Relationship of stress-reactive cortisol to suicidal intent of prior attempts in major depression

Association between bubble tea consumption and mental health among adults in mainland China: A national cross-sectional analysis of cohort study

BACKGROUND

Bubble tea has emerged as an essential beverage in the daily lives of many individuals, which is particularly pronounced among nurses. However, few studies have investigated the potential effects of bubble tea consumption on mental health among nurses. In this study, we aimed to investigate the association between bubble tea consumption and mental health among nurses.

METHODS

A cross-sectional analysis using baseline data from the Nurses' Mental Health Study (NMHS), a national cohort study. Odds ratios (ORs) were employed to evaluate the relationship between bubble tea consumption and mental health.

RESULTS

A total of 132,910 participants were enumerated nationwide in our survey. 8666 (6.52 %) were male and 124,244 (93.48 %) were female. The median age of participants was 34 years. After adjusting for potential confounders, the odds ratios (ORs) for depressive symptoms, anxiety symptoms, psychiatric diagnosis, fatigue, burnout, loneliness, and well-being trend changed across categories of bubble tea consumption. Low frequency of bubble tea consumption was associated with a lower risk of suicidal ideation, while high frequency of consumption was related to an increased suicidal risk. The relation between bubble tea and mental health varies with gender and age.

CONCLUSIONS

This large-sample cross-sectional study found that consumption of bubble tea was significantly associated with increased anxiety, depression, psychiatric diagnosis, fatigue, job burnout and loneliness, and decreased well-being among nurses. Moreover, research indicates that limited consumption of bubble tea may be correlated with a reduction in suicidal ideation, whereas excessive consumption may be linked to an increase in such ideation.

Diminished salivary cortisol response to mental stress predict all-cause mortality in general population

OBJECTIVES

To characterize individuals with a diminished salivary cortisol response to mental stress, assess its association with all-cause mortality, and quantify the mediating effects of the most relevant and modifiable factors to identify potential target for prevention.

METHODS

Data from MIDUS II study with a 16-year follow-up, were used to categorize 1129 participants as responders or non-responders based on the existence of increase in salivary cortisol under mental stress. LASSO-logistics analysis identified the most relevant factors. Cox regression models and restricted cubic splines evaluated the prognostic impact. Further analyses examined the mediating effects of identified factors on prognosis.

RESULTS

After employing Inverse Probability of Treatment Weighting to adjust for demographic differences between groups, individuals with diminished cortisol responses were found to have higher levels of depressive symptoms (p = 0.050), increased inflammation (IL-6, 2.30 [1.41, 3.79] vs. 1.96[1.33, 3.31], p = 0.011), and were less likely to regularly exercise (74.3 % vs. 79.9 %, p = 0.030). IL-6 (OR: 1.25 [1.04, 1.52]，p = 0.021) and regularly exercising (OR 0.71 [0.51, 0.97], p = 0.032) emerged as significant modifiable factors in multivariate analysis. A notable prognostic association of diminished cortisol response with all-cause mortality (HR = 1.33 [1.01-1.76], p = 0.046) was observed, consistent across various subgroups and supported by non-linear model analysis. Approximately 13 % of the mortality risk associated with diminished cortisol response was mediated by increased IL-6 levels (p = 0.043).

CONCLUSION

Diminished salivary cortisol response is linked to an increased risk of all-cause mortality, significantly mediated by elevated IL-6. This study offers a new perspective on prognostic prediction while highlighting potential avenues for intervention.

Influences of sleep, cortisol reactivity, and risk/reward-based decision-making on suicide

BACKGROUND AND OBJECTIVES

Poor sleep quality is a known contributor to suicidal thoughts and behaviors. This study examines whether sleep quality modulates the effect of an individual's stress response and risk/reward-based decision making on suicide risk.

METHODS

Participants were 160 adults at a residential substance use treatment facility with lifetime exposure to trauma who completed a clinician-administered measure of suicide risk, the Iowa Gambling Task (IGT), and a self-report measure of sleep. Cortisol reactivity (i.e., changes in cortisol before and after a personalized trauma script) was used to measure stress response. We used quantile regression to examine the effects of sleep, cortisol, and risk/reward decision-making on suicide risk.

RESULTS

We found poor sleep quality to be increasingly salient in individuals at greater risk for suicide than those at lower risk for suicide. Furthermore, individuals with moderate to moderate-high levels of suicide risk seem to have greater cortisol reactivity. In the low-moderate quantile, we found suicide risk to be associated with both high stress reactivity and low-risk, high-reward decision-making, as well as low stress reactivity and high-risk/low-reward decision-making.

LIMITATIONS

These findings should be interpreted considering several methodological constraints, such as the use of a pre-determined sample and instruments not tailored for our hypotheses, the MINI 'Suicide' Module's limited differentiation between suicidal ideation and behavior, and variably timed cortisol sampling.

CONCLUSIONS

Despite these limitations, the findings from this study support the use of evidence-based interventions focused on improving sleep quality and managing emotional reactivity to decrease suicide risk.

The impact of ACTH levels on neurotransmitters and antioxidants in patients with major depressive disorder: A novel investigation

BACKGROUND

The relationship between neurotransmitters and oxidative stress in Major Depressive Disorder (MDD) patients, considering HPA axis activity and psychological and cognitive states, is unclear. This study examines changes in neurotransmitters (GABA, Glx) and antioxidants (GSH) in the dorsal anterior cingulate cortex (dACC) of MDD patients under varying levels of ACTH, and their relationship with psychological and cognitive conditions.

METHODS

Forty-five MDD patients were divided into high-ACTH (>65 pg/mL; n = 16) and normal-ACTH (7-65 pg/mL; n = 29) groups based on blood ACTH levels, along with 12 healthy controls (HC). All participants underwent HAM-D, HAM-A assessments, and most completed MMSE and MoCA tests. GABA+, Glx, and GSH levels in the dACC were measured using the MEGA-PRESS sequence. Intergroup differences and correlations between clinical factors, HPA axis activity, and metabolites were analyzed.

RESULTS

Compared to HC, the normal ACTH group showed higher Glx and lower GSH levels. Glx and GSH were negatively correlated with MDD severity. In the high-ACTH MDD group, Glx positively correlated with delayed memory, and GSH positively correlated with abstraction. Factors influencing GABA included ACTH levels, depression duration, and negative events. Predictive factors for HAM-D scores were GSH and GABA.

LIMITATIONS

The sample size is small.

CONCLUSION

MDD patients exhibit neurochemical differences in the brain related to HPA axis levels, MDD severity, and cognitive function. Clinical factors, neurotransmitters, and neuroendocrine levels significantly influence depression severity.

GLP-1 agonists and risk of suicidal thoughts and behaviours: Confound by indication once again? A narrative review

Glucagon-like peptide-1 (GLP-1) agonists have been successfully used in clinical practice for the treatment of diabetes and obesity, offering significant clinical benefits. However, concerns regarding their potential link to psychiatric side effects, like suicidal thoughts and behaviours (STB) have emerged. This narrative review investigates the complex interplay between GLP-1 agonists and STB, focusing on the biological stress induced by rapid weight loss, psychological and social consequences, similar mechanism with addiction, and the evaluative lens of the Bradford Hill criteria on causality. While GLP-1 agonists can contribute to substantial health improvements, they also introduce biological and psychological stressors. Disruptions in homeostasis from quick weight reduction can elevate cortisol and norepinephrine levels, heightening the risk for, or exacerbation of STB. Psychological factors, including unfulfilled expectations and identity changes after significant weight loss, compound these risks. Utilizing the Bradford Hill criteria reveals insufficient evidence for a direct causal link between GLP-1 agonists and STB. Yet, the indirect effects related to the metabolic and psychological disturbances associated with rapid weight loss call for a cautious approach. Used carefully in targeted populations GLP-1 agonists may even emerge as protective agents against STB. Therefore, it is crucial to monitor patients during the treatment and screen for preexisting mental health conditions. If detected, appropriate clinical management should be applied. Future studies should aim at optimizing dosing schedules to mitigate the adverse effects of rapid weight loss and further investigate GLP-1 agonists in possible STB prevention.

Functional connectivity alterations in PTSD patients with suicidal ideation

Post-traumatic stress disorder (PTSD) is a highly prevalent psychological disorder characterized by intense feelings of fear or helplessness after experiencing a traumatic event. PTSD is highly comorbid with mood disorders and patients are at increased risk for suicide. The present study aimed to identify neural connectivity alterations associated with suicidal ideation (SI) in PTSD patients by using resting-state functional magnetic resonance imaging. Voxel-to-voxel intrinsic connectivity was compared between PTSD patients with no (N-SI; N = 26) and high (H-SI; N = 7) SI. Region-to-voxel functional connectivity analysis was performed to identify the regions that contributed to intrinsic connectivity changes. H-SI patients had increased connectivity to various brain regions representing the central executive network, salience network, and default mode network in the frontal, temporal, and occipital lobes as well as subcortical structures involved in executive and limbic functioning, and motor systems. These results suggest SI is associated with large network-level alterations in PTSD patients and is not the result of neuronal abnormalities in any one specific area.

Research progress on antidepressant effects and mechanisms of berberine

Depression, a global health problem with growing prevalence, brings serious impacts on the daily life of patients. However, the antidepressants currently used in clinical are not perfectly effective, which greatly reduces the compliance of patients. Berberine is a natural quaternary alkaloid which has been shown to have a variety of pharmacological effects, such as hypoglycemic, lipid-regulation, anti-cancer, antibacterial, anti-oxidation, anti-inflammatory, and antidepressant. This review summarizes the evidence of pharmacological applications of berberine in treating depression and elucidates the mechanisms of berberine regulating neurotransmitter levels, promoting the regeneration of hippocampal neurons, improving hypothalamic-pituitary-adrenal axis dysfunction, anti-oxidative stress, and suppressing inflammatory status in order to provide a reference for further research and clinical application of berberine.

Searching for diagnoses and subgroups: a suggestion for criteria

New subgroups of psychiatric disorders are often claimed. In contrast, classification systems have repeatedly had to abandon established subgroups such as paranoid vs. disorganised and catatonic schizophrenia due to lack of empirical evidence. Four criteria are proposed that should be met to claim valid subgroups: 1. distinct distribution of the defining characteristic between groups; 2. significant differences in variables other than those defining the subgroups cross-sectionally and longitudinally; 3. long-term stability; 4. significant differences between groups in aetiology, pathophysiology, and evidence-based therapy. In contrast to examples from somatic medicine, such as type 1 and type 2 diabetes, few psychiatric disorders meet these requirements.