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Serravalle L, Trespalacios F, Ellenbogen MA. Hypothalamic-pituitary-adrenal axis functioning in offspring of parents with a major affective disorder: a meta-analytic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02553-0. [PMID: 39207496 DOI: 10.1007/s00787-024-02553-0] [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: 08/30/2023] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Abstract
Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic-pituitary-adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge's g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.
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Affiliation(s)
- Lisa Serravalle
- Department of Psychology, Centre for Research in Human Development, Concordia University, 7141 Sherbrooke W., Montréal, QC, H4B 1R6, Canada
| | - Florencia Trespalacios
- Department of Psychology, Centre for Research in Human Development, Concordia University, 7141 Sherbrooke W., Montréal, QC, H4B 1R6, Canada
| | - Mark A Ellenbogen
- Department of Psychology, Centre for Research in Human Development, Concordia University, 7141 Sherbrooke W., Montréal, QC, H4B 1R6, Canada.
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2
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Fu Q, Qiu R, Chen L, Chen Y, Qi W, Cheng Y. Music prevents stress-induced depression and anxiety-like behavior in mice. Transl Psychiatry 2023; 13:317. [PMID: 37828015 PMCID: PMC10570293 DOI: 10.1038/s41398-023-02606-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023] Open
Abstract
Depression is the most prevalent psychiatric disorder worldwide and remains incurable; however, there is little research on its prevention. The leading cause of depression is stress, and music has been hypothesized to alleviate stress. To examine the potential beneficial effects of music on stress and depression, we subjected mice to chronic unpredictable mild stress (CUMS) during the day and music at night. Strikingly, our results indicated that music completely prevented CUMS-induced depression and anxiety-like behaviors in mice, as assessed by the open field, tail suspension, sucrose preference, novelty suppressed feeding, and elevated plus maze tests. We found that listening to music restored serum corticosterone levels in CUMS mice, which may contribute to the beneficial effects of music on the mouse brain, including the restoration of BDNF and Bcl-2 levels. Furthermore, listening to music prevented CUMS-induced oxidative stress in the serum, prefrontal cortex, and hippocampus of mice. Moreover, the CUMS-induced inflammatory responses in the prefrontal cortex and hippocampus of mice were prevented by listening to music. Taken together, we have demonstrated for the first time in mice experiments that listening to music prevents stress-induced depression and anxiety-like behaviors in mice. Music may restore hypothalamus-pituitary-adrenal axis homeostasis, preventing oxidative stress, inflammation, and neurotrophic factor deficits, which had led to the observed phenotypes in CUMS mice.
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Affiliation(s)
- Qiang Fu
- Institute of National Security, Center on Translational Neuroscience, Minzu University of China, Beijing, China
- School of Ethnology and Sociology, Minzu University of China, Beijing, China
| | - Rui Qiu
- Institute of National Security, Center on Translational Neuroscience, Minzu University of China, Beijing, China
- School of Ethnology and Sociology, Minzu University of China, Beijing, China
| | - Lei Chen
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Yuewen Chen
- Chinese Academy of Sciences Key Laboratory of Brain Connectome and Manipulation, Shenzhen Key Laboratory of Translational Research for Brain Diseases, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences; Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong, 518055, China.
- Guangdong Provincial Key Laboratory of Brain Science, Disease and Drug Development, HKUST Shenzhen Research Institute, Shenzhen, Guangdong, 518057, China.
| | - Wen Qi
- College of Dance, Minzu University of China, Beijing, China.
| | - Yong Cheng
- Institute of National Security, Center on Translational Neuroscience, Minzu University of China, Beijing, China
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
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Hastings PD, Ugarte E, Mashash M, Marceau K, Natsuaki MN, Shirtcliff EA, Zahn-Waxler C, Klimes-Dougan B. The codevelopment of adolescents' and parents' anxiety and depression: Moderating influences of youth gender and psychophysiology. Depress Anxiety 2021; 38:1234-1244. [PMID: 34110070 DOI: 10.1002/da.23183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/22/2021] [Accepted: 05/22/2021] [Indexed: 12/28/2022] Open
Abstract
METHODS In a 2-year longitudinal study of 220 families, we examined how youth gender and adrenocortical and parasympathetic activity moderated reciprocal, bidirectional relations between parent and youth anxiety and depression problems. RESULTS Maternal anxiety predicted subsequent youth anxiety and depression. Maternal depression predicted youth anxiety and, for daughters and youth with low adrenocortical reactivity, youth depression. Youth depression predicted maternal depression only for youth with high adrenocortical reactivity. There were no associations between paternal and youth psychopathology. DISCUSSION Examining youth gender and psychophysiological characteristics that shape the nature of bidirectional influences may inform efforts to identify families at heightened risk for intergenerational transmission of psychopathology.
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Affiliation(s)
- Paul D Hastings
- Department of Psychology, University of California Davis, Davis, California, USA
| | - Elisa Ugarte
- Department of Human Ecology, University of California Davis, Davis, California, USA
| | - Meital Mashash
- Department of Human Ecology, University of California Davis, Davis, California, USA
| | - Kristine Marceau
- Department of Human Development & Family Studies, Purdue University, West Lafayette, Indiana, USA
| | - Misaki N Natsuaki
- Department of Psychology, University of California Riverside, Riverside, California, USA
| | | | - Carolyn Zahn-Waxler
- Department of Psychology and Center for Healthy Minds, University of Wisconsin, Madison, Wisconsin, USA
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Zonca V. Preventive strategies for adolescent depression: What are we missing? A focus on biomarkers. Brain Behav Immun Health 2021; 18:100385. [PMID: 34825234 PMCID: PMC8604665 DOI: 10.1016/j.bbih.2021.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022] Open
Abstract
Adolescent depression is an important global issue with several unmet needs that still must be addressed and, to date, there are only few effective preventive strategies to reduce the burden of this disorder worldwide. In this mini-review, the evidence and potential ways to improve an early detection will be discussed as well as prompt interventions by focusing on a better understanding of the risks underlying the developing of adolescent depression from both a sociodemographic and a biological perspective.
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Affiliation(s)
- Valentina Zonca
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Biological Psychiatry Lab, IRCCS Istituto Centro San Giovanni di Dio, Brescia, Italy
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Moreno MA, Gaus Q, Wilt M, Arseniev-Koehler A, Ton A, Adrian M, VanderStoep A. Displayed Depression Symptoms on Facebook at Two Time Points: Content Analysis. JMIR Form Res 2021; 5:e20179. [PMID: 34057422 PMCID: PMC8204233 DOI: 10.2196/20179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/29/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Depression is a prevalent and problematic mental disorder that often has an onset in adolescence. Previous studies have illustrated that depression disclosures on social media are common and may be linked to an individual’s experiences of depression. However, most studies have examined depression displays on social media at a single time point. Objective This study aims to investigate displayed depression symptoms on Facebook at 2 developmental time points based on symptom type and gender. Methods Participants were recruited from an ongoing longitudinal cohort study. The content analysis of text-based Facebook data over 1 year was conducted at 2 time points: time 1 (adolescence; age 17-18 years) and time 2 (young adulthood; ages 20-22 years). Diagnostic criteria for depression were applied to each post to identify the displayed depression symptoms. Data were extracted verbatim. The analysis included nonparametric tests for comparisons. Results A total of 78 participants’ Facebook profiles were examined, of which 40 (51%) were male. At time 1, 62% (48/78) of the adolescents had a Facebook profile, and 54% (26/78) displayed depression symptom references with an average of 9.4 (SD 3.1) references and 3.3 (SD 2.3) symptom types. Of the 78 participants, 15 (19%) females and 12 (15%) males displayed depression symptom references; these prevalence estimates were not significantly different by gender (P=.59). At time 2, 35 young adults displayed symptoms of depression with an average of 4.6 (SD 2.3) references and 2.4 (SD 1.3) symptom types. There were no differences in the prevalence of symptoms of depression displayed between males (n=19) and females (n=16; P=.63). Conclusions This content analysis study within an ongoing cohort study illustrates the differences in depression displays on Facebook by developmental stage and symptom. This study contributes to a growing body of literature by showing that using social media to observe and understand depression during the emerging adult developmental period may be a valuable approach.
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Affiliation(s)
- Megan A Moreno
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Quintin Gaus
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Megan Wilt
- Department of Nursing, St Catherine University, Minneapolis, MN, United States
| | - Alina Arseniev-Koehler
- Department of Sociology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adrienne Ton
- Department of Nursing, Columbia University, New York, NY, United States
| | - Molly Adrian
- Department of Psychiatry, University of Washington, Seattle, WA, United States
| | - Ann VanderStoep
- Department of Psychiatry, University of Washington, Seattle, WA, United States
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Shields GS, Hostinar CE, Vilgis V, Forbes EE, Hipwell AE, Keenan K, Guyer AE. Hypothalamic-Pituitary-Adrenal Axis Activity in Childhood Predicts Emotional Memory Effects and Related Neural Circuitry in Adolescent Girls. J Cogn Neurosci 2021; 33:872-886. [PMID: 34449842 PMCID: PMC8764738 DOI: 10.1162/jocn_a_01687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Negative emotional experiences can be more difficult to forget than neutral ones, a phenomenon termed the "emotional memory effect." Individual differences in the strength of the emotional memory effect are associated with emotional health. Thus, understanding the neurobiological underpinnings of the emotional memory effect has important implications, especially for individuals at risk for emotional health problems. Although the neural basis of emotional memory effects has been relatively well defined, less is known about how hormonal factors that can modulate emotional memory, such as glucocorticoids, relate to that neural basis. Importantly, probing the role of glucocorticoids in the stress- and emotion-sensitive period of late childhood to adolescence could provide actionable points of intervention. We addressed this gap by testing whether hypothalamic-pituitary-adrenal (HPA) axis activity during a parent-child conflict task at 11 years of age predicted emotional memory and its primary neural circuitry (i.e., amygdala-hippocampus functional connectivity) at 16 years of age in a longitudinal study of 147 girls (104 with complete data). Results showed that lower HPA axis activity predicted stronger emotional memory effects, r(124) = -.236, p < .01, and higher emotional memory-related functional connectivity between the right hippocampus and the right amygdala, β = -.385, p < .001. These findings suggest that late childhood HPA axis activity may modulate the neural circuitry of emotional memory effects in adolescence, which may confer a potential risk trajectory for emotional health among girls.
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Rovnaghi CR, Rigdon J, Roué JM, Ruiz MO, Carrion VG, Anand KJS. Longitudinal Trajectories of Hair Cortisol: Hypothalamic-Pituitary-Adrenal Axis Dysfunction in Early Childhood. Front Pediatr 2021; 9:740343. [PMID: 34708011 PMCID: PMC8544285 DOI: 10.3389/fped.2021.740343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to examine if longitudinal trajectories of hair cortisol concentrations (HCC) measured at two or three yearly time points can identify 1-3 year old children at risk for altered hypothalamic-pituitary-adrenal (HPA)-axis function due to early life stress (ELS). HCC was measured (N = 575) in 265 children using a validated enzyme-linked immunosorbent assay. Hair was sampled in Clinic Visits (CV) centered at years 1, 2, and 3 (n = 45); 1 and 2 (n = 98); 1 and 3 (n = 27); 2 and 3 (n = 95). Log-transformed HCC values were partitioned using latent class mixed models (LCMM) to minimize the Bayesian Information Criterion. Multivariable linear mixed effects models for ln-HCC as a function of fixed effects for age in months and random effects for participants (to account for repeated measures) were generated to identify the factors associated with class membership. Children in Class 1 (n = 69; 9% Black) evidenced declining ln-HCC across early childhood, whereas Class 2 members (n = 196; 43% Black) showed mixed trajectories. LCMM with only Class 2 members revealed Class 2A (n = 17, 82% Black) with sustained high ln-HCC and Class 2B (n = 179, 40% Blacks) with mixed ln-HCC profiles. Another LCMM limited to only Class 2B members revealed Class 2B1 (n = 65, 57% Black) with declining ln-HCC values (at higher ranges than Class 1), and Class 2B2 (n = 113, 30% Black) with sustained high ln-HCC values. Class 1 may represent hair cortisol trajectories associated with adaptive HPA-axis profiles, whereas 2A, 2B1, and 2B2 may represent allostatic load with dysregulated profiles of HPA-axis function in response to varying exposures to ELS. Sequential longitudinal hair cortisol measurements revealed the allostatic load associated with ELS and the potential for developing maladaptive or dysregulated HPA-axis function in early childhood.
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Affiliation(s)
- Cynthia R Rovnaghi
- Pain/Stress Neurobiology Lab, Maternal and Child Health Research Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Joseph Rigdon
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States
| | - Jean-Michel Roué
- Department of Pediatrics, University Hospital of Brest, Brest, France.,Laboratory LIEN, University of Brest, Brest, France.,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Monica O Ruiz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Victor G Carrion
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Kanwaljeet J S Anand
- Pain/Stress Neurobiology Lab, Maternal and Child Health Research Institute, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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8
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Child depressive symptoms: Associations with salivary cortisol and alpha amylase in two distinct challenges. Biol Psychol 2019; 149:107808. [PMID: 31707039 DOI: 10.1016/j.biopsycho.2019.107808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 09/08/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
Child depression has been inconsistency linked to cortisol and salivary alpha-amylase (sAA) reactivity. This study assessed three factors that contribute to inconsistencies: 1) the differential effectiveness of laboratory challenges to elicit cortisol and sAA; 2) the impact of cortisol-sAA coordination; and 3) variation in parent versus child ratings of depression. A community sample of 52 children participated in the Trier Social Stress Test-Child Version (TSST-C) and a competition challenge. Saliva was collected and assayed for cortisol and sAA. Analyses were conducted using multilevel modeling. Child-reported depressive symptoms were associated with a declining cortisol trajectory in the TSST-C. Mother-reported depressive symptoms were associated with higher baseline sAA in the TSST-C and the competition challenge. Further, child-reported depressive symptoms were associated with cortisol-sAA coordination in the competition challenge. Findings underscore the nature of the challenge and the behavioral informant as impacting associations between child depressive symptoms and cortisol and sAA secretion.
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Roberts AG, Lopez-Duran NL. Developmental influences on stress response systems: Implications for psychopathology vulnerability in adolescence. Compr Psychiatry 2019; 88:9-21. [PMID: 30466015 DOI: 10.1016/j.comppsych.2018.10.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/30/2022] Open
Abstract
The adolescent transition is marked by increases in stress exposure and significant maturation of neural and hormonal stress processing systems. Variability in the development of these systems during adolescence may influence the risk for stress-related psychopathology. This paper aims to review the developmental maturation of the HPA axis and related stress regulation systems, and demonstrate how interference in this adaptive developmental process may increase the risk for negative outcomes. We argue that the developmental maturation of the HPA axis aims to improve the regulatory capacity of the axis in order to more adaptively respond to these increases in stress reactivity. Additionally, we review evidence that sex differences in the development of the HPA and related axes may contribute to sex differences in the risk for stress-related psychopathology. Finally, we discuss how contextual factors, such as early trauma and obesity may alter the development of HPA axis during the adolescence transition and how alterations of normative development increase the risk for stress-related disorders.
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Skoranski A, Kelly NR, Radin RM, Thompson KA, Galescu O, Demidowich AP, Brady SM, Chen KY, Tanofsky-Kraff M, Yanovski JA, Shomaker LB. Relationship of Mindfulness to Distress and Cortisol Response in Adolescent Girls At-Risk for Type 2 Diabetes. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:2254-2264. [PMID: 30100695 PMCID: PMC6085111 DOI: 10.1007/s10826-018-1065-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Altered stress response theoretically contributes to the etiology of cardiometabolic disease. Mindfulness may be a protective buffer against the effects of stress on health outcomes by altering how individuals evaluate and respond to stress. We engaged adolescent girls at risk for developing Type 2 diabetes in a cold-pressor test in order to determine the relationship of dispositional mindfulness to cortisol response and subjective stress, including perceived pain and unpleasantness during the stressor, and negative affect following the stressor. We also evaluated mindfulness as a moderator of psychological distress (depressive/anxiety symptoms) and stress response. Participants were 119 girls age 12-17 years with overweight/obesity, family history of diabetes, and mild-to-moderate depressive symptoms. Greater mindfulness was associated with less perceived pain and negative affect, but was unrelated to cortisol response to the stressor. Regardless of mindfulness, greater depressive/anxiety symptoms related to a more blunted cortisol response. Mindfulness might promote better distress tolerance in adolescents at risk for diabetes by altering how youth perceive and relate to acute stress, rather than through altering the physiological stress response. At all levels of mindfulness, depressive/anxiety symptoms relate to greater blunting of cortisol response. Findings contribute to emerging literature on the role of mindfulness in promoting the mental and physical health and well-being of individuals at risk for Type 2 diabetes.
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Affiliation(s)
- Amanda Skoranski
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Nichole R. Kelly
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
- Department of Counseling Psychology and Human Services and the Prevention Science Institute, College of Education, University of Oregon, Eugene, OR, USA
| | - Rachel M. Radin
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Department of Defense, Bethesda, MD, USA
| | - Katherine A. Thompson
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Ovidiu Galescu
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Andrew P. Demidowich
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Sheila M. Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Kong Y. Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, DHHS, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Department of Defense, Bethesda, MD, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Lauren B. Shomaker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
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Neither antecedent nor consequence: Developmental integration of chronic stress, pubertal timing, and conditionally adapted stress response. DEVELOPMENTAL REVIEW 2018. [DOI: 10.1016/j.dr.2018.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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12
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Koss KJ, Gunnar MR. Annual Research Review: Early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. J Child Psychol Psychiatry 2018; 59:327-346. [PMID: 28714126 PMCID: PMC5771995 DOI: 10.1111/jcpp.12784] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research on early adversity, stress biology, and child development has grown exponentially in recent years. FINDINGS We review the current evidence for the hypothalamic-pituitary-adrenocortical (HPA) axis as a stress-mediating mechanism between various forms of childhood adversity and psychopathology. We begin with a review of the neurobiology of the axis and evidence for relations between early adversity-HPA axis activity and HPA axis activity-psychopathology, as well as discuss the role of regulatory mechanisms and sensitive periods in development. CONCLUSIONS We call attention to critical gaps in the literature to highlight next steps in this research including focus on developmental timing, sex differences, stress buffering, and epigenetic regulation. A better understanding of individual differences in the adversity-HPA axis-psychopathology associations will require continued work addressing how multiple biological and behavioral systems work in concert to shape development.
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Affiliation(s)
- Kalsea J. Koss
- Center for Research on Child Wellbeing, Office of Population Research, Department of Molecular Biology, Princeton, Princeton University, NJ, USA
| | - Megan R. Gunnar
- Center for Research on Child Wellbeing, Office of Population Research, Department of Molecular Biology, Princeton, Princeton University, NJ, USA
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13
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Lu Q, Pan F, Ren L, Xiao J, Tao F. Sex differences in the association between internalizing symptoms and hair cortisol level among 10-12 year-old adolescents in China. PLoS One 2018. [PMID: 29522544 PMCID: PMC5844552 DOI: 10.1371/journal.pone.0192901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Although numerous studies have described the relationship between HPA axis dysregulation and internalizing symptoms among adolescents, research using hair cortisol concentrations in pre- and young adolescent samples has not been reported. We investigated the association of self-reported internalizing symptoms with cortisol concertration in hair among pre- and young adolescents aged 10–12 years. Forty-six boys and 39 girls supplied a hair sample of at least 3 cm in length for an analysis of this period (3 months) cortisol excretion. Saliva cortisol reactivity to the Trier Social Stress Test for Children (TSST-C) also was assessed. The study found a positive association between ratings of depressive symptoms and cumulative levels of hair cortisol only in boys. Furthermore, higher ratings of anxiety symptoms were associated with lower hair cortisol concertration and lower saliva cortisol reactivity among girls. This study provides the first evidence for the notion that depressive symptoms in boys are associated with long-term cortisol concertration in hair, whereas anxiety symptoms in girls are associated with HPA-axis hypoactivity, when hair cortisol concentrations and saliva cortisol reactivity to acute stress are assessed concurrently.
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Affiliation(s)
- Qingyun Lu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Department of Child and Adolescent Health, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Fada Pan
- Colleage of education science, Nantong University, Nantong, Jiangsu, China
| | - Lingling Ren
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Jing Xiao
- Department of Child and Adolescent Health, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- * E-mail:
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Rudolph KD, Troop-Gordon W, Modi HH, Granger DA. An exploratory analysis of the joint contribution of HPA axis activation and motivation to early adolescent depressive symptoms. Dev Psychobiol 2018; 60:303-316. [DOI: 10.1002/dev.21600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/15/2017] [Accepted: 11/18/2017] [Indexed: 01/07/2023]
Affiliation(s)
| | | | - Haina H. Modi
- University of Illinois, Urbana-Champaign; Urbana Illinois
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research; University of California; Irvine California
- Johns Hopkins University School of Medicine; School of Nursing, and Bloomberg School of Public Health; Baltimore Maryland
- Department of Psychology and Salivary Bioscience Laboratory; University of Nebraska at Lincoln; Lincoln Nebraska
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15
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A Randomized Controlled Trial to Prevent Depression and Ameliorate Insulin Resistance in Adolescent Girls at Risk for Type 2 Diabetes. Ann Behav Med 2017; 50:762-774. [PMID: 27333897 DOI: 10.1007/s12160-016-9801-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Prospective data suggest depressive symptoms worsen insulin resistance and accelerate type 2 diabetes (T2D) onset. PURPOSE We sought to determine whether reducing depressive symptoms in overweight/obese adolescents at risk for T2D would increase insulin sensitivity and mitigate T2D risk. METHOD We conducted a parallel-group, randomized controlled trial comparing a 6-week cognitive-behavioral (CB) depression prevention group with a 6-week health education (HE) control group in 119 overweight/obese adolescent girls with mild-to-moderate depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D] ≥16) and T2D family history. Primary outcomes were baseline to post-intervention changes in CES-D and whole body insulin sensitivity index (WBISI), derived from 2-h oral glucose tolerance tests. Outcome changes were compared between groups using ANCOVA, adjusting for respective baseline outcome, puberty, race, facilitator, T2D family history degree, baseline age, adiposity, and adiposity change. Multiple imputation was used for missing data. RESULTS Depressive symptoms decreased (p < 0.001) in CB and HE from baseline to posttreatment, but did not differ between groups (ΔCESD = -12 vs. -11, 95 % CI difference = -4 to +1, p = 0.31). Insulin sensitivity was stable (p > 0.29) in CB and HE (ΔWBISI = 0.1 vs. 0.2, 95 % CI difference = -0.6 to +0.4, p = 0.63). Among all participants, reductions in depressive symptoms were associated with improvements in insulin sensitivity (p = 0.02). CONCLUSIONS Girls at risk for T2D displayed reduced depressive symptoms following 6 weeks of CB or HE. Decreases in depressive symptoms related to improvements in insulin sensitivity. Longer-term follow-up is needed to determine whether either program causes sustained decreases in depressive symptoms and improvements in insulin sensitivity. TRIAL REGISTRATION NUMBER The trial was registered with clinicaltrials.gov (NCT01425905).
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16
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Endocrinological and subjective stress responses in children with depressive, anxiety, or externalizing disorders. Dev Psychopathol 2017; 30:605-622. [DOI: 10.1017/s0954579417001146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractIn this study, we used a stress test to investigate endocrinological and subjective stress responses of 8- to 14-year-old children with internalizing or externalizing disorders and healthy controls. The sample (N = 170) consisted of clinical and community children. Parents were given a diagnostic interview to diagnose their children's psychiatric condition. We measured saliva cortisol and subjectively experienced arousal in children before and after the Trier Social Stress Test for Children. Children also rated their performance immediately after the stress test, and 1 hr later they rated their positive and negative thoughts about this stressful event. Children with internalizing or externalizing disorders exhibited a blunted cortisol response compared to healthy controls. Depressed children rated their test performance lower and reported more negative thoughts after the test in comparison to healthy controls, anxious children reported more arousal before and after the task, and children with externalizing disorders reported more positive thoughts. In regression analyses, cortisol and subjective stress responses were both predictive of psychiatric disorders. The study extends previous work on the relation between psychiatric disorders and children's stress responses to an experimentally induced stress task by including a broad range of psychiatric disorders and by integrating endocrinological and subjective stress responses.
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17
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Girard-Joyal O, Ismail N. Effect of LPS treatment on tyrosine hydroxylase expression and Parkinson-like behaviors. Horm Behav 2017; 89:1-12. [PMID: 28025041 DOI: 10.1016/j.yhbeh.2016.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 12/13/2016] [Accepted: 12/20/2016] [Indexed: 01/18/2023]
Abstract
Puberty is a critical period of development during which the brain undergoes reorganizing and remodeling. Exposure to stress during this period is thought to interfere with normal brain development and increase susceptibility to mental illnesses. In female mice, pubertal exposure to lipopolysaccharide (LPS), a bacterial endotoxin, has been shown to alter sexual, anxiety-like, and depression-like behaviors and cognition in an enduring manner. However, the mechanisms underlying these effects remain unknown. The present study examined age and sex difference in tyrosine hydroxylase (TH) expression and dopamine-dependent and Parkinson-like behaviors following LPS treatment. The results show that LPS treatment during adulthood causes an enduring increase in TH expression in many of the brain regions examined. In contrast, there is no change in TH expression following LPS treatment during puberty. However, pubertal LPS treatment induces enduring behavioral deficits in tests of Parkinson-like behaviors, more so in male than in female mice. These results suggest that the low levels of TH following exposure to pubertal immune challenge may predispose mice to Parkinson-like behavior. These findings add to our understanding of stress and immune responses during puberty and their impact on mental health later in life.
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Affiliation(s)
| | - Nafissa Ismail
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.
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18
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Radin RM, Shomaker LB, Kelly NR, Pickworth CK, Thompson KA, Brady SM, Demidowich A, Galescu O, Altschul AM, Shank LM, Yanovski SZ, Tanofsky-Kraff M, Yanovski JA. Cortisol response to an induction of negative affect among adolescents with and without loss of control eating. Pediatr Obes 2016; 11:513-520. [PMID: 26667312 PMCID: PMC4909600 DOI: 10.1111/ijpo.12095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Adults with binge eating disorder may have an exaggerated or blunted cortisol response to stress. Yet, limited data exist among youth who report loss of control (LOC) eating, a developmental precursor to binge eating disorder. METHODS We studied cortisol reactivity among 178 healthy adolescents with and without LOC eating. Following a buffet lunch meal adolescents were randomly assigned to watch a neutral or sad film clip. After, they were offered snacks from a multi-item array to assess eating in the absence of hunger. Salivary cortisol was collected at -80, 0, 30 and 50 min relative to film administration, and state mood ratings were reported before and after the film. RESULTS Adolescents with LOC had greater increases in negative affect during the experimental paradigm in both conditions (ps > 0.05). Depressive symptoms, but not LOC, related to a greater cortisol response in the sad film condition (ps > 0.05). Depressive symptoms and state LOC were related to different aspects of eating behaviour, independent of film condition or cortisol response (ps > 0.05). CONCLUSIONS A film clip that induced depressed state affect increased salivary cortisol only in adolescents with more elevated depressive symptoms. Adolescents with and without LOC were differentiated by greater increases in state depressed affect during laboratory test meals but had no difference in cortisol reactivity. Future studies are required to determine if adolescents with LOC manifest alterations in stress reactivity to alternative stress-inducing situations.
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Affiliation(s)
- Rachel M. Radin
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Lauren B. Shomaker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - Nichole R. Kelly
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA,Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - Courtney K. Pickworth
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Katherine A. Thompson
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Sheila M. Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Andrew Demidowich
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Ovidiu Galescu
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Anne M. Altschul
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Lisa M. Shank
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Susan Z. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Office of Obesity Research, Division of Digestive Diseases and Nutrition, National Institute of Diabetes, Digestive, and Kidney Disorders, NIH, DHHS, Bethesda, Maryland, 20892, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
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Cortisol Response to Psychosocial Stress in Chinese Early Puberty Girls: Possible Role of Depressive Symptoms. BIOMED RESEARCH INTERNATIONAL 2015; 2015:781241. [PMID: 26146632 PMCID: PMC4471250 DOI: 10.1155/2015/781241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/17/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
Objective. The present study aimed at investigating unique patterns of salivary cortisol reactivity and recovery in response to a social stressor among girls with early puberty and exploring possible role of depressive symptom in this association. Design. Case-control study. Patients. Fifty-six girls with early puberty and age- and body mass index- (BMI-) matched normal puberty controls (n = 56) were selected. Measurements. Salivary cortisol was measured in response to the Groningen Social Stress Test for Children. Results. Girls with early puberty had higher cortisol concentration at the end of the GSST (C3), cortisol concentration 20 min after the end of the GSST (C4), and AUC increment (AUCi) compared to non-early puberty girls. Depressive symptoms correlated with blunted HPA reactivity among girls with early puberty. Conclusion. This study demonstrated the disturbance effect of objectively examined early pubertal timing on HPA axis responses. It also suggested that stress reactivity might be blunted for individuals with depressive symptoms.
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Colich NL, Kircanski K, Foland-Ross LC, Gotlib IH. HPA-axis reactivity interacts with stage of pubertal development to predict the onset of depression. Psychoneuroendocrinology 2015; 55:94-101. [PMID: 25745954 PMCID: PMC4380614 DOI: 10.1016/j.psyneuen.2015.02.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/05/2015] [Accepted: 02/07/2015] [Indexed: 01/01/2023]
Abstract
UNLABELLED Both elevated and blunted levels of cortisol secretion during childhood and adolescence have been linked to the subsequent onset of major depressive disorder (MDD). These mixed findings may be due to developmental changes in HPA-axis functioning, which have not been previously assessed in the context of risk. In the present study, therefore, we examined whether pubertal development moderated the influence of cortisol secretion on the subsequent development of MDD. Eighty-nine never-disordered girls ages 9-15 years, many of whom were at high risk for depression by virtue of having a maternal history of the disorder, completed a laboratory stress task. To index cortisol reactivity, salivary cortisol samples were collected at baseline and 15 min following the onset of the stressor. Girls' levels of pubertal development were measured using Tanner staging. All participants were followed through age 18 in order to assess the subsequent development of MDD. Pubertal stage moderated the effects of cortisol stress reactivity on the development of MDD. Specifically, the onset of MDD was predicted by cortisol hyporeactivity in girls who were earlier in pubertal development (Tanner stage ≤ 2), but by cortisol hyperreactivity in girls who were later in pubertal development (Tanner stage ≥ 3.5). CONCLUSIONS These findings demonstrate that girls' cortisol stress reactivity predicts the subsequent onset of MDD, and further, that the nature of this effect depends on the girls' level of pubertal development. Results are discussed in the context of clarifying previous findings, and directions for future research are offered.
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Affiliation(s)
| | | | | | - Ian H Gotlib
- Department of Psychology, Stanford University, USA
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21
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Wang DC, Chen TJ, Lin ML, Jhong YC, Chen SC. Exercise prevents the increased anxiety-like behavior in lactational di-(2-ethylhexyl) phthalate-exposed female rats in late adolescence by improving the regulation of hypothalamus-pituitary-adrenal axis. Horm Behav 2014; 66:674-84. [PMID: 25251977 DOI: 10.1016/j.yhbeh.2014.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/13/2014] [Accepted: 09/15/2014] [Indexed: 11/25/2022]
Abstract
Both the detrimental effects of early life adversity and the beneficial effects of exercise on the hypothalamic-pituitary-adrenal (HPA) axis have been reported. Early life exposure to di-(2-ethylhexyl)-phthalate (DEHP) may impair the development of endocrine system. In this study, we investigated the effects of lactational DEHP exposure on stress responses in late adolescent female rats and examined the protective role of treadmill running. Sprague-Dawley dams were fed with DEHP (10mg/kg per day) or vehicle during lactation. After weaning, the female offspring rats were trained to exercise on a treadmill for 5 weeks and then stressed by exploring on an elevated plus maze. The activities of HPA axis were evaluated by measuring the plasma levels of ACTH and corticosterone, the expressions of adrenal enzymes cholesterol side-chain cleavage enzyme (CYP11A1) and cytochrome P-450 11β-hydroxylase (CYP11B1), and the expression of hypothalamic glucocorticoid receptors (GR). The results demonstrate that DEHP-exposed rats exhibited enhanced anxiety-like behaviors. Increased hypothalamic GR and plasma ACTH levels, but decreased adrenal CYP11A1 and corticosterone levels, were observed in DEHP-exposed animals under stressed condition. Importantly, in DEHP-exposed animals, exercise during childhood-adolescence reduced anxiety-like behaviors by normalizing stress-induced alterations in ACTH level and adrenal CYP11A1 expression. The findings of this study suggest that treadmill running may provide beneficial effects on ameliorating the dysregulation of HPA axis in lactational DEHP-exposed adolescent female rats.
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Affiliation(s)
- Dean-Chuan Wang
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Tsan-Ju Chen
- Department of Physiology, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ming-Lu Lin
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yue-Cih Jhong
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Shih-Chieh Chen
- Department of Anatomy, Kaohsiung Medical University, Kaohsiung City, Taiwan
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