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Influence and interaction of genetic, cognitive, neuroendocrine and personalistic markers to antidepressant response in Chinese patients with major depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110036. [PMID: 32702381 DOI: 10.1016/j.pnpbp.2020.110036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/04/2020] [Accepted: 07/12/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Despite there is a wide range of antidepressants available, with various mechanisms of actions, the efficacy of current therapeutic options is yet satisfactory. Previous shreds of evidence have indicated that genetics, cognitive, neuroendocrine, as well as personality factors, are all intrinsically linked and contribute to the diversity of treatment outcomes. We, therefore, sought to investigate this hypothesis in this study. METHOD Based on 610 samples treated with a selection of serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), noradrenergic and specific serotonergic antidepressant (NaSSA) or tricyclic antidepressant (TCA), we compared the therapeutic effects of these four classes of drugs by survival analyses. Pharmacogenomic and survival analyses were carried out to explore the hereditary factors for curative effect and the accumulation of genetic factors was further discussed through pathway analysis and the global test. We built a machine learning-based prediction model that integrates genetic and non-genetic factors (including cognition, endocrinology, personality intelligence) to distinguish drug efficacy in single class drug situations. The values of the non-genetic makers after 6 weeks' treatment were collected to evaluate the efficacy of the model. RESULTS Our results from the 6-week antidepressant therapeutic study indicated that SSRI and SNRI are better treatments than those of TCA and NaSSA in the Chinese population. Among all possible paired single-agent survival analyses, citalopram and venlafaxine were more effective than mirtazapine. Allele C carriers at rs6354 (SLC6A4) and allele G carriers at rs12150214 (SLC6A4) were significantly prone to poorer treatment response to fluoxetine. Besides, the combination of three loci (rs929377-rs6191-rs32897) located in HPA pathway was significantly associated with the treatment outcome of fluoxetine. In female MDD patients, the minor allele of rs6323 and rs1137070 on the MAOA gene likely lead to a worse response to venlafaxine. Furthermore, genetic variants linked to drug efficacy tended to concentrate on the neurotrophin pathway in depressed patients comorbid with anxiety. From multivariate models, more severe cognitive deficits, psychopathic personality and lower levels of operational intelligence, and higher levels of cortisol predicted worse response status with SSRI or SNRI after 6-week treatment. Notably, genetic factors in the multi-dimensional prediction model for both classes of drugs include loci in HTR2A and CRHBP genes. CONCLUSION SSRI and SNRI are more suitable for the treatment of Chinese people with depression. SLC6A4 genetic variants, as well as HPA pathway, play an important role in the fluoxetine antidepressant therapeutic response while the polymorphism of MAOA gene involved in the pharmacological action of venlafaxine among female MDD patients. The presence of anxiety in MDD patients was related to the neurotrophin pathway. Genetic, cognitive, neuroendocrine, and personality intelligence factors combined have an ensemble impact on the medication effect of patients with major depression, leading to more precise and personalized medicine for specific groups of people.
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Kennis M, Gerritsen L, van Dalen M, Williams A, Cuijpers P, Bockting C. Prospective biomarkers of major depressive disorder: a systematic review and meta-analysis. Mol Psychiatry 2020; 25:321-338. [PMID: 31745238 PMCID: PMC6974432 DOI: 10.1038/s41380-019-0585-z] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/09/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
Leading biological hypotheses propose that biological changes may underlie major depressive disorder onset and relapse/recurrence. Here, we investigate if there is prospective evidence for biomarkers derived from leading theories. We focus on neuroimaging, gastrointestinal factors, immunology, neurotrophic factors, neurotransmitters, hormones, and oxidative stress. Searches were performed in Pubmed, Embase and PsychInfo for articles published up to 06/2019. References and citations of included articles were screened to identify additional articles. Inclusion criteria were having an MDD diagnosis as outcome, a biomarker as predictor, and prospective design search terms were formulated accordingly. PRISMA guidelines were applied. Meta-analyses were performed using a random effect model when three or more comparable studies were identified, using a random effect model. Our search resulted in 67,464 articles, of which 75 prospective articles were identified on: Neuroimaging (N = 24), Gastrointestinal factors (N = 1), Immunology (N = 8), Neurotrophic (N = 2), Neurotransmitters (N = 1), Hormones (N = 39), Oxidative stress (N = 1). Meta-analyses on brain volumes and immunology markers were not significant. Only cortisol (N = 19, OR = 1.294, p = 0.024) showed a predictive effect on onset/relapse/recurrence of MDD, but not on time until MDD onset/relapse/recurrence. However, this effect disappeared when studies including participants with a baseline clinical diagnosis were removed from the analyses. Other studies were too heterogeneous to compare. Thus, there is a lack of evidence for leading biological theories for onset and maintenance of depression. Only cortisol was identified as potential predictor for MDD, but results are influenced by the disease state. High-quality (prospective) studies on MDD are needed to disentangle the etiology and maintenance of MDD.
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Affiliation(s)
- Mitzy Kennis
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Lotte Gerritsen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marije van Dalen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Alishia Williams
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.,School of Psychology, Faculty of Science, the University of New South Wales, Sydney, NSW, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands. .,Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands.
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Imani MM, Sadeghi M, Khazaie H, Sanjabi A, Brand S, Brühl A, Sadeghi Bahmani D. Associations Between Morning Salivary and Blood Cortisol Concentrations in Individuals With Obstructive Sleep Apnea Syndrome: A Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:568823. [PMID: 33542703 PMCID: PMC7851085 DOI: 10.3389/fendo.2020.568823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) may be associated with an increase in hypothalamic-pituitary-adrenocortical axis activity (HPA AA). We reviewed research comparing morning salivary and blood (serum and plasma) cortisol concentrations of individuals with OSAS to those of healthy controls. METHODS We made a systematic search without any restrictions of the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases for relevant articles published up to August 25, 2019. RESULTS Sixteen studies were analyzed in this meta-analysis; five studies compared morning salivary concentrations, five compared serum concentrations, four compared plasma cortisol concentrations, and two compared both salivary and plasma concentrations. In pediatric samples, compared to healthy controls, those with OSAS had significantly lower saliva morning cortisol concentrations (MD = -0.13 µg/dl; 95% CI: 0.21, -0.04; P = 0.003). In contrast, no significant differences were observed for serum cortisol concentrations, plasma cortisol concentrations, or salivary morning cortisol concentrations between adults with and without OSAS (p = 0.61, p = 0.17, p = 0.17). CONCLUSION Cortisol concentrations did not differ between adults with OSAS and healthy controls. In contrast, morning salivary cortisol concentrations were lower in children with OSAS, compared to healthy controls. Given that a reduced HPA AA is observed among individuals with chronic stress, it is conceivable that children with OSAS are experiencing chronic psychophysiological stress.
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Affiliation(s)
- Mohammad Moslem Imani
- Kermanshah University of Medical Sciences, Department of Orthodontics, Kermanshah, Iran
| | - Masoud Sadeghi
- Kermanshah University of Medical Sciences, Medical Biology Research Center, Kermanshah, Iran
| | - Habibolah Khazaie
- Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran
| | - Arezoo Sanjabi
- Kermanshah University of Medical Sciences, Students Research Committee, Kermanshah, Iran
| | - Serge Brand
- Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
- University of Basel, Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, Basel, Switzerland
- Kermanshah University of Medical Sciences, Substance Abuse Prevention Research Center, Kermanshah, Iran
- Tehran University of Medical Sciences, School of Medicine, Tehran, Iran
- *Correspondence: Serge Brand,
| | - Annette Brühl
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Dena Sadeghi Bahmani
- Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
- Kermanshah University of Medical Sciences, Substance Abuse Prevention Research Center, Kermanshah, Iran
- University of Basel, Psychiatric Clinics, Old Age Department, Basel, Switzerland
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Jahangard L, Hedayati M, Abbasalipourkabir R, Haghighi M, Ahmadpanah M, Faryadras M, Mikoteit T, Sadeghi Bahmani D, Brand S. Omega-3-polyunsatured fatty acids (O3PUFAs), compared to placebo, reduced symptoms of occupational burnout and lowered morning cortisol secretion. Psychoneuroendocrinology 2019; 109:104384. [PMID: 31382171 DOI: 10.1016/j.psyneuen.2019.104384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Occupational burnout is both a serious health concern at both public and individual levels. Treatment options are psychopharmacological, psychological and physical activity-related interventions. Here, we tested whether, compared to placebo, omega-3-polyunsaturated fatty acids (O3PUFAs) have a positive impact on burnout and morning cortisol secretion. METHOD A total of 43 individuals (mean age: 38.4 years, 76.7% females) took part in the present double-blind and placebo-controlled intervention. Participants were randomly assigned either to the O3PUFA or to the placebo condition. At baseline and again eight weeks later, participants completed the Maslach Burnout Inventory and collected morning saliva samples for analysis of the cortisol awakening response (CAR). RESULTS Emotional exhaustion and depersonalization decreased, and sense of personal accomplishment increased over time, but more so in the O3PUFA condition than in the placebo condition. Likewise, CAR decreased over time, but again more so in the O3PUFA condition than in the placebo condition. CONCLUSIONS The present pattern of results suggests that, compared to placebo, administration of daily omega-3-polyunsaturated fatty acids for eight consecutive weeks positively influences both psychological and physiological markers of occupational burnout.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical sciences, Hamadan, Iran
| | - Mahmoud Hedayati
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical sciences, Hamadan, Iran
| | | | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical sciences, Hamadan, Iran
| | - Mohammad Ahmadpanah
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical sciences, Hamadan, Iran
| | - Mohammad Faryadras
- Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Thorsten Mikoteit
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland; University of Basel, Psychiatric Hospital Solothurn, Solothurn, Switzerland
| | - Dena Sadeghi Bahmani
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Substance Abuse Prevention Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Isfahan University of Medical Sciences, Neurosciences Research Center, Alzahra Research Institute, Isfahan, Iran
| | - Serge Brand
- University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Substance Abuse Prevention Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; University of Basel, Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, Basel, Switzerland.
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The selective orexin-2 antagonist seltorexant (JNJ-42847922/MIN-202) shows antidepressant and sleep-promoting effects in patients with major depressive disorder. Transl Psychiatry 2019; 9:216. [PMID: 31481683 PMCID: PMC6722075 DOI: 10.1038/s41398-019-0553-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/25/2019] [Accepted: 08/11/2019] [Indexed: 12/18/2022] Open
Abstract
Excessive arousal has a role in the pathophysiology of major depressive disorder (MDD). Seltorexant (JNJ-42847922/MIN-202) is a selective antagonist of the human orexin-2 receptor (OX2R) that may normalize excessive arousal and thereby attenuate depressive symptoms. In this study, the effects of night-time arousal suppression on depressive symptoms were investigated. 47 MDD patients with a total Inventory of Depressive Symptomatology (IDS) score of ≥30 at screening were included in a randomized, double-blind, diphenhydramine-, and placebo-controlled multicentre study. Symptoms of depression were rated using the 17-item Hamilton Depression Rating Scale (HDRS17). Effects on sleep were evaluated by polysomnography and by the Leeds Sleep Evaluation Questionnaire (LSEQ). To investigate the safety and tolerability of seltorexant, vital signs, suicidal ideation and adverse events were monitored. At baseline the severity of depressive symptoms correlated with sleep efficiency (SE), wake after sleep onset (WASO), duration of stage 2 sleep, and ruminations. Ten days of treatment with seltorexant (and not diphenhydramine) resulted in a significant improvement of core depressive symptoms compared to placebo; the antidepressant efficacy of seltorexant was maintained with continued treatment up to 28 days. Compared to placebo, the antidepressant efficacy of seltorexant coincided with an overall increase in (left posterior) EEG power and a relative increase in delta- and decrease in theta-, alpha- and beta power during stage 2 sleep. Treatment with seltorexant was associated with mild, self-limiting adverse drug reactions. Seltorexant affected core symptoms of depression in the absence of overt changes in the hypnogram; in contrast, diphenhydramine was not efficacious.
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Imboden C, Gerber M, Beck J, Eckert A, Pühse U, Holsboer-Trachsler E, Hatzinger M. Effects of Aerobic Exercise as Add-On Treatment for Inpatients With Moderate to Severe Depression on Depression Severity, Sleep, Cognition, Psychological Well-Being, and Biomarkers: Study Protocol, Description of Study Population, and Manipulation Check. Front Psychiatry 2019; 10:262. [PMID: 31073292 PMCID: PMC6497035 DOI: 10.3389/fpsyt.2019.00262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/08/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Aerobic exercise (AE) may be a non-pharmacological strategy to improve depression treatment and lessen the burden of somatic comorbidity of depression. Only few studies have examined the effect of AE as an add-on treatment for moderate to severe depression in an inpatient setting, and most studies have focused on depression severity and cardiovascular parameters. The purpose of the present article is to present the study protocol, to provide information about the assessed study population, and to perform a manipulation check in order to examine whether the intervention program was properly implemented. Methods: We conducted a randomized controlled trial in two centers comparing 6 weeks of AE to a placebo control intervention (stretching) as an add-on to standardized inpatient treatment of moderate to severe depression. Besides depression severity, several other psychological and biological variables were measured such as salivary cortisol, brain-derived neurotropic factor, cognitive tests, and polysomnography. To evaluate long-term effects of the intervention, we also scheduled a follow-up 6 months after completion of the study intervention. Results: Forty-five patients were randomized to either AE (n = 23) or the placebo intervention (n = 22); 36 patients completed the 6-week intervention. In the AE group, 65% completed all 18 training sessions. Patients who were less physically active prior to admission were less likely to complete the study. With regard to energy expenditure, mean kcal/kg/week was 16.4 kcal/kg/week (range: 13.8-17.7), coming close to the targeted dose of 17.5 kcal/kg/week. Conclusions: Overall, patients showed good adherence to the intervention protocol despite at least moderate depression severity. However, the dropout rate suggests that depressed inpatients may need special support to adhere to a structured exercise intervention program. This study will add evidence on the effects of AE as an add-on to inpatient treatment of moderate to severe depression. Besides antidepressant effects, potentially beneficial effects of AE on a broad array of further variables associated with depression will be evaluated. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02679053.
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Affiliation(s)
- Christian Imboden
- Psychiatric Services Solothurn, Solothurn, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland.,Private Clinic Wyss, Münchenbuchsee, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Johannes Beck
- Psychiatric University Hospital, University of Basel, Basel, Switzerland.,Private Clinic Sonnenhalde, Riehen, Switzerland
| | - Anne Eckert
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Martin Hatzinger
- Psychiatric Services Solothurn, Solothurn, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
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Abstract
Antidepressants and Suicidality: A Contradiction? Abstract. In 2004, the European and American authorities released a black-box warning on antidepressants indicating an association with an increased risk of suicidality (suicidal ideation and behavior) in young people. Until today, this issue remained controversial. The present review gives an overview on the relationship between antidepressant therapy and the risk of suicide and suicidality, respectively: there is no evidence of an increased risk of suicide, but of an increased rate of suicidality during the first period after starting an antidepressant treatment in young patients. Importantly, this risk was not higher than before treatment initiation. However, an intensified supervision is needed especially during the first weeks of treatment. Finally, the risk posed by untreated depression is far greater than a risk associated with antidepressant treatment.
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Affiliation(s)
- Martin Hatzinger
- 1 Klinken für Psychiatrie, Psychotherapie und Psychosomatik, Solothurner Spitäler AG
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Leistner C, Menke A. How to measure glucocorticoid receptor's sensitivity in patients with stress-related psychiatric disorders. Psychoneuroendocrinology 2018; 91:235-260. [PMID: 29449045 DOI: 10.1016/j.psyneuen.2018.01.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/07/2017] [Accepted: 01/28/2018] [Indexed: 12/31/2022]
Abstract
Stress is a state of derailed homeostasis and a main environmental risk factor for psychiatric diseases. Chronic or uncontrollable stress may lead to a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is a common feature of stress-related psychiatric disorders. One of the key mechanisms underlying a disturbed HPA axis is an impaired function of the glucocorticoid receptor (GR) with an enhanced or reduced feedback sensitivity for glucocorticoids and subsequently altered concentrations of peripheral cortisol. GR function is regulated by a multiprotein complex including the different expression of the hsp90 co-chaperone FK 506 binding protein 51 (FKBP5) that may be genetically determined or acquired in response to stressful stimuli. Specific patterns of a dysregulation of the HPA axis and GR function are found in different stress-related psychiatric entities e.g. major depression, job-related exhaustion or posttraumatic stress disorder. GR challenge tests like the dexamethasone-suppression test (DST), the dexamethasone-corticotropin-releasing hormone (dex-CRH) test or most recently the analysis of the dexamethasone-induced gene expression are employed to sensitively measure HPA axis activity in these disorders. They provide information for a stratification of phenotypic similar but neurobiological diverse psychiatric disorders. In this review we present a synopsis of GR challenge tests with a focus on the application of the DST, the CRH test and the dex-CRH test as well as the dexamethasone-induced gene expression in stress-related psychiatric entities.
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Affiliation(s)
- Carolin Leistner
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, 97080, Germany
| | - Andreas Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, 97080, Germany; Comprehensive Heart Failure Center, University Hospital of Wuerzburg, Am Schwarzenberg 15, Wuerzburg, 97080, Germany.
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9
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Goncharova ND, Oganyan TE. Age-related differences in stress responsiveness of the hypothalamic-pituitary-adrenal axis of nonhuman primates with various types of adaptive behavior. Gen Comp Endocrinol 2018; 258:163-172. [PMID: 28789856 DOI: 10.1016/j.ygcen.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/08/2017] [Accepted: 08/03/2017] [Indexed: 01/08/2023]
Abstract
Aging is characterized by disturbances in the functioning of the hypothalamic-pituitary-adrenal (HPA) axis, associated with disturbances in the adaptation processes and increase of the probability of the onset of post-stress syndrome. However, the individual features of age-related disorders stress reactivity of HPA axis have not been studied. The purpose was to study individual characteristics of the HPA axis responsiveness to acute psycho-emotional stress exposure (restraint, ASE) at different age periods on the model of the young adult and old physically healthy female rhesus monkeys that differ in their behavioral responses to stress, i.e., with depression-like and anxiety-like behavior (DAB) on the one hand and healthy standard (control) adaptive behavior (SB) on the other hand. No significant intergroup differences were observed in HPA axis responses to ASE in young animals. During aging the monkeys with SB showed reduced ACTH response to the ASE, whereas the monkeys with DAB demonstrated its increase. The old animals with DAB in response to ASE demonstrated the most pronounced HPA axis disorders, such as the highest levels of corticotrophin (ACTH), the lowest levels of dehydroepiandrosterone sulfate (DHEAS), reduced cortisol (F) levels and the highest values of the F/DHEAS molar ratio. The ratio F/DHEAS positively correlates with the malondialdehyde concentration in erythrocytes that is considered as the biomarker of oxidative stress. Thus, these data allow us to consider the old monkeys with DAB as individuals with higher vulnerability to the adverse effects of ASE. In addition, depression-like and anxiety-like behavior of aged primates under mild/moderate stress along with reduced DHEAS plasma concentration and increased values of F/DHEAS ratio can be used to identify individuals with increased vulnerability to ASE and accelerated aging.
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Affiliation(s)
- Nadezhda D Goncharova
- Laboratory of Experimental Endocrinology, Research Institute of Medical Primatology, 177 Mira Street, Veseloye, Adler, Sochi 354376, Russia.
| | - Tamara E Oganyan
- Laboratory of Experimental Endocrinology, Research Institute of Medical Primatology, 177 Mira Street, Veseloye, Adler, Sochi 354376, Russia
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10
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O'Connell CP, Goldstein-Piekarski AN, Nemeroff CB, Schatzberg AF, Debattista C, Carrillo-Roa T, Binder EB, Dunlop BW, Craighead WE, Mayberg HS, Williams LM. Antidepressant Outcomes Predicted by Genetic Variation in Corticotropin-Releasing Hormone Binding Protein. Am J Psychiatry 2018; 175:251-261. [PMID: 29241359 PMCID: PMC5832545 DOI: 10.1176/appi.ajp.2017.17020172] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Genetic variation within the hypothalamic-pituitary-adrenal (HPA) axis has been linked to risk for depression and antidepressant response. However, these associations have yet to produce clinical gains that inform treatment decisions. The authors investigated whether variation within HPA axis genes predicts antidepressant outcomes within two large clinical trials. METHOD The test sample comprised 636 patients from the International Study to Predict Optimized Treatment in Depression (iSPOT-D) who completed baseline and 8-week follow-up visits and for whom complete genotyping data were available. The authors tested the relationship between genotype at 16 candidate HPA axis single-nucleotide polymorphisms (SNPs) and treatment outcomes for three commonly used antidepressants (escitalopram, sertraline, and extended-release venlafaxine), using multivariable linear and logistic regression with Bonferroni correction. Response and remission were defined using the Hamilton Depression Rating Scale. Findings were then validated using the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study of outcome predictors in treatment-naive patients with major depression. RESULTS The authors found that the rs28365143 variant within the corticotropin-releasing hormone binding protein (CRHBP) gene predicted antidepressant outcomes for remission, response, and symptom change. Patients homozygous for the G allele of rs28365143 had greater remission rates, response rates, and symptom reductions. These effects were specific to drug class. Patients homozygous for the G allele responded significantly better to the selective serotonin reuptake inhibitors escitalopram and sertraline than did A allele carriers. In contrast, rs28365143 genotype was not associated with treatment outcomes for the serotonin norepinephrine reuptake inhibitor venlafaxine. When patients were stratified by race, the overall effect of genotype on treatment response remained. In the validation sample, the GG genotype was again associated with favorable antidepressant outcomes, with comparable effect sizes. CONCLUSIONS These findings suggest that a specific CRHBP SNP, rs28365143, may have a role in predicting which patients will improve with antidepressants and which type of antidepressant may be most effective. The results add to the foundational knowledge needed to advance a precision approach to personalized antidepressant choices.
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Affiliation(s)
- Chloe P. O'Connell
- School of Medicine, Stanford University, Stanford, CA 94305; Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
| | - Andrea N. Goldstein-Piekarski
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Charles B. Nemeroff
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136; Dept. of Translational Research in Psychiary, Max Planck Institute for Psychiatry, Munich, Germany
| | - Alan F. Schatzberg
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
| | - Charles Debattista
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
| | - Tania Carrillo-Roa
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136; Dept. of Translational Research in Psychiary, Max Planck Institute for Psychiatry, Munich, Germany
| | - Elisabeth B. Binder
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136; Dept. of Translational Research in Psychiary, Max Planck Institute for Psychiatry, Munich, Germany,Dept. of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327; Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327
| | - Boadie W. Dunlop
- Dept. of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327; Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327
| | - W. Edward Craighead
- Dept. of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327; Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327,Dept. of Psychology, Emory University, Atlanta, GA 30322
| | - Helen S. Mayberg
- Dept. of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327; Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327
| | - Leanne M. Williams
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
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Klimes-Dougan B, Westlund Schreiner M, Thai M, Gunlicks-Stoessel M, Reigstad K, Cullen KR. Neural and neuroendocrine predictors of pharmacological treatment response in adolescents with depression: A preliminary study. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:194-202. [PMID: 29100972 DOI: 10.1016/j.pnpbp.2017.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/09/2017] [Accepted: 10/24/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Typically, about 30 to 50% of adolescents with depression fail to respond to evidence-based treatments, including antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). Efforts for identifying predictors and moderators of treatment response are needed to begin to address critical questions relevant to personalized care in adolescent depression. In this pilot study, we aim to identify biological predictors of response to antidepressant treatment. METHOD We used a multiple levels of analysis approach to evaluate threat system functioning (fronto-limbic system and the associated hormonal cascade) to determine if key biological indexes at baseline could predict improvement in depressive symptoms after eight weeks of antidepressant treatment in adolescents with depression. RESULTS Neural predictors of favorable treatment response included lower amygdala connectivity with left supplementary motor area and with right precentral gyrus, and greater amygdala connectivity with right central opercular cortex and Heschl's gyrus connectivity during rest. During an emotion task, neural predictors of treatment response were greater activation of the bilateral anterior cingulate cortex and left medial frontal gyrus. Additionally, different patterns of salivary cortisol obtained in the context of a modified Trier Social Stress Test were associated with those whose depressive symptoms remitted as compared to those whose symptoms persisted. CONCLUSIONS This approach shows significant promise for identifying predictors of treatment response in adolescents with depression. Future work is needed that incorporates sufficiently powered, randomized control trials to provide the basis by which both predictors and moderators of treatment response are identified. The hope is that this work will inform the development of methods that can guide clinician decision-making in assigning beneficial treatments for adolescents who are suffering from depression.
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Affiliation(s)
- Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States.
| | - Melinda Westlund Schreiner
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States; Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Michelle Thai
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | | | - Kristina Reigstad
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
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Hatzinger M, Hemmeter U, Hirsbrunner T, Holsboer-Trachsler E, Leyhe T, Mall JF, Mosimann U, Rach N, Trächsel N, Savaskan E. [Not Available]. PRAXIS 2018; 107:127-144. [PMID: 29382263 DOI: 10.1024/1661-8157/a002883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Diese Empfehlungen sollen dazu dienen, Fachpersonen das Wissen über die aktuelle Evidenz von Diagnostik und Therapie der Depression im Alter zur Verfügung zu stellen und damit zur frühzeitigen Erkennung und evidenzbasierten Behandlung beizutragen. Da für einige Behandlungsansätze nur rudimentär kontrollierte Studien vorliegen, wird auch das klinische Expertenwissen in die Beurteilung einbezogen. Im diagnostischen Vorgehen wird die besondere Symptomatik der Depression im Alter beleuchtet, auf die Suizidalität eingegangen und werden die häufig vorkommenden somatischen Komorbiditäten hervorgehoben. Auch Hypothesen zur Pathogenese, wie Neuroendokrinologie, Neurodegeneration und vaskuläre Faktoren, werden erläutert. In der Behandlung gilt heute ein integrierter biopsychosozialer Ansatz mit gezielten psychosozialen Interventionen, spezifischer Psychotherapie und einer antidepressiven Pharmakotherapie bei schweren Depressionen als sinnvoll. Daneben kommen auch chronobiologische oder Neurostimulationsverfahren zum Einsatz.
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Affiliation(s)
- Martin Hatzinger
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
- 2 Schweizerische Gesellschaft für Biologische Psychiatrie (SGBP)
| | - Ulrich Hemmeter
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
| | - Therese Hirsbrunner
- 4 Schweizerischer Berufsverband der Pflegefachfrauen und Pflegefachmänner (SBK)
| | | | - Thomas Leyhe
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
| | - Jean-Frédéric Mall
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
| | - Urs Mosimann
- 2 Schweizerische Gesellschaft für Biologische Psychiatrie (SGBP)
| | - Nicole Rach
- 5 Schweizerische Fachgesellschaft für Gerontopsychologie (SFGP)
| | - Nathalie Trächsel
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
| | - Egemen Savaskan
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
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Assessment of leukocyte activity in mice devoid of the glucocorticoid receptor in the noradrenergic system (GR DBHCre). Immunobiology 2017; 223:227-238. [PMID: 29030008 DOI: 10.1016/j.imbio.2017.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/05/2017] [Accepted: 10/07/2017] [Indexed: 12/30/2022]
Abstract
Disturbances in brain monoamines, overactivity of the hypothalamo-pituitary adrenal (HPA) axis and pro-inflammatory tendency in the immune system are the key features of depressive disorders. Recently, several murine lines with mutations in glucocorticoid receptors (GRs) have been generated and these animals may be utilized for study depressive-like disorders. In the present study, we have investigated whether selective ablation of GRs in noradrenergic neurons affects functional properties of leukocytes and redirects them towards pro-inflammatory activity. Transgenic mice selectively devoid of GRs on noradrenergic cells were constructed using the Cre/loxP approach. Peritoneal leukocytes were collected from mutant and wild type (WT) animals of both sexes and were cultured in vitro for 24h both in basal conditions and after application of selected pro- or anti-inflammatory stimuli. Metabolic activity and adherence were measured in basal conditions. Nitric oxide (NO) synthesis and arginase (ARG) activity were assessed as the markers of functional status of the cells. Because adult mutant mice lack adrenal medulla and thereby peripheral adrenaline, we modulated pro- and anti-inflammatory culture conditions by addition of noradrenaline (10-6M). Finally, effects of in vivo pro-inflammatory challenge (with intraperitoneal administration of lipopolysaccharide) on properties of leukocytes were assessed 24h (in both sexes) and 48h later (in males only). The experiments indicated that selective ablation of GR in noradrenergic neurons did not affect fundamental properties of peritoneal leukocytes and exerted effects only under conditions of selected pro- or anti-inflammatory stimuli in vitro. Stronger response to pro-inflammatory stimulation in terms of NO synthesis and ARG activity may suggest pro-inflammatory tendency in mutant mice. In vivo inflammatory challenge failed to show any effect of GR ablation on selected parameters of leukocyte activity. Both in vitro studies and in vivo challenge revealed mainly sex-related differences in leukocyte activity.
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14
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Mazurka R, Wynne-Edwards KE, Harkness KL. Stressful Life Events Prior to Depression Onset and the Cortisol Response to Stress in Youth with First Onset Versus Recurrent Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 44:1173-84. [DOI: 10.1007/s10802-015-0103-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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15
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Kunugi H, Hori H, Ogawa S. Biochemical markers subtyping major depressive disorder. Psychiatry Clin Neurosci 2015; 69:597-608. [PMID: 25825158 DOI: 10.1111/pcn.12299] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 01/07/2023]
Abstract
The pathophysiology of major depressive disorder (MDD) remains elusive, and there is no established biochemical marker used in the daily clinical setting. This situation may result in part from the heterogeneity of MDD, which might include heterogeneous subgroups with different biological mechanisms. In this review, we discuss three promising biological systems/markers to potentially subtype MDD: the dopamine system, the hypothalamic-pituitary-adrenal axis, and chronic inflammatory markers. Several lines of evidence suggest that a facet of MDD is a dopamine agonist-responsive subtype. Focusing on the hypothalamic-pituitary-adrenal axis, depressive spectrum disorders show hypercortisolism to hypocortisolism, which could be detected by hormonal challenge tests, such as the dexamethasone/corticotrophin-releasing hormone test. Finally, accumulating evidence suggests that at least some MDD patients show characteristics similar to those of chronic inflammatory diseases, including neuroinflammatory markers and reduced tryptophan due to the increased activation of the tryptophan-kynurenine pathway. Future studies should examine the inter-relations between these systems/markers to subtype and integrate the pathophysiology of MDD.
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Affiliation(s)
- Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shintaro Ogawa
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Hellman N, Morris MC, Rao U, Garber J. Depression history as a moderator of relations between cortisol and shame responses to social-evaluative threat in young adults. Biol Psychol 2015; 109:159-65. [PMID: 26048679 PMCID: PMC4516595 DOI: 10.1016/j.biopsycho.2015.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 11/26/2022]
Abstract
Changes in cortisol and shame are commonly elicited by psychosocial stressors involving social-evaluative threat. According to social self preservation theory, this coordinated psychobiological response is adaptive. Individuals with a history of depression, however, may exhibit diminished cortisol reactivity to acute stressors, which could interfere with coordinated cortisol and shame responses. The present study examined temporal relations between cortisol and shame responses to a psychosocial stress task in young adults who varied in their history of depression (56 remitted-depressed, 46 never-depressed). Lagged effects multilevel models revealed that depression history moderated relations between cortisol levels and shame ratings 25-55min later. The pattern of these interactions was similar: whereas higher cortisol levels predicted increases in shame in never-depressed individuals, cortisol levels were unrelated to shame responses in remitted-depressed individuals. Findings suggest a dissociation between cortisol and shame responses to stress in individuals with a history of depression.
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Affiliation(s)
- Natalie Hellman
- Department of Family and Community Medicine (NH and MCM) and the Center for Molecular and Behavioral Neuroscience (MCM), Meharry Medical College, from Children's Mental Health Services Research Center (UR), University of Tennessee, Knoxville, and from the Departments of Psychology and Human Development (JG), Psychiatry (JG), Pediatrics (UR), and Kennedy Center (UR, JG), Vanderbilt University, Nashville, TN, USA
| | - Matthew C Morris
- Department of Family and Community Medicine (NH and MCM) and the Center for Molecular and Behavioral Neuroscience (MCM), Meharry Medical College, from Children's Mental Health Services Research Center (UR), University of Tennessee, Knoxville, and from the Departments of Psychology and Human Development (JG), Psychiatry (JG), Pediatrics (UR), and Kennedy Center (UR, JG), Vanderbilt University, Nashville, TN, USA; Department of Psychology, Vanderbilt University, USA.
| | - Uma Rao
- Department of Family and Community Medicine (NH and MCM) and the Center for Molecular and Behavioral Neuroscience (MCM), Meharry Medical College, from Children's Mental Health Services Research Center (UR), University of Tennessee, Knoxville, and from the Departments of Psychology and Human Development (JG), Psychiatry (JG), Pediatrics (UR), and Kennedy Center (UR, JG), Vanderbilt University, Nashville, TN, USA
| | - Judy Garber
- Department of Family and Community Medicine (NH and MCM) and the Center for Molecular and Behavioral Neuroscience (MCM), Meharry Medical College, from Children's Mental Health Services Research Center (UR), University of Tennessee, Knoxville, and from the Departments of Psychology and Human Development (JG), Psychiatry (JG), Pediatrics (UR), and Kennedy Center (UR, JG), Vanderbilt University, Nashville, TN, USA
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17
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Hardeveld F, Spijker J, Peyrot WJ, de Graaf R, Hendriks SM, Nolen WA, Penninx BWJH, Beekman ATF. Glucocorticoid and mineralocorticoid receptor polymorphisms and recurrence of major depressive disorder. Psychoneuroendocrinology 2015; 55:154-63. [PMID: 25765757 DOI: 10.1016/j.psyneuen.2015.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/17/2015] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous research found that variants of the glucocorticoid receptor (GR) (9β, ER22/23EK, BclI, TthIIIl, NR3C1-1 and N363S) and mineralocorticoid receptor (MR) gene polymorphism (-2 C/G and I180V) are associated with both glucocorticoid (GC) sensitivity and major depressive disorder (MDD). There are no data which investigated prospectively whether these variants are associated with recurrence of MDD. METHODS Data were derived from the Netherlands Study of Depression and Anxiety (NESDA) which used the Composite International Diagnostic Interview (CIDI) to determine MDD. Polymorphisms in the GR and MR gene were determined and haplotypes were characterized. We analyzed in retrospect whether recurrent MDD (n=951) in comparison with first onset MDD (n=919) was associated with polymorphisms in the GR and MR gene. Furthermore, we analyzed prospectively for 4 years the time to recurrence among 683 subjects with a remitted MDD diagnosis. Time to recurrence of MDD was assessed using the CIDI and a life chart interview. Additionally, we analyzed interactions of the investigated polymorphisms with childhood trauma and recent negative life events. RESULTS GR and MR gene polymorphisms and derived haplotypes were not associated with recurrence of depression in both retrospective and prospective analyses. In addition, no consistent interactions between GR and MR polymorphisms and childhood trauma or life events were found. CONCLUSION This study did not find consistent associations between GR and MR gene polymorphisms, interactions between GR and MR haplotypes and stressful conditions and recurrence of MDD.
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Affiliation(s)
- Florian Hardeveld
- Pro Persona, Institute for Mental Health Care, PO Box 70, 6710 RR Ede, The Netherlands.
| | - Jan Spijker
- Pro Persona, Institute for Mental Health Care, PO Box 70, 6710 RR Ede, The Netherlands; Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands; Behavioral Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Wouter J Peyrot
- Department of Psychiatry/EMGO Institute for Health and Care Research/Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Sanne M Hendriks
- Pro Persona, Institute for Mental Health Care, PO Box 70, 6710 RR Ede, The Netherlands
| | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 72, 9700 AB Groningen, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry/EMGO Institute for Health and Care Research/Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry/EMGO Institute for Health and Care Research/Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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18
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Liang CS, Lee JF, Chen CC, Chang YC. Reactive heart rate variability in male patients with first-episode major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:52-7. [PMID: 25149628 DOI: 10.1016/j.pnpbp.2014.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/26/2014] [Accepted: 08/08/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The association between cardiovascular reactivity and major depressive disorder (MDD) remains unclear. This study aimed to examine this association via reactive heart rate variability (HRV) in a well-diagnosed first-episode MDD group and a control group. METHODS A total of 160 physically healthy, drug-naive patients presenting with their first-episode MDD and 50 healthy controls were recruited. All participants underwent a 5-min electrocardiography at rest and during a mental arithmetic task. Depression severity was assessed using the Beck Depression Inventory II (BDI). RESULTS HRV measures that showed between-group differences at rest did not reached significance during mental stress. In contrast, HRV measures that revealed between-group differences during stress did not reach significance at rest. In response to mental stress, HRV measures did not significantly change in both group. However, LF and HF in response to stress were different between groups. Patients with MDD revealed an increasing trend in HF and a decreasing trend in LF; conversely, healthy controls had a decreasing trend in HF and an increasing trend in LF. BDI scores correlated with changes in heart rate in the control group. CONCLUSIONS The fundamental change to reactive HRV in patients with first-episode MDD appears qualitative, not quantitative. A distinctly reverse trend in reactive HRV measures were evident between these two groups. Moreover, patients with MDD showed entirely distinct changes in reactive HRV from those in resting HRV. We suggest that in patients with MDD, autonomic system shifts to sympathetic dominance at rest but toward parasympathetic dominance in response to stress.
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Affiliation(s)
- Chih-Sung Liang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Jia-Fu Lee
- Department of Psychiatry, Taipei Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
| | - Chia-Chi Chen
- Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei, Taiwan, ROC
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan, ROC
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Knöchel C, Alves G, Friedrichs B, Schneider B, Schmidt-Rechau A, Wenzlera S, Schneider A, Prvulovic D, Carvalho AF, Oertel-Knöchel V. Treatment-resistant Late-life Depression: Challenges and Perspectives. Curr Neuropharmacol 2015; 13:577-91. [PMID: 26467408 PMCID: PMC4761630 DOI: 10.2174/1570159x1305151013200032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 12/28/2022] Open
Abstract
The current Review article provides a narrative review about the neurobiological underpinnings and treatment of treatment resistant late-life depression (TRLLD). The manuscript focuses on therapeutic targets of late-life depression, which include pharmacological, psychological, biophysical and exercise treatment approaches. Therefore, we summarize available evidences on that kind of therapies for patients suffering from late-life depression. The search for evidences of therapeutic options of late-life depression were done using searching websites as "pubmed", and using the searching terms "depression", "late-life depression", "treatment", "biophysical therapy", "exercise therapy", "pharmacological therapy" and "psychological therapy". To the end, we summarize and discuss current data, providing some directions for further research. Treatment recommendations for elderly depressive patients favour a multimodal approach, containing psychological, pharmacological and secondary biophysical therapeutic options. Particularly, a combination of psychotherapy and antidepressant medication reflects the best therapeutic option. However, mostly accepted and used is the pharmacological treatment although evidence suggests that the drug therapy is not as effective as it is in younger depressive patients. Further studies employing larger samples and longer follow-up periods are necessary and may focus on comparability of study designs and involve novel approaches to establish the validity and reliability of multimodal treatment programs.
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Affiliation(s)
- Christian Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Gilberto Alves
- Center for Alzheimer’s Disease and Related Disorders, Universidade Federal, do Rio de Janeiro, Brazil
| | - Benedikt Friedrichs
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | | | - Anna Schmidt-Rechau
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Sofia Wenzlera
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Angelina Schneider
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - David Prvulovic
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - André F. Carvalho
- Center for Alzheimer’s Disease and Related Disorders, Universidade Federal, do Rio de Janeiro, Brazil
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
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20
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Hardeveld F, Spijker J, Vreeburg SA, Graaf RD, Hendriks SM, Licht CMM, Nolen WA, Penninx BWJH, Beekman ATF. Increased cortisol awakening response was associated with time to recurrence of major depressive disorder. Psychoneuroendocrinology 2014; 50:62-71. [PMID: 25179322 DOI: 10.1016/j.psyneuen.2014.07.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Although HPA-axis activity has been studied extensively in relation to depression, there is no consensus whether HPA-axis parameters predicts major depressive disorder (MDD) recurrence. We investigated whether HPA-axis parameters (cortisol awakening response (CAR), the dexamethasone suppression test (DST) and evening cortisol) predict time to recurrence in remitted subjects with a history of MDD and whether childhood trauma and life events interact with HPA-axis parameters in increasing the risk for recurrence. METHOD Data were derived from 549 subjects with a lifetime diagnosis of MDD in remission for at least six months preceding the baseline assessment of the Netherlands Study of Depression and Anxiety (NESDA). Subjects were followed up with two interviews over the course of four years to assess recurrence. DSM-IV based diagnostic interviews were used to assess time to recurrence of MDD. Seven salivary cortisol samples collected at baseline with information on CAR, evening cortisol and the DST. Hazard ratios were calculated using Cox regression analysis, adjusted for covariates. RESULTS A higher CAR was associated with time to recurrence of MDD (HR=1.03, 95%CI 1.003-1.060, p=0.03) whereas evening cortisol and DST were not. No interactions between HPA-axis parameters and stress-related factors were found. CONCLUSIONS Our data support previous studies reporting that subjects with a higher CAR are more vulnerable to recurrence of MDD.
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Affiliation(s)
- Florian Hardeveld
- Pro Persona, Institute for Mental Health Care, P.O. Box 70, 6710 RR Ede, The Netherlands.
| | - Jan Spijker
- Pro Persona, Institute for Mental Health Care, P.O. Box 70, 6710 RR Ede, The Netherlands; Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands; Behavioral Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Sophie A Vreeburg
- Department of Psychiatry/EMGO Institute for Health and Care/Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Ron De Graaf
- Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands
| | - Sanne M Hendriks
- Pro Persona, Institute for Mental Health Care, P.O. Box 70, 6710 RR Ede, The Netherlands
| | - Carmilla M M Licht
- Department of Psychiatry/EMGO Institute for Health and Care/Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, P.O. Box 72, 9700 AB Groningen, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry/EMGO Institute for Health and Care/Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry/EMGO Institute for Health and Care/Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
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Abstract
Depression constitutes a novel and independent risk factor for cardiovascular disease, which despite extensive support in the literature has been underappreciated. While much of the evidence for depression as a risk factor for cardiovascular disease is based on studies following myocardial infarction, the elevated vascular risk conveyed by depression is not confined to periods following acute coronary syndromes. For that matter, the risk appears across mood disorders with evidence for even greater risk in bipolar disorder. This review summarizes the literature linking depressive disorders to cardiovascular mortality with a focus on how the course of illness of mood disorders may influence this risk. Mood disorders may influence risk over decades of illness in a dose-response to symptom burden, or the persistence of affective symptomatology. This may be mediated through changes in the activity of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, and inflammatory cytokines. Whether treatment of depression can mitigate this risk is not established although there are suggestions to support this contention, which could be better studied with more effective treatments of depression and larger standardized samples. Directions for future study of mechanisms and treatment are discussed. Regardless of causal mechanisms, persons with depressive disorders and other risk factors for vascular disease represent a neglected, high-risk group for cardiovascular events. In addition to the appropriate treatment for depression, screening and optimized management of traditional risk factors for cardiovascular diseases is necessary.
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Hatzinger M, Brand S, Perren S, Von Wyl A, Stadelmann S, von Klitzing K, Holsboer-Trachsler E. In pre-school children, sleep objectively assessed via actigraphy remains stable over 12 months and is related to psychological functioning, but not to cortisol secretion. J Psychiatr Res 2014; 55:22-8. [PMID: 24814637 DOI: 10.1016/j.jpsychires.2014.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/22/2014] [Accepted: 04/07/2014] [Indexed: 01/13/2023]
Abstract
STUDY OBJECTIVES Studies of the long-term stability of sleep in pre-schoolers are scarce. The aim of the present study was to investigate objectively assessed sleep via actigraphy in pre-schoolers longitudinally, and to predict sleep, psychological functioning and cortisol secretion prospectively as a function of sleep 12 months earlier. METHOD A total of 73 pre-schoolers (mean age: 5.45 years; 53% females) were assessed again after 12 (mean age: 6.4 years). Sleep-actigraphy recordings were performed, saliva cortisol was analysed, and parents and experts rated children's psychological functioning. RESULTS Longitudinally, poor sleep at age 5.45 years was associated with poor sleep and internalizing and peer problems but not with externalizing problems and hyperactivity, and cortisol secretion 12 months later. At age 6.4 years and cross-sectionally, poor sleep was concurrently associated with greater psychological difficulties and increased cortisol secretion. CONCLUSION In pre-schoolers, poor sleep objectively assessed at age five was associated with psychological difficulties and poor sleep as assessed via actigraph and one year later. Results indicate that in pre-schoolers sleep remains stable over a 12-mont interval. Pre-schoolers with poor sleep appear to be at risk for developing further psychological difficulties.
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Affiliation(s)
- Martin Hatzinger
- Psychiatric Services Solothurn, Department of Adult Psychiatry, Solothurn, Switzerland; Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics of the University of Basel, Switzerland
| | - Serge Brand
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics of the University of Basel, Switzerland; Department of Sport, Exercise and Health, Division of Sport Science, University of Basel, Basel, Switzerland.
| | - Sonja Perren
- University of Konstanz and Thurgau, University of Teacher Education, Switzerland
| | - Agnes Von Wyl
- Institute of Psychology, University of Zurich, Switzerland
| | - Stephanie Stadelmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Germany
| | - Edith Holsboer-Trachsler
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics of the University of Basel, Switzerland
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Morris MC, Rao U, Wang L, Garber J. Cortisol reactivity to experimentally manipulated psychosocial stress in young adults at varied risk for depression. Depress Anxiety 2014; 31:44-52. [PMID: 23606237 PMCID: PMC3735776 DOI: 10.1002/da.22125] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/22/2013] [Accepted: 02/24/2013] [Indexed: 11/05/2022] Open
Abstract
This study examined cortisol and affective reactivity to a psychosocial stress task in 102 young adults who varied in risk for depression (56 remitted depressed, 46 never depressed). Participants were randomly assigned to either a stress (i.e., social-evaluative threat) or control (i.e., no social-evaluative threat) condition. For never-depressed individuals, cortisol responses were significantly greater in the stress compared to the control condition. Moreover, cortisol responses were significantly greater for never-depressed than remitted-depressed individuals in the stress condition. For individuals with a history of depression, cortisol responses did not differ significantly between the stress and control conditions. Negative affective reactivity also was higher for never depressed, but not remitted depressed, individuals in the stress compared to the control condition. Moreover, cortisol responses were inversely related to negative affect during the recovery phase in both stress and control conditions. Findings indicate the lack of a robust cortisol response to social evaluation stress among remitted-depressed individuals as compared to that of never-depressed controls. Future studies should investigate unique and interactive links between these hypothalamic-pituitary-adrenal and affective reactivity alterations and risk for subsequent depressive episodes.
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Affiliation(s)
- Matthew C. Morris
- Center for Molecular and Behavioral Neuroscience (MCM and UR) and the Department of Psychiatry and Behavioral Sciences (UR), Meharry Medical College, and from the Departments of Psychology and Human Development (JG), Psychiatry (JG, UR), and Biostatistics (LW), and Kennedy Center (JG, UR), Vanderbilt University, Nashville, Tennessee
| | - Uma Rao
- Center for Molecular and Behavioral Neuroscience (MCM and UR) and the Department of Psychiatry and Behavioral Sciences (UR), Meharry Medical College, and from the Departments of Psychology and Human Development (JG), Psychiatry (JG, UR), and Biostatistics (LW), and Kennedy Center (JG, UR), Vanderbilt University, Nashville, Tennessee
| | - Lily Wang
- Center for Molecular and Behavioral Neuroscience (MCM and UR) and the Department of Psychiatry and Behavioral Sciences (UR), Meharry Medical College, and from the Departments of Psychology and Human Development (JG), Psychiatry (JG, UR), and Biostatistics (LW), and Kennedy Center (JG, UR), Vanderbilt University, Nashville, Tennessee
| | - Judy Garber
- Center for Molecular and Behavioral Neuroscience (MCM and UR) and the Department of Psychiatry and Behavioral Sciences (UR), Meharry Medical College, and from the Departments of Psychology and Human Development (JG), Psychiatry (JG, UR), and Biostatistics (LW), and Kennedy Center (JG, UR), Vanderbilt University, Nashville, Tennessee
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Sarubin N, Nothdurfter C, Schmotz C, Wimmer AM, Trummer J, Lieb M, Uhr M, Baghai TC, Wetter TC, Bühner M, Rupprecht R, Schüle C. Impact on cortisol and antidepressant efficacy of quetiapine and escitalopram in depression. Psychoneuroendocrinology 2014; 39:141-151. [PMID: 24275013 DOI: 10.1016/j.psyneuen.2013.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND In this study, the impact of quetiapine fumarate extended release (QXR) and escitalopram (ESC) on HPA axis activity was investigated in depressed patients in relationship to antidepressant efficacy. METHODS In a randomized, open-label 5-week trial 60 inpatients suffering from major depression (DSM-IV criteria) were treated for 5 weeks with either QXR (300 mg/day) or ESC (10mg/day). The dexamethasone/CRH (DEX/CRH) test was performed before treatment, after 1, and after 5 weeks of treatment. Cortisol (COR) AUC values were used to assess HPA axis function. The Hamilton Depression Rating Scale was used weekly to estimate antidepressant efficacy. RESULTS QXR and ESC showed comparable antidepressant effects but strongly differed in their impact on HPA axis activity. In the QXR group, a marked inhibition of COR AUC levels was observed which was most pronounced after one week of treatment but showed a partial re-increase after 5 weeks of treatment. In contrast, ESC transiently stimulated COR AUC values (week 1) whereas COR AUC levels at week 0 and week 5 were comparable. COR improvement at week 1 (defined as COR peak value reduction between DEX/CRH test 1 and 2) was significantly associated with better clinical outcome. CONCLUSION Apparently, different effects on HPA axis activity reflect distinct pharmacoendocrinological properties of psychotropic drugs.
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Affiliation(s)
- Nina Sarubin
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
| | - Caroline Nothdurfter
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany; Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Christian Schmotz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anna-Maria Wimmer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Julia Trummer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Martin Lieb
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Manfred Uhr
- Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Thomas C Baghai
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Thomas C Wetter
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Markus Bühner
- Department of Psychology/Statistics and Evaluation, Ludwig-Maximilian-University, Munich, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany; Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Cornelius Schüle
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
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25
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Sher L, Oquendo MA, Burke AK, Cooper TB, Mann JJ. Combined dexamethasone suppression-corticotrophin-releasing hormone stimulation test in medication-free major depression and healthy volunteers. J Affect Disord 2013; 151:1108-12. [PMID: 23866302 DOI: 10.1016/j.jad.2013.06.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal (HPA) axis is dysfunctional in a subgroup of mood disorders. METHODS We compared cortisol and adrenocorticotropic hormone (ACTH) responses in major depression and healthy volunteers to the combined dexamethasone suppression-corticotrophin-releasing hormone stimulation (DEX-CRH) test. Unlike other published studies, the study patients were medication-free and the healthy volunteers did not have first-degree relatives with a mood or psychotic disorder. Demographics, DSM-IV diagnoses and other clinical parameters were evaluated in major depressive disorder (MDD) and healthy control groups. Participants received an oral dose of 1.5mg dexamethasone at 11 pm the day before CRH administration. On the following day, at 3 pm, 100 µg of ovine CRH was infused. Blood samples for determination of cortisol and ACTH were collected every 15 min from 3 pm to 4:15 pm. Cortisol and ACTH responses were calculated as areas under the curve. RESULTS Controlling for age, baseline (i.e., post-dexamethasone) ACTH levels were higher in depressed patients compared to controls (p=0.01). There was a trend for higher ACTH responses in depressed patients compared to the control group (p=0.08). In depressed patients, cortisol and ACTH responses correlated positively with age, duration of illness and number of hospitalizations. LIMITATIONS Because of the cross-sectional study design we can only evaluate the nature of potential HPA axis disturbances that were present in patients when they are acutely depressed. CONCLUSIONS Feedback inhibition of ACTH secretion by cortisol is compromised in MDD, and this is independent of an age effect on the HPA axis function.
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Affiliation(s)
- Leo Sher
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA; James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, 130 West Kingsbridge Road, Bronx, New York, NY, USA.
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26
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Tsai HC, Lin SH, Lee IH, Chen PS, Chen KC, Yeh TL, Yao WJ, Chiu NT, Lu RB, Yang YK. Probing the association between dexamethasone-induced cortisol suppression and serotonin transporter availability among drug-free patients with major depressive disorder--a small-sample SPECT study with [¹²³I]ADAM. Psychoneuroendocrinology 2013; 38:2805-9. [PMID: 23816429 DOI: 10.1016/j.psyneuen.2013.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/26/2022]
Abstract
The association between hypothalamo-pituitary-adrenal (HPA) axis function and the serotonergic system could be involved in the mechanism of depression. However, neuroimaging evidence is scarce. The aim of the present study was to probe the association between dexamethasone suppression test response and serotonin transporter (SERT) availability in drug-free patients with major depressive disorder (MDD). Seventeen MDD patients (five males and twelve females) were recruited. SPECT with [(123)I] ADAM was used to measure the midbrain SERT availability, and HPA axis function was measured by the dexamethasone suppression test (DST). The association was significant when considering all participants (ρ=0.69, p=0.002). This association may have clinical implications for the treatment of MDD.
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Affiliation(s)
- Hsin Chun Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Douliou Branch, Yunlin, Taiwan
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27
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Vreeburg SA, Hoogendijk WJG, DeRijk RH, van Dyck R, Smit JH, Zitman FG, Penninx BWJH. Salivary cortisol levels and the 2-year course of depressive and anxiety disorders. Psychoneuroendocrinology 2013; 38:1494-502. [PMID: 23313277 DOI: 10.1016/j.psyneuen.2012.12.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/14/2012] [Accepted: 12/19/2012] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Depression and anxiety disorders have been associated with hyperactivity of the hypothalamic-pituitary adrenal (HPA) axis. However, lower cortisol levels have also been observed in depressed patients. Whether cortisol level predicts the course of these disorders has not been examined in detail. We examined whether salivary cortisol indicators predict the 2-year course of depression and anxiety disorders. METHODS Longitudinal data are obtained from 837 participants of the Netherlands Study of Depression and Anxiety, with a DSM-IV based depressive and/or anxiety disorder at baseline. At baseline, seven saliva samples were obtained, including the 1-h cortisol awakening response, evening cortisol level and a 0.5mg dexamethasone suppression test. At follow-up, DSM-IV based diagnostic interviews and Life Chart Interview integrating diagnostic and symptom trajectories over 2 years were administered to determine an unfavorable course. RESULTS 41.5% of the respondents had a 2-year unfavorable course trajectory without remission longer than 3 months. Adjusted analyses showed that a lower awakening response was associated with an unfavorable course (RR=0.83, p=0.03). No associations were found between evening cortisol or cortisol suppression after dexamethasone ingestion and an unfavorable course trajectory. CONCLUSIONS Among patients with depressive or anxiety disorders, a lower cortisol awakening response - which may be indicative of underlying exhaustion of the HPA axis - predicted an unfavorable course trajectory.
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Affiliation(s)
- Sophie A Vreeburg
- Department of Psychiatry, EMGO institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands
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28
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Sensitivity of depression-like behavior to glucocorticoids and antidepressants is independent of forebrain glucocorticoid receptors. Brain Res 2013; 1525:1-15. [PMID: 23727405 DOI: 10.1016/j.brainres.2013.05.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/14/2013] [Accepted: 05/19/2013] [Indexed: 12/13/2022]
Abstract
The location of glucocorticoid receptors (GR) implicated in depression symptoms and antidepressant action remains unclear. Forebrain glucocorticoid receptor deletion on a C57B/6×129×CBA background (FBGRKO-T50) reportedly produces increased depression-like behavior and elevated glucocorticoids. We further hypothesized that forebrain GR deletion would reduce behavioral sensitivity to glucocorticoids and to antidepressants. We have tested this hypothesis in mice with calcium calmodulin kinase IIα-Cre-mediated forebrain GR deletion derived from a new founder on a pure C57BL/6 background (FBGRKO-T29-1). We measured immobility in forced swim or tail suspension tests after manipulating glucocorticoids or after dose response experiments with tricyclic or monoamine oxidase inhibitor antidepressants. Despite forebrain GR deletion that was at least as rapid and more extensive than reported in the mixed-strain FBGRKO-T50 mice (Boyle et al. 2005), and possibly because of their different founder, our FBGRKO-T29-1 mice did not exhibit increases in depression-like behavior or adrenocortical axis hormones. Nevertheless, FBGRKO-T29-1 mice were at least as sensitive as floxed GR controls to the depressive effects of glucocorticoids and the effects of two different classes of antidepressants. FBGRKO-T29-1 mice also unexpectedly exhibited increased mineralocorticoid receptor (MR) gene expression. Our results reinforce prior evidence that antidepressant action does not require forebrain GR, and suggest a correlation between the absence of depression-like phenotype and combined MR up-regulation and central amygdala GR deficiency. Our findings demonstrate that GR outside the areas targeted in FBGRKO-T29-1 mice are involved in the depressive effects of glucocorticoids, and leave open the possibility that these GR populations also contribute to antidepressant action.
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29
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Dunlop BW, Binder EB, Cubells JF, Goodman MM, Kelley ME, Kinkead B, Kutner M, Nemeroff CB, Newport DJ, Owens MJ, Pace TWW, Ritchie JC, Rivera VA, Westen D, Craighead WE, Mayberg HS. Predictors of remission in depression to individual and combined treatments (PReDICT): study protocol for a randomized controlled trial. Trials 2012; 13:106. [PMID: 22776534 PMCID: PMC3539869 DOI: 10.1186/1745-6215-13-106] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 05/22/2012] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Limited controlled data exist to guide treatment choices for clinicians caring for patients with major depressive disorder (MDD). Although many putative predictors of treatment response have been reported, most were identified through retrospective analyses of existing datasets and very few have been replicated in a manner that can impact clinical practice. One major confound in previous studies examining predictors of treatment response is the patient's treatment history, which may affect both the predictor of interest and treatment outcomes. Moreover, prior treatment history provides an important source of selection bias, thereby limiting generalizability. Consequently, we initiated a randomized clinical trial designed to identify factors that moderate response to three treatments for MDD among patients never treated previously for the condition. METHODS/DESIGN Treatment-naïve adults aged 18 to 65 years with moderate-to-severe, non-psychotic MDD are randomized equally to one of three 12-week treatment arms: (1) cognitive behavior therapy (CBT, 16 sessions); (2) duloxetine (30-60 mg/d); or (3) escitalopram (10-20 mg/d). Prior to randomization, patients undergo multiple assessments, including resting state functional magnetic resonance imaging (fMRI), immune markers, DNA and gene expression products, and dexamethasone-corticotropin-releasing hormone (Dex/CRH) testing. Prior to or shortly after randomization, patients also complete a comprehensive personality assessment. Repeat assessment of the biological measures (fMRI, immune markers, and gene expression products) occurs at an early time-point in treatment, and upon completion of 12-week treatment, when a second Dex/CRH test is also conducted. Patients remitting by the end of this acute treatment phase are then eligible to enter a 21-month follow-up phase, with quarterly visits to monitor for recurrence. Non-remitters are offered augmentation treatment for a second 12-week course of treatment, during which they receive a combination of CBT and antidepressant medication. Predictors of the primary outcome, remission, will be identified for overall and treatment-specific effects, and a statistical model incorporating multiple predictors will be developed to predict outcomes. DISCUSSION The PReDICT study's evaluation of biological, psychological, and clinical factors that may differentially impact treatment outcomes represents a sizeable step toward developing personalized treatments for MDD. Identified predictors should help guide the selection of initial treatments, and identify those patients most vulnerable to recurrence, who thus warrant maintenance or combination treatments to achieve and maintain wellness.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Elisabeth B Binder
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Joseph F Cubells
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Mark M Goodman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mary E Kelley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Becky Kinkead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Michael J Owens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Thaddeus W W Pace
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - James C Ritchie
- Department of Clinical Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Vivianne Aponte Rivera
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Drew Westen
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
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Lok A, Mocking RJT, Ruhé HG, Visser I, Koeter MWJ, Assies J, Bockting CLH, Olff M, Schene AH. Longitudinal hypothalamic-pituitary-adrenal axis trait and state effects in recurrent depression. Psychoneuroendocrinology 2012; 37:892-902. [PMID: 22094110 DOI: 10.1016/j.psyneuen.2011.10.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/28/2011] [Accepted: 10/15/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Hypothalamic-pituitary-adrenal (HPA)-axis hyperactivity has been observed in (recurrent) major depressive disorder (MDD), although inconsistently and mainly cross-sectional. Longitudinal studies clarifying state-trait issues are lacking. We aimed to determine whether HPA-axis (hyper)activity in recurrent MDD is: (I) reflecting a persistent trait; (II) influenced by depressive state; (III) associated with stress or previous episodes; (IV) associated with recurrence; and (V) influenced by cognitive therapy. METHODS We included 187 remitted highly recurrent MDD-patients (mean number of previous episodes: 6.3), participating in a randomized-controlled-trial investigating the preventive effect of additional cognitive therapy on recurrence. In an add-on two-staged patient-control and prospective-cohort design, we first cross-sectionally compared patients' salivary morning and evening cortisol concentrations with 72 age- and sex-matched controls, and subsequently longitudinally followed-up the patients with repeated measures after three months and two years. RESULTS Patients had higher cortisol concentrations than controls (p<.001), which did not change by MDD-episodes during follow-up. HPA-axis activity had no relation with daily hassles or childhood life events. Cortisol concentrations were lower in patients with more previous episodes (p=.047), but not associated with recurrence(s) during follow-up. Finally, randomly assigned cognitive therapy at study-entry enhanced cortisol declines over the day throughout the two-year follow-up (p=.052). CONCLUSIONS Our results indicate that remitted recurrent MDD-patients have a persistent trait of increased cortisol concentrations, irrespective of stress. In combination with our finding that patients' cortisol concentrations do not change during new MDD-episodes (and thus not represent epiphenomenal or state-effects), our results support that hypercortisolemia fulfills the state-independence criterion for an endophenotype for recurrent depression.
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Affiliation(s)
- Anja Lok
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Mikoteit T, Brand S, Beck J, Perren S, von Wyl A, von Klitzing K, Holsboer-Trachsler E, Hatzinger M. Visually detected NREM Stage 2 sleep spindles in kindergarten children are associated with stress challenge and coping strategies. World J Biol Psychiatry 2012; 13:259-68. [PMID: 21486109 DOI: 10.3109/15622975.2011.562241] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Sleep EEG spindles are linked to efficient cortical-subcortical connectivity and intellectual abilities. The aim of the present study was to investigate the relationship of spindle activity to psychosocial stress response and coping strategies in healthy kindergarten children. METHODS In a cross-sectional study of 41 5-year old kindergarten children we examined stress-induced hypothalamic-pituitary-adrenocortical (HPA) system activity by saliva cortisol measurements and sleep regulation by sleep EEG-monitoring. Stress response was measured during the application of a standardized psychological challenge appropriate at this age. NREM S2 sleep EEG spindles were visually scored and put into relation to coping and HPA activity parameters. RESULTS An increased total number of NREM S2 sleep spindles correlated positively with increased high ego-involvement strategies such as "positive emotions". By contrast, total number of NREM S2 sleep spindles correlated negatively with low ego-involvement strategies such as "denial" and "avoidance". Stress induced HPA-activity correlated positively with coping strategies with high ego-involvement; while there was no correlation with low ego-involvement strategies. CONCLUSIONS Total number of visually detected NREM S2 sleep spindles is elevated in children with coping involving positive, high ego-involvement; in contrast, low ego-involvement during stress is associated with reduced total number of NREM S2 sleep spindles.
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Affiliation(s)
- Thorsten Mikoteit
- Psychiatric Hospital of the University of Basel, Psychiatric Out-Patient Clinic, Basel, Switzerland.
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Bschor T, Ising M, Erbe S, Winkelmann P, Ritter D, Uhr M, Lewitzka U. Impact of citalopram on the HPA system. A study of the combined DEX/CRH test in 30 unipolar depressed patients. J Psychiatr Res 2012; 46:111-7. [PMID: 22030468 DOI: 10.1016/j.jpsychires.2011.09.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/16/2011] [Accepted: 09/29/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system is one of the best replicated pathophysiological findings in depression. However, studies on the influence of treatment on the HPA system have partly yielded inconsistent results. OBJECTIVE To assess the effects of citalopram monotherapy on the HPA system of mainly drug naïve patients with major depression by means of the combined DEX/CRH test. METHODS The DEX/CRH test was conducted twice in 30 patients (25 drug naïve for the index episode) with major depression (single episode or unipolar recurrent; SCID I- and II-confirmed): directly before the start of a citalopram monotherapy (day 0) and four weeks thereafter (day 28). RESULTS Twenty-three patients responded (≥50% reduction in the HDRS(21)-score), and 17 of them also reached criteria of remission (HDRS ≤ 7). Baseline (dexamethasone-suppressed) and CRH-stimulated ACTH concentrations significantly decreased from day 0 to day 28. CRH-stimulated cortisol concentrations also fell, although not significantly, but baseline cortisol concentrations exhibited a significant increase from day 0 to day 28. CONCLUSIONS The blunting of the ACTH response in the DEX/CRH test under citalopram is in line with what has been observed in most studies with antidepressants. However, the partial rise in cortisol concentrations indicates an increase in the sensitivity of the adrenal cortex to ACTH. State-dependent alterations in the volume and the ACTH responsiveness of the adrenal gland have repeatedly been reported in depressed subjects, which indicates the possibility that SSRIs such as citalopram might exhibit a direct or indirect effect on the adrenal cortex.
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Affiliation(s)
- Tom Bschor
- Schlosspark-Clinic, Department of Psychiatry, Berlin, Germany.
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Bschor T, Ritter D, Winkelmann P, Erbe S, Uhr M, Ising M, Lewitzka U. Lithium monotherapy increases ACTH and cortisol response in the DEX/CRH test in unipolar depressed subjects. A study with 30 treatment-naive patients. PLoS One 2011; 6:e27613. [PMID: 22132117 PMCID: PMC3223180 DOI: 10.1371/journal.pone.0027613] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/20/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Distorted activity of the hypothalamic-pituitary-adrenocortical (HPA) system is one of the most robustly documented biological abnormalities in major depression. Lithium is central to the treatment of affective disorders, but little is known about its effects on the HPA system of depressed subjects. OBJECTIVE To assess the effects of lithium monotherapy on the HPA system of patients with major depression by means of the combined DEX/CRH test. METHOD Thirty drug-naive outpatients with major depression (single episode or unipolar recurrent; SCID I- and II-confirmed) were treated with lithium monotherapy for four weeks. The DEX/CRH test was conducted directly before intake of the first lithium tablet and four weeks thereafter. Weekly ratings with the HDRS(21) were used to determine response (≥50% symptom reduction) and remission (HDRS ≤7). RESULTS Lithium levels within the therapeutic range were achieved rapidly. Tolerability was good; no patient terminated the treatment prematurely. Response and remission rates were 50% and 33% respectively. Compared to the DEX/CRH test before the start of the treatment, a considerable and significant increase in all CRH-stimulated ACTH and cortisol parameters could be detected in the second DEX/CRH test. When analysed with particular regard to responders and non-responders, that significant increase was only present in the responders. CONCLUSIONS We were able to demonstrate that lithium leads to a significant activation of the HPA system. This is possibly connected to stimulation of hypothalamic arginine vasoporessin (AVP), to direct intracellular effects of lithium on pituitary cells and to an induction of gene expression. TRIAL REGISTRATION drks-nue.uniklinik-freiburg.de DRKS00003185.
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Affiliation(s)
- Tom Bschor
- Department of Psychiatry, Schlosspark-Clinic, Berlin, Germany.
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Carpenter LL, Tyrka AR, Lee JK, Tracy AP, Wilkinson CW, Price LH. A placebo-controlled study of sertraline's effect on cortisol response to the dexamethasone/corticotropin-releasing hormone test in healthy adults. Psychopharmacology (Berl) 2011; 218:371-9. [PMID: 21617914 PMCID: PMC4467780 DOI: 10.1007/s00213-011-2336-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 04/20/2011] [Indexed: 11/29/2022]
Abstract
RATIONALE The dexamethasone/corticotropin-releasing hormone (Dex/CRH) test is a neuroendocrine probe involving serial blood sampling of cortisol during a standardized pharmacological challenge without inducing psychological distress in humans. Some past studies in depressed patients have shown a "normalization" or decrease in cortisol response to the Dex/CRH test following successful treatment with an antidepressant. Studies in nondepressed healthy adult samples have also shown aberrant cortisol reactivity to be associated with depression risk factors. These findings prompted research into the use of the Dex/CRH test as a tool for developing antidepressant drugs. OBJECTIVES In this study, the Dex/CRH test was evaluated with regard to its potential utility for drug development in nonclinical samples. METHODS The Dex/CRH test was administered before and after 6 weeks of blinded treatment with either sertraline 100 mg/day or matching placebo in 22 healthy adults (13 women, nine men). RESULTS Cortisol response to the Dex/CRH test increased following treatment with standard doses of sertraline, compared to placebo, after controlling for age and sex. CONCLUSIONS The observed pattern of change contrasts with results from published studies in depressed patients and with our initial hypothesis.
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Affiliation(s)
- Linda L. Carpenter
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Brown Department of Psychiatry and Human Behavior, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA
| | - Audrey R. Tyrka
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Brown Department of Psychiatry and Human Behavior, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA
| | - Janet K. Lee
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Brown Department of Psychiatry and Human Behavior, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA
| | - Aaron P. Tracy
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Brown Department of Psychiatry and Human Behavior, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA
| | - Charles W. Wilkinson
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA. Department of Psychiatry and Behavioral Sciences, University of Washington, 1660 S. Columbian Way, Seattle, WA 98108, USA
| | - Lawrence H. Price
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Brown Department of Psychiatry and Human Behavior, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA
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Paslakis G, Krumm B, Gilles M, Schweiger U, Heuser I, Richter I, Deuschle M. Discrimination between patients with melancholic depression and healthy controls: comparison between 24-h cortisol profiles, the DST and the Dex/CRH test. Psychoneuroendocrinology 2011; 36:691-8. [PMID: 21035272 DOI: 10.1016/j.psyneuen.2010.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 09/04/2010] [Accepted: 10/03/2010] [Indexed: 11/30/2022]
Abstract
Diurnal (24-h) cortisol profiles were compared to DST and Dex/CRH test outcomes with regard to their discriminative power in depressive disorder. With regard to several statistical measures (effect sizes, area under the curve) we found 24-h cortisol profiles to better discriminate between healthy controls and inpatients with the melancholic subtype of depression compared to the DST and Dex/CRH test. In search of a shortened time interval we found the 2-h time window 1000-1200 h of the cortisol profile to be the one with the highest sensitivity (83.3%) and specificity (87.9%). The specificity of the DST was 93.3% and somewhat higher than that of the cortisol profiles and the Dex/CRH test (87.9% and 78.8.%, respectively). However, the sensitivity of the DST was very low (30.8%), in fact similar to that of the Dex/CRH test (30.8%), but much lower than that of the 1000-1200 h interval (83.3%). The assessment of cortisol in plasma is an easy to perform, cost-saving method for the evaluation of the HPA system activity, which may have a series of clinical and scientific implications for the depressive disorder.
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Affiliation(s)
- Georgios Paslakis
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany.
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Abstract
INTRODUCTION Glucocorticoids and the stress hormone system have been implicated in the pathophysiology of depression and in the mechanism of action of antidepressant response. Many studies have investigated this system in an effort to predict response to antidepressant treatment. The purpose of this review is to evaluate the evidence for using glucocorticoid-related measures for personalized treatment of depression. METHODS We conducted a MEDLINE search from 1966 through 2010 and examined English-language studies reporting on the use of endocrine challenge tests and genetic polymorphisms in genes regulating the stress hormone system as predictors of antidepressant response. RESULTS While measures of glucocorticoid levels using endocrine tests, as well polymorphisms in genes regulating the stress hormone system, show associations with response to antidepressant treatment, these measures will need to be combined with other variables, including clinical information and other biological measures, to realize the goal of highly predictive and clinically relevant biomarkers. DISCUSSION The glucocorticoid system is potentially of great use in predicting antidepressant response. New combinations of biomarkers including these measures should be tested to develop clinically relevant predictors.
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Affiliation(s)
- Sonja Horstmann
- Max Planck Institute of Psychiatry-RG Molecular Genetics of Affective Disorders, Munich, Germany
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Goncharova ND, Marenin VY, Oganyan TE. Aging of the hypothalamic-pituitary-adrenal axis in nonhuman primates with depression-like and aggressive behavior. Aging (Albany NY) 2011; 2:854-66. [PMID: 21098884 PMCID: PMC3006027 DOI: 10.18632/aging.100227] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We have investigated aging of the hypothalamic-pituitary-adrenal (HPA) axis in female rhesus monkeys that differ in adaptive behavior. Plasma cortisol (F) and dehydroepiandrosterone sulfate (DHEA-S) concentrations under basal conditions and under acute psycho-emotional stress were evaluated in blood plasma of young (6-8 years) and old (20-27 years) female rhesus monkeys with various types of adaptive behavior (aggressive, depression-like, and average). We have found that the age-related changes in the HPA axis of monkeys with depression-like behavior were accompanied by the maximal absolute and relative hypercortisolemia under both basal conditions and stress. Moreover, young aggressive monkeys, in comparison with young monkeys of other behavior groups, demonstrated the highest plasma levels of DHEA-S and the lowest molar ratios between F and DHEA-S. Thus, age-related dysfunctions of the HPA axis are associated with adaptive behavior of animals.
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Affiliation(s)
- Nadezhda D Goncharova
- Laboratory of Endocrinology, Research Institute of Medical Primatology of the Russian Academy of Medical Sciences, Sochi, Adler, Veseloye 1, 354376, Russian Federation.
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Dunlop BW, Betancourt Y, Binder EB, Heim C, Holsboer F, Ising M, McKenzie M, Mletzko T, Pfister H, Nemeroff CB, Craighead WE, Mayberg HS. Tolerability of the dexamethasone-corticotropin releasing hormone test in major depressive disorder. J Psychiatr Res 2011; 45:24-8. [PMID: 20488460 PMCID: PMC2950910 DOI: 10.1016/j.jpsychires.2010.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/15/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The dexamethasone-corticotropin releasing hormone (Dex-CRH) test may differentially predict which depressed patients will respond to antidepressant medication. However, a comprehensive analysis of the safety of this test in psychiatric patients has not previously been performed. METHODS We conducted a pooled analysis of depressed patients in four clinical studies. Observed and subjectively reported side-effects in 454 patients were collected for 90 minutes following CRH administration. Pre-test electrocardiograms were available in 250 patients to assess cardiac safety. Descriptive statistics were performed to evaluate these safety data. RESULTS Eight-six (18.9%) subjects experienced no side-effects from the procedure. The mean number of side-effects per subject was 1.4±1.0. The most frequent adverse events were: flushing (n=216, 47.6%), feeling of warmth (144, 31.7%), hyperpnea/tachypnea (108, 23.8%), palpitations (37, 8.1%), and tachycardia (28, 6.2%). Side-effects were consistently mild and brief in duration. There were no serious adverse events. CONCLUSION The Dex-CRH test produces a mild, predictable side-effect profile, characterized by flushing, feelings of warmth, hyperpnea/tachypnea, palpitations, and tachycardia. These results provide reassurance that the Dex-CRH test is well tolerated in psychiatric patients.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road NE, Building A, 3rd Floor, Atlanta, GA 30322, USA.
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Aubry JM, Jermann F, Gex-Fabry M, Bockhorn L, Van der Linden M, Gervasoni N, Bertschy G, Rossier MF, Bondolfi G. The cortisol awakening response in patients remitted from depression. J Psychiatr Res 2010; 44:1199-204. [PMID: 20471032 DOI: 10.1016/j.jpsychires.2010.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 04/14/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
Abstract
An impressive number of data has been accumulated on dysfunctions of the hypothalamo-pituitary-adrenal (HPA) axis and cortisol hypersecretion in depression. To assess the dynamic HPA functioning, the cortisol awakening response (CAR) is an easily accessible and reliable approach. Some data suggest that elevated CAR in depressed patients has trait-like characteristics. Therefore we investigated whether patients in remission from a depressive episode have elevated CAR compared to control subjects. CAR of thirty-eight patients in remission from depression (11 men, 27 women, age range 24-66) and 52 control participants were analyzed (18 men, 34 women, age range 24-63). All patients had experienced ≥3 previous depressive episodes and were off psychotropic medication since at least 3 months. Saliva samples were collected only once, at home, either on weekend or weekday at 0, 15, 30, 45 and 60 min post-awakening. The area under the curve (AUC) above minimum cortisol concentration displayed large interindividual variability (6.4-fold in remitted patients and 8.1-fold in controls, based on 80% range). Investigation of possible variability factors showed that percent explained variance increased from 3.9% when group was considered alone to 8.8%, 12.3% and 19.2% after adjusting for significant effects of weekday vs. weekend, wake-up time and sleep duration, respectively. According to the latter model, AUC was estimated to be 51% higher in remitted patients than in controls (p = 0.007), while a 21% AUC decrease was associated with a 1-h longer sleep duration (p<0.001). In future studies, detection of between-group differences might benefit from adjusting for sleep duration and other possible confounders.
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Affiliation(s)
- Jean-Michel Aubry
- Department of Psychiatry, Geneva University Hospital, Bipolar Program, 6-8 rue du 31 Décembre, 1207 Geneva, Switzerland.
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Paslakis G, Heuser I, Schweiger U, Deuschle M. A single DEX/CRH test in male drug-free depressed patients is associated with the clinical response to treatment with fluoxetine. J Psychiatr Res 2010; 44:1154-7. [PMID: 20447650 DOI: 10.1016/j.jpsychires.2010.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 04/08/2010] [Accepted: 04/08/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The DEX/CRH test has been proposed to be suitable as a biomarker for the prediction of treatment response in depression. METHODS We performed the DEX/CRH test in 10 severely depressed male patients with melancholic features before initiation of antidepressant treatment with 20 mg fluoxetine. RESULTS We found a low cortisol response (as measured by cortisol AUC) to a single DEX/CRH test to be associated with clinical response to treatment. CONCLUSIONS A strength of this study lies in the inclusion of patients after a drug wash-out phase. Despite a certain inconsistency described in the literature, several studies support the notion that it might be of importance to measure baseline HPA system activity before choice of treatment. Further systematic studies are warranted.
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Kunugi H, Hori H, Adachi N, Numakawa T. Interface between hypothalamic-pituitary-adrenal axis and brain-derived neurotrophic factor in depression. Psychiatry Clin Neurosci 2010; 64:447-59. [PMID: 20923424 DOI: 10.1111/j.1440-1819.2010.02135.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Although the pathophysiology of depressive disorder remains elusive, two hypothetical frameworks seem to be promising: the involvement of hypothalamic pituitary-adrenal (HPA) axis abnormalities and brain-derived neurotrophic factor (BDNF) in the pathogenesis and in the mechanism of action of antidepressant treatments. In this review, we focused on research based on these two frameworks in relation to depression and related conditions and tried to formulate an integrated theory of the disorder. Hormonal challenge tests, such as the dexamethasone/corticotropin-releasing hormone test, have revealed elevated HPA activity (hypercortisolism) in at least a portion of patients with depression, although growing evidence has suggested that abnormally low HPA axis (hypocortisolism) has also been implicated in a variety of stress-related conditions. Several lines of evidence from postmortem studies, animal studies, blood levels, and genetic studies have suggested that BDNF is involved in the pathogenesis of depression and in the mechanism of action of biological treatments for depression. Considerable evidence has suggested that stress reduces the expression of BDNF and that antidepressant treatments increase it. Moreover, the glucocorticoid receptor interacts with the specific receptor of BDNF, TrkB, and excessive glucocorticoid interferes with BDNF signaling. Altered BDNF function is involved in the structural changes and possibly impaired neurogenesis in the brain of depressed patients. Based on these findings, an integrated schema of the pathological and recovery processes of depression is illustrated.
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Affiliation(s)
- Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.
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Wirtz PH, Siegrist J, Schuhmacher A, Hoefels S, Maier W, Zobel AW. Higher overcommitment to work is associated with higher plasma cortisol but not ACTH responses in the combined dexamethasone/CRH test in apparently healthy men and women. Psychoneuroendocrinology 2010; 35:536-43. [PMID: 19818562 DOI: 10.1016/j.psyneuen.2009.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 08/31/2009] [Accepted: 09/02/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Overcommitment (OC) is a pattern of excessive striving that has been associated with alterations in the hypothalamus-pituitary-adrenal (HPA) system. To investigate whether overcommitment is associated with alterations in HPA system function we measured cortisol and adrenocorticotropin (ACTH) release in response to the combined dexamethasone/CRH test. METHODS We recruited 92 men and 108 women of a wide range of OC scores including the minimum (6) and maximum (24) of possible OC scores (mean+/-SEM: 13.25+/-.27). We repeatedly measured plasma cortisol and ACTH levels in the combined dexamethasone/CRH test after injection of 100mul CRH preceded by administration of 1.5mg dexamethasone the night before. Moreover, we assessed depressive symptoms (Beck Depression Inventory, BDI) and work stress (effort-reward-imbalance, ERI). RESULTS Independent of age and gender, higher OC was associated with higher repeated cortisol (interaction time-by-OC: p=.014, f=.15) but not ACTH (p=.22) secretion in the combined dexamethasone/CRH test. Similarly, higher cortisol (beta=.16, p=.029, R(2)=.02) but not ACTH (p=.47) increase following CRH injection was predicted by higher OC. Depressive symptoms (BDI score) and work stress scores (effort-reward-ratio) did not relate to neuroendocrine responses to the dexamethasone/CRH test. Controlling for depressive symptoms and work stress scores in addition to age and gender did not change results. OC was not associated with ACTH or cortisol pre-test levels. DISCUSSION Whereas OC was not associated with alterations in negative feedback sensitivity after dexamethasone administration, our findings indicate that with increasing OC scores, a higher reactivity of the adrenal cortex together with a normal reactivity of the pituitary is observed following subsequent stimulation by CRH injection.
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Affiliation(s)
- Petra H Wirtz
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Switzerland
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Heydendael W, Jacobson L. Widespread hypothalamic-pituitary-adrenocortical axis-relevant and mood-relevant effects of chronic fluoxetine treatment on glucocorticoid receptor gene expression in mice. Eur J Neurosci 2010; 31:892-902. [DOI: 10.1111/j.1460-9568.2010.07131.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hatzinger M, Brand S, Perren S, Stadelmann S, von Wyl A, von Klitzing K, Holsboer-Trachsler E. Sleep actigraphy pattern and behavioral/emotional difficulties in kindergarten children: association with hypothalamic-pituitary-adrenocortical (HPA) activity. J Psychiatr Res 2010; 44:253-61. [PMID: 19762039 DOI: 10.1016/j.jpsychires.2009.08.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 08/11/2009] [Accepted: 08/20/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Various studies of adult endocrinology and sleep show close connections between poor sleep quality, deterioration of the HPA axis and negative psychological characteristics. However, the extent to which these associations may have already emerged and developed in childhood remains unclear. METHODS A total of 82 preschoolers (age 4.91+/-0.48) underwent activity monitoring for seven consecutive days and nights, wearing a digital movement-measuring instrument. Additionally, on the first and on the last morning of sleep registration, the activity of the HPA axis was assessed via the amount of cortisol in the saliva. Psychological and behavioral assessments were also made. RESULTS Three sub-groups of good (22%), normal (58.5%) and poor (19.5%) sleepers were distinguished. Poor sleep patterns were associated with higher HPA activity and with behavioral/emotional difficulties. CONCLUSIONS The interplay between unfavorable sleep patterns, deterioration of the HPA axis and behavioral/emotional difficulties is already apparent in pre-school children.
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Affiliation(s)
- Martin Hatzinger
- Psychiatric Outpatient Department, University of Basel, Switzerland
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Holsboer F, Ising M. Stress hormone regulation: biological role and translation into therapy. Annu Rev Psychol 2010; 61:81-109, C1-11. [PMID: 19575614 DOI: 10.1146/annurev.psych.093008.100321] [Citation(s) in RCA: 277] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Stress is defined as a state of perturbed homeostasis following endangerment that evokes manifold adaptive reactions, which are summarized as the stress response. In the case of mental stress, the adaptive response follows the perception of endangerment. Different peptides, steroids, and biogenic amines operate the stress response within the brain and also after they have been released into circulation. We focus in this review on the biological roles of corticosteroids, corticotrophin-releasing hormone (CRH), and arginine vasopressin (AVP), and we evaluate the effects of treatments directed against the actions of these hormones. CRH and AVP are the central drivers of the stress hormone system, but they also act as neuromodulators in the brain, affecting higher mental functions including emotion, cognition, and behavior. When released toward the pituitary, these central neuropeptides elicit corticotrophin into the periphery, which activates corticosteroid release from the adrenal cortex. These stress hormones are essential for the adequate adaptation to stress, but they can also evoke severe clinical conditions once persistently hypersecreted. Depression and anxiety disorders are prominent examples of stress-related disorders associated with an impaired regulation of stress hormones. We summarize the effects of drugs acting at specific targets of the stress hormone axis, and we discuss their potential use as next-generation antidepressant medications. Such treatments require the identification of patients that will optimally benefit from such specific interventions. These could be a first step into personalized medicine using treatments tailored to the specific pathology of the patients.
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Affiliation(s)
- Florian Holsboer
- Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany.
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Abstract
OBJECTIVE The study examined whether cortisol measures are associated with the clinical course of depression in adolescents. Furthermore, the study evaluated whether the relationship between cortisol and clinical course is moderated by environmental stress and/or social support. METHOD Fifty-five adolescents with depression (age range 13-18 years) were recruited. In addition to a systematic diagnostic assessment, information was obtained on environmental stress and social support. Urinary free cortisol measures were collected on three consecutive nights during the index episode. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period, documenting recovery from the index depressive episode and recurrent episodes. Information on environmental stress and social support also was gathered during each follow-up assessment. RESULTS Consistent with prior reports, the majority of adolescents (92.2%) recovered from the initial depressive episode. A substantial proportion of the recovered youth (42.6%) experienced a subsequent episode during the follow-up period. Higher cortisol levels were associated with a longer time to recovery from the index depressive episode. The effect of cortisol on recovery was moderated by social support. The combination of elevated cortisol and recent stressful experiences predicted recurrence, whereas a higher level of social support was protective against recurrence. CONCLUSIONS These data, in conjunction with prior literature, suggest that depression reflects an underlying neurobiological vulnerability that may predispose individuals with high vulnerability to chronic, recurrent episodes. Psychosocial factors, independently or in combination with an underlying neurobiological vulnerability, also play an important role in determining the clinical course of depression.
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Balbo M, Leproult R, Van Cauter E. Impact of sleep and its disturbances on hypothalamo-pituitary-adrenal axis activity. Int J Endocrinol 2010; 2010:759234. [PMID: 20628523 PMCID: PMC2902103 DOI: 10.1155/2010/759234] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 03/27/2010] [Indexed: 11/25/2022] Open
Abstract
The daily rhythm of cortisol secretion is relatively stable and primarily under the influence of the circadian clock. Nevertheless, several other factors affect hypothalamo-pituitary-adrenal (HPA) axis activity. Sleep has modest but clearly detectable modulatory effects on HPA axis activity. Sleep onset exerts an inhibitory effect on cortisol secretion while awakenings and sleep offset are accompanied by cortisol stimulation. During waking, an association between cortisol secretory bursts and indices of central arousal has also been detected. Abrupt shifts of the sleep period induce a profound disruption in the daily cortisol rhythm, while sleep deprivation and/or reduced sleep quality seem to result in a modest but functionally important activation of the axis. HPA hyperactivity is clearly associated with metabolic, cognitive and psychiatric disorders and could be involved in the well-documented associations between sleep disturbances and the risk of obesity, diabetes and cognitive dysfunction. Several clinical syndromes, such as insomnia, depression, Cushing's syndrome, sleep disordered breathing (SDB) display HPA hyperactivity, disturbed sleep, psychiatric and metabolic impairments. Further research to delineate the functional links between sleep and HPA axis activity is needed to fully understand the pathophysiology of these syndromes and to develop adequate strategies of prevention and treatment.
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Affiliation(s)
- Marcella Balbo
- Sleep, Chronobiology and Neuroendocrinology Research Laboratory, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Rachel Leproult
- Sleep, Chronobiology and Neuroendocrinology Research Laboratory, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Eve Van Cauter
- Sleep, Chronobiology and Neuroendocrinology Research Laboratory, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
- *Eve Van Cauter:
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Gallagher P, Reid KS, Ferrier IN. Neuropsychological functioning in health and mood disorder: Modulation by glucocorticoids and their receptors. Psychoneuroendocrinology 2009; 34 Suppl 1:S196-207. [PMID: 19541428 DOI: 10.1016/j.psyneuen.2009.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 05/21/2009] [Accepted: 05/26/2009] [Indexed: 12/14/2022]
Abstract
Numerous studies have shown that disturbances in hypothalamic-pituitary-adrenal (HPA) axis function and consequent hypercortisolaemia occur in a significant proportion of patients with mood disorders. This dysfunction has been proposed to be an exacerbating factor of depressive symptoms and may predict symptomatic relapse. Glucocorticoids are also known to have a specific role in learning and memory processes. In this review we present a brief overview of the relationship between HPA axis dysfunction and neuropsychological impairment in mood disorders and the specific links between glucocorticoids and cognition in health and illness states. Finally we examine the neuropsychological effects of drugs that specifically target glucocorticoid receptor function.
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Marques AH, Silverman MN, Sternberg EM. Glucocorticoid dysregulations and their clinical correlates. From receptors to therapeutics. Ann N Y Acad Sci 2009; 1179:1-18. [PMID: 19906229 PMCID: PMC2933142 DOI: 10.1111/j.1749-6632.2009.04987.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Clinicians have long known that a substantial proportion of patients treated with high-dose glucocorticoids experience a variety of serious side effects, including metabolic syndrome, bone loss, and mood shifts, such as depressive symptomatology, manic or hypomanic symptoms, and even suicide. The reason for individual variability in expression or severity of these side effects is not clear. However, recent emerging literature is beginning to shed light on possible mechanisms of these effects. As an introduction to this volume, this chapter will review the basic biology of glucocorticoid release and molecular mechanisms of glucocorticoid receptor function, and will discuss how dysregulation of glucocorticoid action at all levels could contribute to such side effects. At the molecular level, glucocorticoid receptor polymorphisms may be associated either with receptor hypofunction or hyperfunction and could thus contribute to differential individual sensitivity to the effects of glucocorticoid treatment. Numerous factors regulate hypothalamic-pituitary-adrenal (HPA) axis responsiveness, which could also contribute to individual differences in glucocorticoid side effects. One of these is sex hormone status and the influence of estrogen and progesterone on HPA axis function and mood. Another is immune system activity, in which immune molecules, such as interleukins and cytokines, activate the HPA axis and alter brain function, including memory, cognition, and mood. The effects of cytokines in inducing sickness behaviors, which overlap with depressive symptomatology, could also contribute to individual differences in such symptomatology. Taken together, this knowledge will have important relevance for identifying at-risk patients to avoid or minimize such side effects when they are treated with glucocorticoids. A framework for assessment of patients is proposed that incorporates functional, physiological, and molecular biomarkers to identify subgroups of patients at risk for depressive symptomatology associated with glucocorticoid treatment, and for prevention of side effects, which in many cases can be life-threatening.
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Affiliation(s)
- Andrea H Marques
- Section on Neuroendocrine Immunology and Behavior, Integrative Neural Immune Program, National Institute of Mental Health, National Institutes of Health, Rockville, Maryland, USA
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Dex/CRH test cortisol response in outpatients with major depression and matched healthy controls. Psychoneuroendocrinology 2009; 34:1208-13. [PMID: 19375869 PMCID: PMC3580166 DOI: 10.1016/j.psyneuen.2009.03.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 03/09/2009] [Accepted: 03/12/2009] [Indexed: 12/28/2022]
Abstract
BACKGROUND The dexamethasone/corticotropin releasing hormone (Dex/CRH) test has been proposed as a potential tool for identifying endophenotypes relevant to mood disorders. An exaggerated cortisol response to the test during major depressive episodes has been demonstrated for inpatients with melancholic or psychotic features. A diminished hormone response has been observed in chronically depressed outpatients. METHODS Following a battery of self-report and interview assessments, 68 adults completed the Dex/CRH test. Thirty-four met structured interview criteria for current major depressive disorder and 34 age- and sex-matched control subjects had no current or lifetime DSM-IV depressive disorder. Effect of diagnosis on cortisol response to the Dex/CRH test was examined in a repeated measures general linear model. RESULTS The matched groups were equivalent with regard to childhood adversity. Cortisol response to the Dex/CRH test among subjects with current MDD was not significantly different from that seen in matched healthy controls. Independent of diagnosis, an exploratory analysis showed a trend-level association between maltreatment history and diminished cortisol response; no interactive effects with depression diagnosis were detected. CONCLUSIONS The results do not support the hypothesis that elevated cortisol response to the Dex/CRH test represents a marker for major depressive episodes.
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