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Khawagi WY, Al-Kuraishy HM, Hussein NR, Al-Gareeb AI, Atef E, Elhussieny O, Alexiou A, Papadakis M, Jabir MS, Alshehri AA, Saad HM, Batiha GES. Depression and type 2 diabetes: A causal relationship and mechanistic pathway. Diabetes Obes Metab 2024; 26:3031-3044. [PMID: 38802993 DOI: 10.1111/dom.15630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024]
Abstract
Depression is a mood disorder that may increase risk for the development of insulin resistance (IR) and type 2 diabetes (T2D), and vice versa. However, the mechanistic pathway linking depression and T2D is not fully elucidated. The aim of this narrative review, therefore, was to discuss the possible link between depression and T2D. The coexistence of T2D and depression is twice as great compared to the occurrence of either condition independently. Hyperglycaemia and dyslipidaemia promote the incidence of depression by enhancing inflammation and reducing brain serotonin (5-hydroxytryptamine [5HT]). Dysregulation of insulin signalling in T2D impairs brain 5HT signalling, leading to the development of depression. Furthermore, depression is associated with the development of hyperglycaemia and poor glycaemic control. Psychological stress and depression promote the development of T2D. In conclusion, T2D could be a potential risk factor for the development of depression through the induction of inflammatory reactions and oxidative stress that affect brain neurotransmission. In addition, chronic stress in depression may induce the development of T2D through dysregulation of the hypothalamic-pituitary-adrenal axis and increase circulating cortisol levels, which triggers IR and T2D.
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Affiliation(s)
- Wael Y Khawagi
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Nawar R Hussein
- College of Pharmacy, Pharmacology Department, Al-Farahidi University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Esraa Atef
- Respiratory Therapy Department, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Omnya Elhussieny
- Department of Histology and Cytology, Faculty of Veterinary Medicine, Matrouh University, Marsa Matruh, Egypt
| | - Athanasios Alexiou
- University Centre for Research & Development, Chandigarh University Chandigarh-Ludhiana Highway, Mohali, India
- Department of Research and Development, Funogen, Athens, Greece
- Department of Research and Development, AFNP Med, Wien, Austria
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, New South Wales, Australia
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Wuppertal, Germany
| | - Majid S Jabir
- Applied Science Department, University of Technology, Baghdad, Iraq
| | - Abdullah A Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Hebatallah M Saad
- Department of Pathology, Faculty of Veterinary Medicine, Matrouh University, Marsa Matruh, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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Malik A, Saha S, Morya RK, Bhadada SK, Rana SV. Impact of serotonin transporter gene polymorphism on gut motility in patients with type 2 Diabetes mellitus. J Neurogastroenterol Motil 2021; 27:240-247. [PMID: 33526751 PMCID: PMC8026373 DOI: 10.5056/jnm20211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aims The pathogenesis of gastrointestinal (GI) symptoms in patients with type 2 diabetes mellitus (T2DM) is yet to be delineated clearly. Serotonin, a monoamine neurotransmitter, resides primarily in the gut and plays a vital role in GI system. However, no study has been documented the role of serotonin and serotonin transporter gene (SLC6A4) polymorphism in the development of GI symptoms in T2DM patients. Methods Three hundred diabetes patients attending diabetes clinic at Postgraduate Institute of Medical Education and Research, Chandigarh, and matched healthy controls were enrolled for this study. Plasma from collected blood sample was used for serotonin measurement by enzyme-linked immunosorbent assay method and buffy coat was used for isolation of DNA by phenol chloroform method. Serotonin transporter gene polymorphism was analyzed by polymerase chain reaction method. Results The frequency of short allele (S) and SS genotype was significantly higher in patients with T2DM than controls and was associated with increased risk of T2DM. The frequency of LS genotype showed an association with protection from the disease. Regarding GI symptoms, 78.2% of patients with constipation showed LL and LS genotypes, and 97.7% of patients with diarrhea had SS genotype. The patients without GI symptoms did not show any association of gut motility with genotype. Furthermore, serotonin was significantly higher in diabetic patients who belonged to SS genotype compared to LS or LL genotype and who presented with diarrhea. Conclusion SS genotypes are prone to develop diarrhea because of faster gut motility resulting from higher serotonin levels as compared to LS and LL genotype in T2DM patients.
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Affiliation(s)
- Aastha Malik
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarama Saha
- Department of Biochemistry, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Rajesh K Morya
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay K Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satya V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Biochemistry, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
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Vrshek-Schallhorn S, Sapuram V, Avery BM. Letter to the Editor: Bias in the measurement of bias. Letter regarding 'Citation bias and selective focus on positive findings in the literature on the serotonin transporter gene (5-HTTLPR), life stress and depression'. Psychol Med 2017; 47:187-192. [PMID: 27681844 DOI: 10.1017/s0033291716002178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S Vrshek-Schallhorn
- The University of North Carolina at Greensboro,Department of Psychology,Greensboro, NC,USA
| | - V Sapuram
- The University of North Carolina at Greensboro,Department of Psychology,Greensboro, NC,USA
| | - B M Avery
- The University of North Carolina at Greensboro,Department of Psychology,Greensboro, NC,USA
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Carsote M, Radoi V, Geleriu A, Mihai A, Ferechide D, Opris D, Paun D, Poiana C. Serotonin and the bone assessment. J Med Life 2016; 7 Spec No. 2:49-53. [PMID: 25870673 PMCID: PMC4391347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Lately, the in vitro and in vivo studies on serotonin metabolism have been pointing its influence in bone health. Also, there are no particular recommendations in performing the serum serotonin assessment in order to evaluate the skeletal status. Aim: We aimed to correlate the bone turnover markers and lumbar bone mineral density (BMD) with serotonin. Material and methods: There is a cross-sectional study in Caucasian postmenopausal women. They were not diagnosed with carcinoid syndrome, or bone anomalies, and received no treatment (including antiresorptives). The following bone formation markers were performed: serum alkaline phosphatase (AP), serum osteocalcin (OC), and the bone resorption marker: serum CrossLaps (CL). Serum serotonin (high-pressure liquid chromatography), as well as central DXA (GE Prodigy) were assessed. Results: 191 women of 57.1 years mean age were grouped according to DXA (WHO criteria). The linear regression analysis between serum serotonin and CL were not statistically significant (SS), between serotonin and OC was SS in the newly diagnosed osteoporosis group (N=40, r=0.4, p=0.03), between serotonin and AP SS was found in osteopenia group (N=88, r=0.24, p=0.03), with no changes when adjusting for age and BMI. The partial correlation between serotonin and BMD was not SS. Discussion: The study raises the question of serotonin as a bone metabolism marker seeing that the results were not consistent. The main limit of our study was that we did not analyze the possible use of antidepressants to these women. Overall, this was a pilot study in clinical practice where few reports have been published, but still necessary, because the use of serum serotonin in current skeletal evaluation is still unclear.
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Affiliation(s)
- M Carsote
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - V Radoi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - A Geleriu
- "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - A Mihai
- "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - D Ferechide
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Opris
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Paun
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - C Poiana
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
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Prabhakar V, Gupta D, Kanade P, Radhakrishnan M. Diabetes-associated depression: the serotonergic system as a novel multifunctional target. Indian J Pharmacol 2015; 47:4-10. [PMID: 25821303 PMCID: PMC4375817 DOI: 10.4103/0253-7613.150305] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/16/2013] [Accepted: 12/05/2014] [Indexed: 12/26/2022] Open
Abstract
Diabetes associated depression is a largely understudied field which nonetheless carries a significant disease burden. The very low therapeutic efficacy of the existing conventional drugs with poor outcome may be, in part, due to uncertainty of the mechanism involved that clearly explains the existing comorbidity. The main purpose of this review was to address the sophisticated mechanisms of this comorbidity with a view of developing potential novel targets with higher efficacy and specificity. Data were collected from database searches including PubMed, references from relevant English language research/review articles and other official publications. Articles from 1990 to 2013 were included, and a broad search term criteria were followed for data mining so that relevant information was not missed out. Some of the search terms used included; diabetes-induced depression, diabetes and serotonin, hypothalamic-pituitary-adrenal (HPA) axis and diabetes and glucocorticoids in diabetes. Neuropathologically, depletion of brain monoaminergic activity specifically the serotonin (5-hydroxytryptamine [5-HT]) system, due to chronically persisting diabetic state may lead to the mood and behavioral complications that further add on worsening the quality life years. The 5-HT system through multifunctional tasks regulates neurogenesis and plasticity and by complex receptor mechanism controls the emotional and behavioral activity. Persisting hyperglycemia leads to impaired neurogenesis, decreased synaptic plasticity, undesired neuro-anatomical alterations, neurochemical deficits, and reduced neurotransmitter activity. The neurotrophic factors and secondary messenger functions affected at molecular and genetic levels indicate the impact of diabetes-mediated dysregulation on neuronal circuits. HPA activity, glycogen synthase kinase 3, and insulin signaling controls were also found to be hampered, interlinked to 5-HT system following diabetic progression.
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Affiliation(s)
- Visakh Prabhakar
- Department of Pharmacy and, Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Deepali Gupta
- Department of Pharmacy and, Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Prateek Kanade
- Department of Pharmacy and, Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Mahesh Radhakrishnan
- Department of Pharmacy and, Birla Institute of Technology and Science, Pilani, Rajasthan, India
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Sharpley CF, Palanisamy SKA, Glyde NS, Dillingham PW, Agnew LL. An update on the interaction between the serotonin transporter promoter variant (5-HTTLPR), stress and depression, plus an exploration of non-confirming findings. Behav Brain Res 2014; 273:89-105. [PMID: 25078292 DOI: 10.1016/j.bbr.2014.07.030] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
Abstract
In the three years since the most recent meta-analysis of the association between the serotonin transported promoter polymorphism (5-HTTLPR), stress and the development of depression, another 27 studies have been published on this issue, which is an increase of 50% more studies than were previously reviewed. In addition, previous findings of inconsistency of results across studies argued for further exploration of this relationship. From the 81 studies identified to June 2013, the significant relationship between the short form of the 5-HTTLPR was confirmed (p=.0000009), which is stronger than the relationship reported in the most recent meta-analysis in 2011. However, nearly 26% of the 81 studies reviewed failed to show any significant association between the 5-HTTLPR, stress and depression, and four studies found opposite results to those expected. Examination of the methodologies of all studies failed to indicate any flaws in the opposite or unequivocal studies, and the latter had larger sample sizes than those studies which supported the expected association, arguing that the null results were not an outcome of insufficient statistical power. The need to consider aspects of samples and measures of depression, particularly the presence of subtypes of depression in future research is discussed.
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Affiliation(s)
- Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia; Centre for Autism Spectrum Disorders, Bond University, Robina, Qld, Australia.
| | - Suresh K A Palanisamy
- Collaborative Network Research, Mental Health and Well-being in Rural and Regional Communities & Centre for Bioactive Discovery in Health and Ageing, University of New England, Armidale, NSW, Australia
| | - Nicarla S Glyde
- School of Science & Technology, University of New England, Armidale, NSW, Australia
| | - Peter W Dillingham
- School of Science & Technology, University of New England, Armidale, NSW, Australia
| | - Linda L Agnew
- Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia
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Ma L, Poulin P, Feldstain A, Chasen M. The association between malnutrition and psychological distress in patients with advanced head-and-neck cancer. Curr Oncol 2013; 20:e554-60. [PMID: 24311956 PMCID: PMC3851352 DOI: 10.3747/co.20.1651] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Malnutrition and psychological distress are often seen in patients with head-and-neck cancer, but little is known about the interrelationships between those two symptoms. The present study examined the relationship between malnutrition and psychological distress in patients with advanced head-and-neck cancer. METHODS Using the Patient-Generated Subjective Global Assessment, 99 patients with advanced-stage head-and-neck cancer were screened for nutrition status. The patients were also screened for psychosocial distress (using the Distress Thermometer) and for psychosocial issues (using the Problem Checklist). Any relationship between malnutrition and psychosocial distress was determined by regression and correlation analysis. We also used t-tests to compare distress levels for patients with and without specific nutrition-related symptoms. RESULTS The study group included 80 men and 19 women [mean age: 58.4 ± 10.9 years (range: 23-85 years)]. The correlation between poorer nutrition status and level of psychological distress was significant r = 0.37 (p < 0.001). Specifically, reduced food intake and symptoms were both positively associated with distress: r = 0.27 and r = 0.29 respectively, both significant at p < 0.01. After controlling for the effects of psychosocial problems and pain, nutrition status remained a significant predictor of distress, explaining 3.8% of the variance in the distress scores of the patients (p < 0.05). CONCLUSIONS Malnutrition and symptoms were strongly related to distress in patients with advanced head-and-neck cancer. Our results suggest the need for further research into the complex relationship between nutrition status and distress and into the management of both nutrition and distress in cancer care.
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Affiliation(s)
- L. Ma
- Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - P. Poulin
- Psychosocial Oncology Program, The Ottawa Hospital Health Institute, Ottawa, ON
| | - A. Feldstain
- School of Psychology, University of Ottawa, Ottawa, ON
| | - M.R. Chasen
- Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON
- Division of Palliative Care, The Ottawa Hospital Cancer Centre, Ottawa, ON
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Salminen LE, Schofield PR, Pierce KD, Lane EM, Heaps JM, Bolzenius JD, Baker LM, Luo X, Paul RH. Triallelic relationships between the serotonin transporter polymorphism and cognition among healthy older adults. Int J Neurosci 2013; 124:331-8. [PMID: 24044728 DOI: 10.3109/00207454.2013.845822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The biallelic serotonin transporter polymorphism (5-hydroxytryptamine transporter linked polymorphic region (5-HTTLPR)) is a common genetic sequence associated with serotonin transporter (5-hydroxytryptamine transporter (5-HTT)) expression, which is further modulated by a triallelic single-nucleotide polymorphism (rs25531). Recent studies using the biallelic 5-HTTLPR have identified a beneficial role of low 5-HTT expression on cognitive performance, although no studies have examined the impact of the triallelic 5-HTTLPR/rs25531 marker on cognitive performance among healthy older adults. In the present study, we addressed this issue in 84 healthy older adults genotyped for biallelic and triallelic variants of 5-HTT. Groups were created based on low, medium and high levels of expression, as indicated by the triallelic marker. Results indicated that individuals with low 5-HTT expression performed significantly better on a test of memory compared with individuals with medium 5-HTT expression. This suggests that possession of low-expressing genetic variants of 5-HTT is modestly associated with enhanced cognitive performance among healthy older adults.
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Affiliation(s)
- Lauren E Salminen
- 1Department of Psychology, University of Missouri-Saint Louis , Saint Louis , MOy2USA
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9
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Carsote M, Radoi V, Geleriu A, Mihai A, Ferechide D, Opris D, Paun D, Poiana C. The serotonin and the bone assessment. J Med Life 2013; 6:151-5. [PMID: 23904874 PMCID: PMC3725439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 04/10/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction. Lately, the in vitro and in vivo studies on serotonin metabolism pointed their influence in bone health. In addition, there are no particular recommendations in performing the serum serotonin assessment in order to evaluate the skeletal status. Aim. We aimed to correlate the bone turnover markers and lumbar bone mineral density (BMD) with serotonin. Material and Methods. There is a cross-sectional study in Caucasian postmenopausal women. They were not diagnosed with carcinoid syndrome, or bone anomalies, and received no treatment (including antiresorptives). We performed the bone formation markers: serum alkaline phosphatase (AP), serum osteocalcin (OC), and the bone resorption marker: serum CrossLaps (CL). Serum serotonin (high-pressure liquid chromatography), as well as central DXA (GE Prodigy) were assessed. Results. 191 women of 57.1 years mean age were grouped according to DXA (WHO criteria). The linear regression analysis between serum serotonin and CL was not statistically significant (SS), between serotonin and OC was SS in the newly diagnosed osteoporosis group (N=40, r=0.4, p=0.03), between serotonin and AP we found SS in osteopenia group (N=88, r=0.24, p=0.03), with no changes when adjusting for age and BMI. The partial correlation between serotonin and BMD was not SS. Discussion. The study raises the question of serotonin as a bone metabolism marker seeing that the results were not consistent. The main limit of our study is that we did not analyze the possible use of antidepressants by these women. Overall, this is a pilot study in clinical practice in which few reports have been published yet, but still necessary because the use of serum serotonin in current skeletal evaluation is still unclear.
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Affiliation(s)
- M Carsote
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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