenitor cells (EPCs) is closely related to the development of depression. It has been reported that the number of peripheral blood EPCs in patients with depression was reduced. However, effects on the function of EPCs in depression are still unclear. This paper aims to analyze and summarize the research of EPCs in depression, and we envision that EPCs might act as a new target for evaluating the severity of depression and its complications.
Collapse
Affiliation(s)
- Nana Yang
- School of Bioscience and Technology, Weifang Medical University, Weifang, China.,Medical Laboratory Animal Center, Weifang Medical University, Weifang, China
| | - Shiyu Sun
- School of Bioscience and Technology, Weifang Medical University, Weifang, China
| | - Guangqing Duan
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Kaixuan Lv
- School of Bioscience and Technology, Weifang Medical University, Weifang, China
| | - Chen Liang
- School of Chemical Engineering, Qingdao University of Science & Technology, Qingdao, China
| | - Linlin Zhang
- School of Bioscience and Technology, Weifang Medical University, Weifang, China
| | - Jielun Yu
- School of Bioscience and Technology, Weifang Medical University, Weifang, China.,Medical Laboratory Animal Center, Weifang Medical University, Weifang, China
| | - Yaohui Tang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Guohua Lu
- School of Psychology, Weifang Medical University, Weifang, China
| |
Collapse
|
7
|
Greaney JL, Surachman A, Saunders EFH, Alexander LM, Almeida DM. Greater Daily Psychosocial Stress Exposure is Associated With Increased Norepinephrine-Induced Vasoconstriction in Young Adults. J Am Heart Assoc 2020; 9:e015697. [PMID: 32340506 PMCID: PMC7428556 DOI: 10.1161/jaha.119.015697] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Epidemiological data suggest a link between psychological stress and increased cardiovascular disease risk; however, the underlying mechanisms remain incompletely understood. The purpose of this investigation was to directly examine the influence of daily psychosocial stress on microvascular adrenergic vasoconstrictor responsiveness in healthy adults. We hypothesized increased daily psychosocial stress would be positively related to increased norepinephrine-induced vasoconstriction. Methods and Results Eighteen healthy adults (19-36 years; 10 women) completed a daily psychosocial experiences telephone interview for 8 consecutive evenings in order to document their exposure and emotional responsiveness to common stressors (eg, arguments, work stress) over the preceding 24 hrs. On the last interview day, red cell flux (laser Doppler flowmetry) was measured during graded intradermal microdialysis perfusion of norepinephrine (10-12 to 10-2 mol/L) and expressed as a percentage of baseline vascular conductance. Exogenous norepinephrine elicited progressive and robust vasoconstriction in all individuals (maximal vasoconstriction: 71±4%base; cumulative vasoconstriction [area under the curve]: 118±102 arbitrary units). Participants experienced a stressor on 51±5% of days and a total of 5.2±0.9 stressors over the 8-day time frame. Increased daily frequency of stressor exposure was positively related to both maximal (R2=0.26; P=0.03) and cumulative (R2=0.31; P=0.02) vasoconstrictor responsiveness. Likewise, the total number of stressors was associated with increased maximal (R2=0.40; P<0.01) and cumulative (R2=0.27; P=0.03) norepinephrine-induced vasoconstriction. Neither stressor severity nor stress-related emotions were related to vasoconstrictor responsiveness. Conclusions Collectively, these data suggest that daily psychosocial stressor exposure by itself is sufficient to adversely influence microvascular vasoconstrictor function, regardless of the perceived severity or emotional consequences of the stressor exposure.
Collapse
Affiliation(s)
- Jody L Greaney
- Noll Laboratory Department of Kinesiology The Pennsylvania State University University Park PA.,Department of Kinesiology The University of Texas at Arlington Arlington TX
| | - Agus Surachman
- Department of Human Development and Family Studies The Pennsylvania State University University Park PA.,Center for Healthy Aging The Pennsylvania State University University Park PA
| | | | - Lacy M Alexander
- Noll Laboratory Department of Kinesiology The Pennsylvania State University University Park PA.,Center for Healthy Aging The Pennsylvania State University University Park PA
| | - David M Almeida
- Department of Human Development and Family Studies The Pennsylvania State University University Park PA.,Center for Healthy Aging The Pennsylvania State University University Park PA
| |
Collapse
|
8
|
Greaney JL, Koffer RE, Saunders EFH, Almeida DM, Alexander LM. Self-Reported Everyday Psychosocial Stressors Are Associated With Greater Impairments in Endothelial Function in Young Adults With Major Depressive Disorder. J Am Heart Assoc 2020; 8:e010825. [PMID: 30741602 PMCID: PMC6405663 DOI: 10.1161/jaha.118.010825] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Despite the epidemiological associations between psychological stress, depression, and increased cardiovascular disease risk, no studies have examined the relation between naturally occurring psychosocial stressors and directly measured microvascular function in adults with major depressive disorder (MDD). We tested the hypothesis that young adults with MDD exposed to everyday psychosocial stressors would exhibit more severe impairments in endothelium‐dependent dilation (EDD) compared with: (1) healthy nondepressed adults (HCs); and (2) adults with MDD without acute psychosocial stress exposure. Methods and Results Twenty HCs (22±1 years) and 23 otherwise healthy adults with MDD (20±0.3 years) participated in the study. Participants completed a psychosocial experiences survey to document their exposure to any of 6 stressors over the preceding 24 hours (eg, arguments, work stressors). Red cell flux (laser Doppler flowmetry) was measured during graded intradermal microdialysis perfusion of acetylcholine (10−10 to 10−1mol/L). EDD was expressed as a percentage of maximum vascular conductance (flux/mm Hg). Multiple linear regression was used to determine the associations between stress, EDD, and MDD. Adults with MDD reported a greater number and severity of psychosocial stressors compared with HCs (all P<0.05). EDD was blunted in adults with MDD (HCs: 91±2 versus MDD: 74±3%; P<0.001). Exposure to any stressor was related to more severe impairments in EDD in patients with MDD (no stressor: 81±3 versus 1+ stressors: 69±5%; P=0.04) but not in HCs (P=0.48). Conclusions These data indicate that exposure to everyday psychosocial stressors is associated with greater impairments in endothelial function in patients with MDD, suggesting a potential mechanistic link between daily stress and depression in increased cardiovascular risk.
Collapse
Affiliation(s)
- Jody L Greaney
- 1 Noll Laboratory Department of Kinesiology The Pennsylvania State University State College PA
| | - Rachel E Koffer
- 2 Department of Human Development and Family Studies The Pennsylvania State University State College PA
| | | | - David M Almeida
- 2 Department of Human Development and Family Studies The Pennsylvania State University State College PA
| | - Lacy M Alexander
- 1 Noll Laboratory Department of Kinesiology The Pennsylvania State University State College PA
| |
Collapse
|
9
|
Greaney JL, Saunders EFH, Santhanam L, Alexander LM. Oxidative Stress Contributes to Microvascular Endothelial Dysfunction in Men and Women With Major Depressive Disorder. Circ Res 2019; 124:564-574. [PMID: 30582458 DOI: 10.1161/circresaha.118.313764] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
RATIONALE In rodent models of depression, oxidative stress-induced reductions in NO bioavailability contribute to impaired endothelium-dependent dilation. Endothelial dysfunction is evident in major depressive disorder (MDD); however, the molecular mediators remain undefined. OBJECTIVE We sought to translate preclinical findings to humans by testing the role of oxidative stress in mediating microvascular endothelial dysfunction, including potential modulatory influences of sex, in MDD. METHODS AND RESULTS Twenty-four treatment-naive, otherwise healthy, young adults with MDD (14 women; 18-23 years) and 20 healthy adults (10 women; 19-30 years) participated. Red blood cell flux (laser Doppler flowmetry) was measured during graded intradermal microdialysis perfusion of the endothelium-dependent agonist acetylcholine, alone and in combination with an NO synthase inhibitor (L-NAME), a superoxide scavenger (Tempol), and an NADPH oxidase inhibitor (apocynin), as well as during perfusion of the endothelium-independent agonist sodium nitroprusside. Tissue oxidative stress markers (eg, nitrotyrosine abundance, superoxide production) were also quantified. Endothelium-dependent dilation was blunted in MDD and mediated by reductions in NO-dependent dilation. Endothelium-independent dilation was likewise attenuated in MDD. In MDD, there were no sex differences in either NO-mediated endothelium-dependent dilation or endothelium-independent dilation. Acute scavenging of superoxide or inhibition of NADPH oxidase improved NO-dependent dilation in MDD. Expression and activity of oxidative stress markers were increased in MDD. In a subset of adults with MDD treated with a selective serotonin reuptake inhibitor for their depressive symptoms and in remission (n=8; 7 women; 19-37 years), NO-mediated endothelium-dependent dilation was preserved, but endothelium-independent dilation was impaired, compared with healthy adults. CONCLUSIONS Oxidative stress-induced reductions in NO-dependent dilation, as well as alterations in vascular smooth muscle function, directly contribute to microvascular dysfunction in MDD. Strategies targeting vascular oxidative stress may be viable therapeutic options for improving NO-mediated endothelial function and reducing cardiovascular risk in MDD.
Collapse
Affiliation(s)
- Jody L Greaney
- From the Noll Laboratory, Department of Kinesiology, Pennsylvania State University, University Park (J.L.G., L.M.A.)
| | - Erika F H Saunders
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA (E.F.H.S.)
| | - Lakshmi Santhanam
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.S.)
| | - Lacy M Alexander
- From the Noll Laboratory, Department of Kinesiology, Pennsylvania State University, University Park (J.L.G., L.M.A.)
| |
Collapse
|
10
|
Tanaka A, Tomiyama H, Maruhashi T, Matsuzawa Y, Miyoshi T, Kabutoya T, Kario K, Sugiyama S, Munakata M, Ito H, Ueda S, Vlachopoulos C, Higashi Y, Inoue T, Node K. Physiological Diagnostic Criteria for Vascular Failure. Hypertension 2019; 72:1060-1071. [PMID: 30354826 DOI: 10.1161/hypertensionaha.118.11554] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Atsushi Tanaka
- From the Department of Cardiovascular Medicine, Saga University, Japan (A.T., K.N.)
| | - Hirofumi Tomiyama
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Japan (H.T.)
| | - Tatsuya Maruhashi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences (T.M.), Hiroshima University, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Japan (Y.M.)
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan (T.M., H.I.)
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (T.K., K.K.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (T.K., K.K.)
| | - Seigo Sugiyama
- Division of Cardiovascular Medicine, Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan (S.S.)
| | - Masanori Munakata
- Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.)
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan (T.M., H.I.)
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyu School of Medicine, Okinawa, Japan (S.U.)
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, Athens Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (C.V.)
| | - Yukihito Higashi
- Department of Regeneration and Medicine, Research Center for Radiation Genome Medicine, Research Institute for Radiation Biology and Medicine (Y.H.), Hiroshima University, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan (T.I.)
| | - Koichi Node
- From the Department of Cardiovascular Medicine, Saga University, Japan (A.T., K.N.)
| |
Collapse
|
11
|
Birdsall JW, Schmitz SL, Abosi OJ, DuBose LE, Pierce GL, Fiedorowicz JG. Inflammatory and vascular correlates of mood change over 8 weeks. HEART AND MIND 2019; 3:47-54. [PMID: 32529166 DOI: 10.4103/hm.hm_24_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mood disorders have been associated with a variety of cardiovascular disease risk factors, including inflammation and large artery stiffness, particularly while depressed although longitudinal studies have been limited. Methods With measurements at baseline and 8 weeks, the researchers prospectively assessed mood, levels of inflammatory markers (hsCRP and TNF-α), serum lipids, and large artery stiffness in a cohort of 26 participants with a diagnosis of a mood disorder, enriched for current depression. Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline and 8 weeks. Associations between depressive symptoms and other measures were assessed using linear mixed models, unadjusted and adjusted for age and BMI. Results The mean age of the participants (n=26) was 41.6 (standard deviation [SD] 12.8) years, and 81% were female. During the study, there was a mean (SD) MADRS score improvement of 9.5 (9.4) from baseline to eight weeks. Reductions in the primary outcome TNF-α with improvement in depression fell short of significance (P=0.076). In secondary analyses, there was a statistically significant association between improved cholesterol ratio (P=0.038) and triglycerides (P=0.042) with depression improvement. There was no statistically significant change in large artery stiffness during the study. Conclusion Improved depressive symptoms were associated with improved cholesterol ratios even after adjustment, suggesting possible mechanism by which acute mood states may influence cardiovascular disease risk. Future longitudinal studies with extended and intensive follow-up investigating cardiovascular disease risk related to acute changes and persistence of mood symptoms is warranted.
Collapse
Affiliation(s)
- Jonathan W Birdsall
- Department of Psychiatry, The University of Iowa, Iowa City, Iowa, 52242.,Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, 52242
| | - Samantha L Schmitz
- Department of Psychiatry, The University of Iowa, Iowa City, Iowa, 52242
| | - Oluchi J Abosi
- Department of Psychiatry, The University of Iowa, Iowa City, Iowa, 52242.,Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, 52242
| | - Lyndsey E DuBose
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa, 52242
| | - Gary L Pierce
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa, 52242.,François M. Abboud Cardiovascular Research Center, The University of Iowa, Iowa City, Iowa, 52242
| | - Jess G Fiedorowicz
- Department of Psychiatry, The University of Iowa, Iowa City, Iowa, 52242.,Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, 52242.,Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, 52242.,François M. Abboud Cardiovascular Research Center, The University of Iowa, Iowa City, Iowa, 52242.,Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, 52242.,Iowa Neuroscience Institute, Obesity Research and Education Initiative, The University of Iowa, Iowa City, Iowa, 52242
| |
Collapse
|
12
|
Kalmbach DA, Abelson JL, Arnedt JT, Zhao Z, Schubert JR, Sen S. Insomnia symptoms and short sleep predict anxiety and worry in response to stress exposure: a prospective cohort study of medical interns. Sleep Med 2019; 55:40-47. [PMID: 30763868 PMCID: PMC7045299 DOI: 10.1016/j.sleep.2018.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVES While anxiety rates are alarmingly high in short sleeping insomniacs, the relationship between insomnia and anxiety symptoms has not been extensively studied, especially in comparison to the relationship between insomnia and depressive symptoms. Using residency training as a naturalistic stress exposure, we prospectively assessed the role of sleep disturbance and duration on anxiety-risk in response to stress. METHODS Web-based survey data from 1336 first-year training physicians (interns) prior to and then quarterly across medical internship. Using mixed effects modeling, we examined how pre-internship sleep disturbance and internship sleep duration predicted symptoms of anxiety, using an established tool for quantifying symptom severity in generalized anxiety disorder (GAD). RESULTS Pre-internship poor sleepers are at more than twice the odds of having short sleep (≤6 h) during internship as good sleepers (OR = 2.38, 95% CI = 1.61, 3.57). Poor sleepers were also at twice the odds for screening positive for probable GAD diagnosis (OR = 2.08, 95% CI = 1.26, 3.45). Notably, sleep onset insomnia strongly predicted anxiety development under stress (OR = 3.55, 95% CI = 1.49, 8.45). During internship, short sleep associated with concurrent anxiety symptoms (b = -0.26, 95% CI = -0.38, -0.14) and predicted future anxiety symptoms even more strongly (b = -0.39, 95% CI = -0.76, -0.03). CONCLUSIONS Poor sleepers, particularly those with sleep onset insomnia symptoms, are vulnerable to short sleep and GAD anxiety and worry during chronic stress.
Collapse
Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Novi, MI, USA
| | - James L Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Todd Arnedt
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zhuo Zhao
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jessica R Schubert
- Department of Behavioral Health, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| |
Collapse
|
13
|
Bipolar disorder and related mood states are not associated with endothelial function of small arteries in adults without heart disease. Gen Hosp Psychiatry 2018; 51:36-40. [PMID: 29309989 PMCID: PMC5869118 DOI: 10.1016/j.genhosppsych.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with bipolar disorder are at increased risk for adverse cardiovascular disease (CVD) events. This study aimed to assess endothelial function and wave reflection, a risk factor for CVD, as measured by finger plethysmography in bipolar disorder to investigate whether CVD risk was higher in bipolar disorder and altered during acute mood episodes. We hypothesized that EndoPAT would detect a lower reactive hyperemia index (RHI) and higher augmentation index (AIX) in individuals with bipolar disorder compared with controls. Second, we predicted lower RHI and higher AIX during acute mood episodes. METHODS Reactive hyperemia index and augmentation index, measures of microvascular endothelial function and arterial pressure wave reflection respectively, were assessed using the EndoPAT 2000 device in a sample of 56 participants with a DSM-IV diagnosis of bipolar I disorder with 82 measures spanning different mood states (mania, depression, euthymia) and cross-sectionally in 26 healthy controls. RESULTS RHI and AIX were not different between adults with and without bipolar disorder (mean age 40.3 vs. 41.2years; RHI: 2.04±0.67 vs. 2.05±0.51; AIX@75 (AIX adjusted for heart rate of 75): 1.4±19.7 vs. 0.8±22.4). When modeled in linear mixed models with a random intercept (to account for repeated observations of persons with bipolar disorder) and adjusting for age and sex, there were no significant differences between those with bipolar disorder and controls (p=0.89 for RHI; p=0.85 for AIX@75). CONCLUSIONS Microvascular endothelial function and wave reflection estimated by finger plethysmography were unable to detect differences between adults with and without bipolar disorder or changes with mood states. Future research is necessary to identify more proximal and sensitive, yet relevant, biomarkers of abnormal mood-related influences on CVD risk or must target higher risk samples.
Collapse
|