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Krupa AJ, Chrobak AA, Sołtys Z, Korkosz M, Nowakowski J, Dudek D, Siwek M. Chronobiological variables predict non-response to serotonin and noradrenaline reuptake inhibitors in fibromyalgia: a cross-sectional study. Rheumatol Int 2024:10.1007/s00296-024-05650-0. [PMID: 39073428 DOI: 10.1007/s00296-024-05650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
Available data shows associations between chronotype, circadian rhythms, sleep quality and fibromyalgia (FM) presentation. However, no studies have explored links between the chronobiological variables and effectiveness of pharmacotherapy. We aimed to assess the chronotypes, circadian rhythms, sleep-wake cycle and sleep quality in FM and their links to treatment response to serotonin and noradrenalin reuptake inhibitors (SNRI). 60 FM patients: 30 responsive to SNRI (FM T[+]), 30 non-responsive to SNRI (FM T[-]) and 30 healthy controls participated. Subjects were assessed by physician and with questionnaire tools: Composite Scale of Morningness, Biological Rhythms Interview of Assessment in Neuropsychiatry, Sleep-Wake Pattern Assessment Questionnaire, Pittsburgh Sleep Quality Index and Fibromyalgia Impact Questionnaire. ANOVA analysis and simple logistic regressions were used to examine the relationships between chronological variables and response to SNRI. FM T[-] vs. FM T[+] presented lower morning affect (11.50[95%CI 9.96-13.04] vs. 14.00[95%CI 12.42-15.57];p=0.04), anytime wakeability (2.27[95%CI 1.4-3.13] vs. 4.03[95%CI 2.99-5.08];p=0.013) worse overall (11.40[95%CI 9.92-12.88] vs. 7.97[95%CI 6.75-9.19];p=0.002) and subjective (1.70[95%CI 1.30-2.01] vs. 1.17[95%CI 0.94-1.39];p=0.008) sleep quality, higher circadian rhythm disruptions (55.47[95%CI 52.32-58.62] vs. 44.97[95%CI 41.31-48.62];p<0.001), sleep disturbances (1.63[95%CI 1.38-1.68] vs. 1.30[95%CI 1.1-1.5];p=0.04), sleeping-medication use (1.80[95%CI 1.27-2.32] vs. 0.70[95%CI 0.28-1.12];p=0.003). Levels of morningness (AIC=82.91,OR=0.93,p=0.05), morning affect (AIC=81.901,OR=0.86,p=0.03) diurnal dysrhythmia (AIC=69.566,OR=1.14,p<0.001), anytime wakeability (AIC=80.307,OR=0.76,p=0.015), overall sleep quality (AIC=74.665, OR=1.31,p=0.002) subjective sleep quality (AIC=79.353, OR=2.832,p=0.01) and disturbances (AIC=82.669,OR=2.54,p=0.043), sleep medication use (AIC=77.017, OR=1.9,p=0.003) and daytime disfunction (AIC=82.908, OR=1.971,p=0.049) were predictors of non-response to SNRI. Chronobiological variables vary between FM T[+] and FM T[-] and are predictors of non-response to SNRI.
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Affiliation(s)
- Anna J Krupa
- Department of Affective Disorders, Jagiellonian University Medical College, Kopernika 21a, Krakow, 31- 501, Poland
| | - Adrian A Chrobak
- Department of Adult Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Sołtys
- Laboratory of Experimental Neuropathology, Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | - Mariusz Korkosz
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Jarosław Nowakowski
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, Kopernika 21a, Krakow, 31- 501, Poland.
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Carta MG, Cossu G, Primavera D, Aviles Gonzalez CI, Testa G, Stocchino S, Finco G, Littera MT, Deidda MC, Lorrai S, Madeddu C, Nardi AE, Sancassiani F. Heart Rate Variability Biofeedback Efficacy on Fatigue and Energy Levels in Fibromyalgia: A Secondary Analysis of RCT NCT0412183. J Clin Med 2024; 13:4008. [PMID: 39064048 PMCID: PMC11278324 DOI: 10.3390/jcm13144008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/26/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Fibromyalgia syndrome (FMs) is a chronic condition characterized by widespread musculoskeletal pain and a range of complex symptoms, with chronic fatigue being a central feature significantly impacting daily life. The aim of this study was to analyze the secondary outcomes, specifically those related to perceived energy and fatigue symptoms in a randomized controlled trial (RCT) assessing the efficacy of heart rate variability biofeedback (HRV-BF) as an adjunctive treatment for FMs. Methods: Sixty-four FMs patients were randomly assigned to either receive 10 HRV-BF training sessions alongside standard pharmacological therapy (experimental group) or standard therapy alone for 10 weeks (control group). For this secondary analysis, potential improvements in specific items were evaluated regarding perceived energy (Item 10 of the Short-Form Health Survey), the ability to walk and climb stairs (Item 7 and Item 11 of the Fibromyalgia Impact Questionnaire, respectively), and the impact of pain on movement ability (Item 17 of the Bodily and Emotional Perception of Pain). Results: The experimental group demonstrated an improvement in the perception of energy, the ability to walk, and the impact of pain on movement ability. However, the same improvement was not observed in the ability to climb stairs. Conclusions: Fatigue assessment has emerged as a crucial factor for evaluating treatment efficacy in FMs and related conditions linked to altered energy levels, such as bipolar depression, and can offer valuable insights for precisely guiding HRV-BF treatments. ClinicalTrials.gov with code: NCT04121832.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Cesar Ivan Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Giorgia Testa
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Serena Stocchino
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Gabriele Finco
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Maria Teresa Littera
- Department of Pedagogy, Psychological Sciences and Philosophy, University of Cagliari, 09042 Cagliari, Italy
| | - Maria Cristina Deidda
- Center for Palliative Care and Pain Management, University Hospital of Cagliari, 09042 Cagliari, Italy;
| | - Stefano Lorrai
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
| | - Antonio Egidio Nardi
- Institute of Psychiatry-IPUB, Federal University of Rio de Janeiro, Rio de Janeiro 20010-90, Brazil;
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (S.S.); (S.L.); (F.S.)
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Krupa AJ, Chrobak AA, Sołtys Z, Dudek D, Szewczyk B, Siwek M. Insulin resistance, clinical presentation and resistance to selective serotonin and noradrenaline reuptake inhibitors in major depressive disorder. Pharmacol Rep 2024:10.1007/s43440-024-00621-5. [PMID: 38980569 DOI: 10.1007/s43440-024-00621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The understanding of mechanisms underlying non-response to antidepressants is limited. The latest data highlights the role of insulin resistance (IR) in major depressive disorder (MDD) pathophysiology, presentation, and treatment efficacy. This work aimed to assess IR in MDD and explore the relationships between IR, MDD presentation and non-response to selective serotonin and noradrenaline reuptake inhibitors (SNRI). METHODS 67 MDD individuals: 36 responsive (MDD T[+]), 31 non-responsive (MDD T[-]) to SNRI and 30 healthy controls were recruited. The treatment response criteria were: Clinical Global Impression Scale-Improvement score of 1 or 2 after ≥ 8 weeks of treatment. Participants were assessed by physician and self-report tools measuring depression, anhedonia, anxiety, bipolarity, sleep quality. Blood samples were collected to assess fasting glucose and insulin levels and calculate HOMA-IR (homeostasis model assessment of insulin resistance). RESULTS MDD T[-] vs. MDD T[+] had significantly higher body mass index, insulin levels, and HOMA-IR. MDD T[-] presented higher levels of depressed mood, appetite/weight changes, loss of interest, energy, overall depressive symptoms, and sleep impairment; some evaluations suggested higher anhedonia and anxiety in MDD T[-] vs. MDD T[+]. Insulin and IR were weakly but significantly correlated with the severity of psychomotor symptoms, energy level, thoughts of death/suicide, self-criticism, appetite/weight, depressed mood symptoms, sleep problems. IR was weakly but significantly correlated with anhedonia. CONCLUSION IR appears to be linked to depressive symptoms characteristic of the "metabolic" MDD subtype, such as psychomotor changes, energy level, anhedonia, sleep problems, appetite/weight changes, state and trait anxiety, sleep quality, and non-response to SNRI.
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Affiliation(s)
- Anna J Krupa
- Department of Affective Disorders, Jagiellonian University Medical College, ul. Kopernika 21a, Krakow, 31-501, Poland
| | - Adrian A Chrobak
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kopernika 21a, Krakow, 31-501, Poland
| | - Zbigniew Sołtys
- Institute of Zoology and Biomedical Research, Laboratory of Experimental Neuropathology, Jagiellonian University, Gronostajowa 9, Krakow, 30-387, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kopernika 21a, Krakow, 31-501, Poland
| | - Bernadeta Szewczyk
- Department of Neurobiology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, Krakow, 31-343, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, ul. Kopernika 21a, Krakow, 31-501, Poland.
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Romanov DV, Nasonova TI, Isaikin AI, Filileeva OV, Sheyanov AM, Iuzbashian PG, Voronova EI, Parfenov VA. Personality Disorders and Traits of ABC Clusters in Fibromyalgia in a Neurological Setting. Biomedicines 2023; 11:3162. [PMID: 38137383 PMCID: PMC10740797 DOI: 10.3390/biomedicines11123162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Evidence suggests that there is substantial comorbidity between fibromyalgia and Axis II pathology (i.e., personality disorders-PDs). The aim of the current study was to find out the exact cluster (A, B, C) of PDs or traits that are more prominent in FM and may be predictors of FM diagnosis. METHODS Data from 86 subjects (53 with FM and 33 controls without FM) were analyzed in an observational, cross-sectional, comparative study in a neurological setting. The assessment of categorical PDs and traits was performed independently with the Structured Clinical Interview for Personality Disorders (SCID-II). Binary logistic regression was used to determine FM predictors among PD traits. RESULTS Compared with controls, FM patients had a higher rate of PD diagnoses (56.7 vs. 18.2%, p < 0.001). However, the rate was significantly higher only for borderline PD diagnosis (28.3% vs. 6.1% p < 0.05). The binary logistic regression analysis showed that schizotypal and schizoid (cluster A), borderline (cluster B), and dependent (cluster C) personality traits may be significant predictors of fibromyalgia (Nagelkerke R2 = 0.415). CONCLUSIONS Our results may reflect the association of FM with personality traits of all three PD clusters: A (eccentric), B (dramatic), and C (anxious). However, the most consistent evidence seems to be for borderline PD.
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Affiliation(s)
- Dmitry V. Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (O.V.F.); (A.M.S.); (P.G.I.); (E.I.V.)
- Mental Health Research Center, 115522 Moscow, Russia
- International Institute of Psychosomatic Health, 127550 Moscow, Russia
| | - Tatiana I. Nasonova
- Department of Nervous Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (T.I.N.); (A.I.I.); (V.A.P.)
| | - Aleksey I. Isaikin
- Department of Nervous Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (T.I.N.); (A.I.I.); (V.A.P.)
| | - Olga V. Filileeva
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (O.V.F.); (A.M.S.); (P.G.I.); (E.I.V.)
- International Institute of Psychosomatic Health, 127550 Moscow, Russia
| | - Andrey M. Sheyanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (O.V.F.); (A.M.S.); (P.G.I.); (E.I.V.)
| | - Polina G. Iuzbashian
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (O.V.F.); (A.M.S.); (P.G.I.); (E.I.V.)
| | - Evgenia I. Voronova
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (O.V.F.); (A.M.S.); (P.G.I.); (E.I.V.)
- Mental Health Research Center, 115522 Moscow, Russia
| | - Vladimir A. Parfenov
- Department of Nervous Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (T.I.N.); (A.I.I.); (V.A.P.)
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