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Hori H, Yoshida F, Ishida I, Matsuo J, Ogawa S, Hattori K, Kim Y, Kunugi H. Blood mRNA expression levels of glucocorticoid receptors and FKBP5 are associated with depressive disorder and altered HPA axis. J Affect Disord 2024; 349:244-253. [PMID: 38199409 DOI: 10.1016/j.jad.2024.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND While depression has been associated with alterations in the hypothalamic-pituitary adrenal (HPA) axis function, there is still controversy regarding the nature and extent of the dysfunction, such as in the debate about hypercortisolism vs. hypocortisolism. It may therefore be necessary to understand whether and how HPA axis function in depression is linked to mRNA expression of key genes regulating this system. METHODS We studied 163 depressed outpatients, most of whom were chronically ill, and 181 healthy controls. Blood mRNA expression levels of NR3C1 (including GRα, GRβ, and GR-P isoforms), FKBP4, and FKBP5 were measured at baseline. HPA axis feedback sensitivity was measured by the dexamethasone (Dex)/corticotropin-releasing hormone (CRH) test. The association between mRNA expression levels and HPA axis feedback sensitivity was examined. RESULTS Compared to controls, patients showed significantly higher expression of GRα and lower expression of FKBP5, and higher post-Dex cortisol levels, even after controlling for age and sex. FKBP5 expression was significantly positively correlated with cortisol levels in patients, while GRα expression was significantly negatively correlated with cortisol levels in controls. LIMITATIONS Most patients were taking psychotropic medications. The large number of correlation tests may have caused type I errors. CONCLUSIONS The tripartite relationship between depression, mRNA expression of GR and FKBP5, and HPA axis function suggests that the altered gene expression affects HPA axis dysregulation and, as a result, impacts the development and/or illness course of depressive disorder. The combination of increased GRα expression and decreased FKBP5 expression may serve as a biomarker for chronic depression.
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Affiliation(s)
- Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Fuyuko Yoshida
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ikki Ishida
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shintaro Ogawa
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan; Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan.
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Hennings JM, Ising M, Uhr M, Holsboer F, Lucae S. Recurrent suicide attempts affect normalization of HPA axis dysregulation after recovery from major depression. Front Psychiatry 2022; 13:937582. [PMID: 36032226 PMCID: PMC9412752 DOI: 10.3389/fpsyt.2022.937582] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
More than 700,000 people worldwide die by suicide every year, and the number of suicide attempts is estimated as 20 times higher, most of them being associated with psychiatric disorders, especially major depression. Knowledge about effective methods for preventing suicide attempts in individuals at high risk for suicide is still scarce. Dysregulation of the neuroendocrine stress response system, i.e., the hypothalamic-pituitary-adrenocortical (HPA) axis, is one of the most consistent neurobiological findings in both major depression and suicidality. While the HPA axis is mostly overactive in depression, individuals with a history of suicide attempts exhibit an attenuated hormonal response to stress. It is unknown, however, whether the HPA axis is constantly attenuated in repeated suicide attempters or whether it regains normal responsivity after recovery from depression. Using the combined dexamethasone suppression/corticotropin-releasing hormone (dex/CRH) test, we assessed HPA axis regulation in acute depression (N = 237) and after recovery with respect to previous suicide attempts. Patients without previous suicide attempts show normalization of the stress hormone response to the second dex/CRH (basal ACTH response and cortisol response) after recovery from acute depression, while patients with multiple previous SA show an increased ACTH response. The change in HPA axis responsivity in patients with only one previous SA lies between the response patterns of the other groups with no change in HPA axis reactivity. Our findings suggest that patients with a history of suicide attempts belong to a subgroup of individuals that exhibit a distinct pattern of stress hormone response during acute depression and after recovery. Future studies may extend our approach by investigating additional psychological stress tasks to gain a broader understanding of the stress pathology of recurrent suicide attempters.
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Affiliation(s)
- Johannes M Hennings
- Translational Department, Max Planck Institute of Psychiatry, Munich, Germany.,Department of Dialectical Behavioral Therapy, kbo-Isar-Amper-Klinikum Munich-East, Munich, Germany
| | - Marcus Ising
- Translational Department, Max Planck Institute of Psychiatry, Munich, Germany
| | - Manfred Uhr
- Translational Department, Max Planck Institute of Psychiatry, Munich, Germany
| | - Florian Holsboer
- Translational Department, Max Planck Institute of Psychiatry, Munich, Germany.,HMNC Brain Health GmbH, Munich, Germany
| | - Susanne Lucae
- Translational Department, Max Planck Institute of Psychiatry, Munich, Germany
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Effects of weariness of life, suicide ideations and suicide attempt on HPA axis regulation in depression. Psychoneuroendocrinology 2021; 131:105286. [PMID: 34090135 DOI: 10.1016/j.psyneuen.2021.105286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023]
Abstract
UNLABELLED The neuropathological mechanisms leading to suicidality are still unknown, which, in view of an annual toll of around 1 million completed suicides constitutes an urgent clinical and societal problem. Alterations of stress hormone (ACTH and cortisol, representing the activity of the hypothalamic-pituitary-adrenocortical, HPA axis) regulation has been repeatedly studied in context of suicidality. Following a suicide attempt, stress hormone activity seems to be blunted, while depressed patients with suicidal ideation often present with elevated HPA axis activity. METHODS We investigated the effects of different forms of suicidality on HPA axis regulation in 568 hospitalized patients of the Munich Antidepressant Response Signature (MARS) project. All patients had a diagnosis of a depressive disorder; 62 patients reported a recent suicide attempt, 192 patients suicide ideation, and 171 patients expressed weariness of life as the weakest form of suicidality, the latter not being analyzed in studies so far. All patients participated in the combined dexamethasone/corticotropin releasing hormone (dex/CRH) test for assessing HPA axis regulation shortly after admission to the hospital. RESULTS We found an increased ACTH and cortisol response following the dex/CRH-test in patients that were weary of life. In contrast, stress hormone response in suicide attempters and suicide ideators did not differ from non-suicidal patients. Further, repeated suicide attempts in patients' history were associated with more pronounced stress hormone attenuation. CONCLUSION In this so far largest study analyzing the HPA axis with respect to suicidality, we could not confirm the assumption of a general attenuation of HPA axis response in depressed suicide ideators and attempters. Conversely, HPA axis appears to be influenced by divergent effects of a specific suicidal psychopathology as well as outlasting effects of previous suicide attempts. We discuss these findings in the light of recent concepts of suicidality, pointing to multifactorial effects of acute and predisposing conditions on HPA axis reactivity in depressed patients.
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Chong L, Han L, Liu R, Ma G, Ren H. Association of Lymphocyte-to-Monocyte Ratio with Poststroke Depression in Patients with Acute Ischemic Stroke. Med Sci Monit 2021; 27:e930076. [PMID: 34021110 PMCID: PMC8152443 DOI: 10.12659/msm.930076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Poststroke depression (PSD) is a common neuropsychiatric disorder after stroke. The neuroinflammatory response exerts a vital effect in the development of PSD. Lymphocyte-to-monocyte ratio (LMR), a systemic inflammation biomarker, is associated with poor prognosis of acute ischemic stroke (AIS). The purpose of this study was to determine the association between LMR and PSD at 3 months. Material/Methods AIS patients (507) were included in this study. Patients were categorized into 3 tertiles and each tertile contains 169 patients: tertile1 (>4.85), tertile 2 (2.96 to 4.85), and tertile 3 (<2.96), based on LMR values and the numbers of patients. PSD was diagnosed with a 17-item Hamilton Depression Scale score of 8 or higher. Results Patients (141; 27.8%) were diagnosed with PSD at 3-month follow-up. Patients in the PSD group presented with more severe stroke and lower LMR values (P<0.001). Decreased LMRs were independently associated with occurrence of PSD (middle tertile: odds ratio [OR] 1.823, P=0.037; lowest tertile: OR 3.024, P<0.001). A significant association of a lower LMR value with PSD severity was found (middle tertile: OR 1.883, P=0.031; lowest tertile: OR 2.633, P=0.001). The receiver operating characteristic curve indicates that the optimal threshold of LMR as a predictor for PSD was 3.14, which yielded a sensitivity of 72.4% and a specificity of 68.1%. Conclusions Decreased LMR is independently associated with PSD and increased PSD severity.
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Affiliation(s)
- Lining Chong
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Lin Han
- Department of Neurology, Hengshui Hospital of Traditional Chinese Medicine, Hengshui, Hebei, China (mainland)
| | - Ruqian Liu
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Guomei Ma
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Hao Ren
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
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Petrowski K, Herhaus B, Conrad R, Bornstein SR. Hormonal responsiveness in the Trier Social Stress Test and the dexamethasone-corticotropin releasing hormone test in healthy individuals. Psych J 2021; 10:305-317. [PMID: 33511783 DOI: 10.1002/pchj.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 11/07/2022]
Abstract
A number of different laboratory procedures investigate the hormonal response in a standardized pharmacological challenge test (dexamethasone-corticotropin releasing hormone; DEX-CRH) or in a psychosocial stress induction on the hypothalamic-pituitary-adrenocortical axis by the Trier Social Stress Test (TSST). However, the magnitude of the response related to the different stressors and the interaction of the responsiveness between the two tests is still unclear. Fifty-two participants underwent both the DEX-CRH test and the TSST on two separate days. The cortisol and the plasma adrenocorticotropic hormone (ACTH) release were assessed before and after the stress tests. For a specification of the cortisol response to both conditions, subgroups of high- and low-cortisol responders to the TSST and the DEX-CRH test were formed. The healthy participants showed a substantial increase in the ACTH and the cortisol concentration after the two tests. This increase was 3 times greater in the TSST than the DEX-CRH test. High responders in both tests demonstrated a higher factor of the cortisol reactivity ratio (TSST/DEX-CRH test). Psychosocial stress as induced by the TSST was associated with a significantly greater increase in cortisol compared to the DEX-CRH test, even though the ACTH response displayed no differences. Our findings indicate an interaction of the hormonal responsiveness between the two tests with regard to the cortisol patterns.
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Affiliation(s)
- Katja Petrowski
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Dresden, Germany
| | - Benedict Herhaus
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Bonn, Bonn, Germany
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Dresden, Germany
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Barroca NCB, Baes CVW, Martins-Monteverde CMS, Bosaipo NB, Santos da Silva Umeoka M, Tejada J, Antunes-Rodrigues J, de Castro M, Juruena MF, Garcia-Cairasco N, Umeoka EHDL. Evaluation of the HPA Axis' Response to Pharmacological Challenges in Experimental and Clinical Early-Life Stress-Associated Depression. eNeuro 2021; 8:ENEURO.0222-20.2020. [PMID: 33318074 PMCID: PMC7814478 DOI: 10.1523/eneuro.0222-20.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/27/2020] [Accepted: 11/20/2020] [Indexed: 02/08/2023] Open
Abstract
Early-life stress (ELS) is associated with a higher risk of psychopathologies in adulthood, such as depression, which may be related to persistent changes in the hypothalamic-pituitary-adrenal (HPA) axis. This study aimed to evaluate the effects of ELS on the functioning of the HPA axis in clinical and experimental situations. Clinically, patients with current depressive episodes, with and without ELS, and healthy controls, composed the sample. Subjects took a capsule containing placebo, fludrocortisone, prednisolone, dexamethasone or spironolactone followed by an assessment of plasma cortisol the morning after. Experimentally, male Wistar rats were submitted to ELS protocol based on variable, unpredictable stressors from postnatal day (PND)1 to PND21. On PND65 animals were behaviorally evaluated through the forced-swimming test (FST). At PND68, pharmacological challenges started, using mifepristone, dexamethasone, spironolactone, or fludrocortisone, and corticosterone levels were determined 3 h after injections. Cortisol response of the patients did not differ significantly from healthy subjects, regardless of their ELS history, and it was lower after fludrocortisone, prednisolone, and dexamethasone compared with placebo, indicating the suppression of plasma cortisol by all these treatments. Animals exposed to ELS presented altered phenotype as indicated by an increased immobility time in the FST when compared with control, but no significant long-lasting effects of ELS were observed on the HPA axis response. Limitations on the way the volunteers were sampled may have contributed to the lack of ELS effects on the HPA axis, pointing out the need for further research to understand these complex phenomena.
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Affiliation(s)
- Nayara Cobra Barreiro Barroca
- Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
| | - Cristiane Von Werne Baes
- Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
| | | | - Nayanne Beckmann Bosaipo
- Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
| | - Marcia Santos da Silva Umeoka
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
- Research Group on Neurobiology of Behavior, Cognition and Emotions, Faculty of Medicine, University Center Unicerrado, Goiatuba, 75600-000, Brazil
| | - Julian Tejada
- Psychology Department, Federal University of Sergipe, São Cristóvão, 49100-000, Brazil
| | - José Antunes-Rodrigues
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
| | - Margaret de Castro
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
| | - Mario Francisco Juruena
- Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
- Department of Psychological Medicine, Kings College London, London, SE5 8AF, United Kingdom
| | - Norberto Garcia-Cairasco
- Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
| | - Eduardo Henrique de Lima Umeoka
- Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14040-900, Brazil
- Research Group on Neurobiology of Behavior, Cognition and Emotions, Faculty of Medicine, University Center Unicerrado, Goiatuba, 75600-000, Brazil
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Scherf-Clavel M, Wurst C, Nitschke F, Stonawski S, Burschka C, Friess L, Unterecker S, Hommers L, Deckert J, Domschke K, Menke A. Extent of cortisol suppression at baseline predicts improvement in HPA axis function during antidepressant treatment. Psychoneuroendocrinology 2020; 114:104590. [PMID: 32006918 DOI: 10.1016/j.psyneuen.2020.104590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/18/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND A dysregulation in the hypothalamic-pituitary-adrenal (HPA)-axis function has been repeatedly observed in major depressive disorders (MDD). Normalization of this dysregulation, i.e. of cortisol suppression after glucocorticoid receptor (GR)-stimulation, may be mandatory for clinical remission in some patient subgroups. However, there are no biological measures applied in the clinical setting to identify patient subgroups with HPA axis alterations. OBJECTIVE We aimed to define a suppression index of cortisol concentrations before and after GR stimulation with dexamethasone to predict the variability in improvement of HPA axis activity during antidepressant treatment. METHODS A modified dexamethasone suppression test (mDST) was performed with blood withdrawal for cortisol and ACTH measurement before and 3 h after 1.5 mg dexamethasone intake at 18:00 in two cohorts of depressed patients treated in a naturalistic setting. The discovery sample consisted of 106 patients, the replication sample of 117 patients. The suppression index was defined as cCORTpreDEXcCORTpostDEX. RESULTS The baseline suppression index explained 27.4 % of the variance in changes of HPA axis activity before and after treatment with antidepressants. Age, cCORTpreDEXcACTHpreDEX at baseline and sex explained further variance up to 56.2 % (stepwise linear regression, p = 7.8e-8). A threshold of the suppression index at baseline was determined by ROC analysis and revealed, that only patients with a maximum index of 2.32 achieved a normalization of the HPA axis activity after antidepressant treatment. In the replication sample, the threshold was 2.86. However, the estimated suppression index was not associated with treatment response. CONCLUSION For the first time, by establishing a short-term suppression index of cortisol before and after GR-stimulation a threshold could be identified to predict improvement of HPA axis activity during antidepressant therapy. After replication in further studies this index may help to identify patients who benefit from a specific treatment that targets components of the HPA axis in the future.
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Affiliation(s)
- Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
| | - Catherina Wurst
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany; Interdisciplinary Center for Clinical Research, University of Würzburg, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany; Comprehensive Heart Failure Center, University Hospital of Würzburg, Am Schwarzenberg 15, Würzburg, 97080, Germany
| | - Felix Nitschke
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Saskia Stonawski
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany; Interdisciplinary Center for Clinical Research, University of Würzburg, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany; Comprehensive Heart Failure Center, University Hospital of Würzburg, Am Schwarzenberg 15, Würzburg, 97080, Germany
| | - Carolin Burschka
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Lisa Friess
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Leif Hommers
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany; Interdisciplinary Center for Clinical Research, University of Würzburg, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany; Comprehensive Heart Failure Center, University Hospital of Würzburg, Am Schwarzenberg 15, Würzburg, 97080, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany
| | - Andreas Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany; Interdisciplinary Center for Clinical Research, University of Würzburg, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany; Comprehensive Heart Failure Center, University Hospital of Würzburg, Am Schwarzenberg 15, Würzburg, 97080, Germany
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Polymorphisms in the BDNF and BDNFOS genes are associated with hypothalamus-pituitary axis regulation in major depression. Prog Neuropsychopharmacol Biol Psychiatry 2019; 95:109686. [PMID: 31295515 DOI: 10.1016/j.pnpbp.2019.109686] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/05/2019] [Indexed: 12/28/2022]
Abstract
Major depression is a stress-related disorder with robust clinical and preclinical data implicating that both, dysregulation of the hypothalamus-pituitary-adrenocortical (HPA) axis and of the neurotrophin system of the brain are involved in the pathophysiology. Genetic variations within the brain-derived neurotrophic factor (BDNF) gene region, a major representative of the brain neurotrophins, are suggested to influence response to antidepressant treatment. Specifically, we recently identified two BDNF single nucleotide polymorphisms (SNP), rs2049046 and rs11030094, as associated with antidepressant treatment response in a large pharmacogenetic study of hospitalized patients. We now analyzed these two SNPs in a sub-sample for their association with HPA axis dysregulation using the combined dexamethasone suppression/corticotropin releasing hormone challenge (dex/CRH) test at hospital admission (N = 266) and at discharge (N = 190). Rs11030094, located 3' outside the coding region of BDNF, is also located in an intron of BDNFOS coding for a functional antagonist of BDNF. We further included the non-synonymous Val66Met (rs6265) polymorphism in our analysis, for which - albeit being extensively studied - conflicting results in respect to its role in antidepressant treatment response have been reported. Similar to the previous analysis, rs2049046 and rs11030094 showed a significant effect on antidepressant response. In a gene-dose dependent manner, we found significant lower cortisol responses to the dex/CRH test at discharge in carriers of the respective SNP alleles ('T' of rs2049046 and 'G' of rs11030094) that were associated with antidepressant response (beneficial alleles). These genetic effects on HPA axis regulation were independent of age, sex, medication and depressive symptomatology. Although not reaching statistical significance, the same direction of effect was observed for cortisol at admission, as well as the ACTH response at admission and discharge. An interaction analysis of both SNPs revealed highest cortisol levels in subjects that were non-carriers of both beneficial alleles. The Val66Met (rs6265) was neither associated with antidepressant response nor with HPA axis regulation. Our findings provide further evidence for an interaction of the HPA axis and the neurotrophin system in major depression. This study stresses the importance investigating BDNF variants beyond the extensively studied Val66Met polymorphism. In-depth analyses of both pathophysiologically relevant systems may point to possible new targets for pharmaceutical intervention and precision medicine of major depression in the future.
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Bonapersona V, Damsteegt R, Adams ML, van Weert LTCM, Meijer OC, Joëls M, Sarabdjitsingh RA. Sex-Dependent Modulation of Acute Stress Reactivity After Early Life Stress in Mice: Relevance of Mineralocorticoid Receptor Expression. Front Behav Neurosci 2019; 13:181. [PMID: 31440147 PMCID: PMC6693524 DOI: 10.3389/fnbeh.2019.00181] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/19/2019] [Indexed: 01/11/2023] Open
Abstract
Early life stress (ELS) is considered a major risk factor for developing psychopathology. Increasing evidence points towards sex-dependent dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis as a contributing mechanism. Additionally, clinical studies suggest that the mineralocorticoid receptor (MR) may further confer genetic vulnerability/resilience on a background of ELS. The link between ELS, sex and the HPA axis and how this interacts with MR genotype is understudied, yet important to understand vulnerability/resilience to stress. We used the early life-limited nesting and bedding model to test the effect of ELS on HPA properties in adult female and male mice carrying a forebrain-specific heterozygous knockout for MR. Basal HPA axis activity was measured by circadian peak and nadir corticosterone levels, in addition to body weight and weight of stress-sensitive tissues. HPA axis reactivity was assessed by mapping corticosterone levels after 10 min immobilization. Additionally, we measured the effects of ELS on steroid receptor [MR and glucocorticoid receptor (GR)] levels in the dorsal hippocampus and medial prefrontal cortex (mPFC) with western blot. Finally, behavioral reactivity towards a novel environment was measured as a proxy for anxiety-like behavior. Results show that HPA axis activity under rest conditions was not affected by ELS. HPA axis reactivity after immobilization was decreased by ELS in females and increased, at trend-level in males. This effect in females was further exacerbated by low expression of the MR. We also observed a sex*ELS interaction regarding MR and GR expression in the dorsal hippocampus, with a significant upregulation of MR in males only. The sex-dependent interaction with ELS was not reflected in the behavioral response to novel environment and time spent in a sheltered compartment. We did find increased locomotor activity in all groups after a history of ELS, which attenuated after 4 h in males but not females regardless of condition. Our findings support that ELS alters HPA axis functioning sex-dependently. Genetic predisposition to low MR function may render females more susceptible to the harmful effect of ELS whereas in males low MR function promotes resilience. We propose that this model may be a useful tool to investigate the underlying mechanisms of sex-dependent and genetic vulnerability/resilience to stress-related psychopathology.
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Affiliation(s)
- Valeria Bonapersona
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Ruth Damsteegt
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Mirjam L Adams
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Lisa T C M van Weert
- Department of Internal Medicine, Leiden University Medical Center, Division of Endocrinology, Leiden, Netherlands
| | - Onno C Meijer
- Department of Internal Medicine, Leiden University Medical Center, Division of Endocrinology, Leiden, Netherlands
| | - Marian Joëls
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands.,University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ratna Angela Sarabdjitsingh
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
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10
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Schubert CF, Schreckenbach M, Kirmeier T, Gall-Kleebach DJ, Wollweber B, Buell DR, Uhr M, Rosner R, Schmidt U. PTSD psychotherapy improves blood pressure but leaves HPA axis feedback sensitivity stable and unaffected: First evidence from a pre-post treatment study. Psychoneuroendocrinology 2019; 100:254-263. [PMID: 30391833 DOI: 10.1016/j.psyneuen.2018.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 01/05/2023]
Abstract
Although key to development of tailored drugs for augmentation treatment of psychotherapy for posttraumatic stress disorder (PTSD), the biological correlates of PTSD remission are still unknown, probably because pre-post treatment studies searching for them are rare. Not even the feedback sensitivity of the otherwise well-studied hypothalamic-pituitary-adrenal (HPA) axis nor arterial blood pressure (BP), which was previously reported to be elevated in PTSD patients, have so far been analyzed during PTSD treatment. To narrow this knowledge gap, we first performed an overnight dexamethasone suppression test (DST) in a mixed-sex cohort of 25 patients with severe PTSD vs. 20 non-traumatized healthy controls (nt-HC). In addition to hormones, BP and heart rate (HR) were measured at each of the four assessment points (APs). Second, the same parameters were assessed again in 16 of these patients after 12 sessions of integrative trauma-focused cognitive behavioral therapy (iTF-CBT). In relation to nt-HC, PTSD patients showed a significant elevation in HR and diastolic BP while their systolic BP, DST outcomes and basal serum cortisol levels (BSCL) were not significantly altered. In response to iTF-CBT, PTSD symptoms and dysfunctional stress coping strategies improved significantly in PTSD patients. Most important, also their systolic and diastolic BP levels ameliorated at distinct APs while their DST outcomes and BSCL remained unchanged. To our knowledge, this is the first pre-post treatment study assessing the stability of the DST outcome and BP levels during PTSD treatment. Our results provide first evidence for a non-involvement of HPA axis feedback sensitivity in PTSD symptom improvement and, furthermore, suggest a possible role for BP-regulating pathways such as the sympathetic nervous system in PTSD remission. Limitations arise from the small sample size, the lack of an untreated patient group and drug treatment of patients.
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Affiliation(s)
- Christine F Schubert
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany; Catholic University of Eichstätt-Ingolstadt, Ostenstraße 25, 85072 Eichstätt, Germany; Ludwig Maximilians University, Department of Psychology, Leopoldstraße 44, 80802 Munich, Germany
| | - Monika Schreckenbach
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany
| | | | - Dominique J Gall-Kleebach
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany; Verein für Klinische Verhaltenstherapie (VFKV) - Ausbildungsinstitut München gGmbH, Lindwurmstr. 117, 80337 München, Germany
| | - Bastian Wollweber
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany
| | - Dominik R Buell
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany
| | - Manfred Uhr
- Max Planck Institute of Psychiatry, Clinical Department, Kraepelinstrasse 10, 80804 Munich, Germany
| | - Rita Rosner
- Catholic University of Eichstätt-Ingolstadt, Ostenstraße 25, 85072 Eichstätt, Germany
| | - Ulrike Schmidt
- Max Planck Institute of Psychiatry, Department of Translational Psychiatry, RG Molecular Psychotraumatology, Kraepelinstrasse 10, 80804 Munich, Germany; University Medical Center Göttingen (UMG), Department of Psychiatry and Psychotherapy, Psychotrauma Treatment Unit & RG Stress Modulation of Neurodegeneration, Göttingen, Germany; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
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11
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Schinke C, Hesse S, Rullmann M, Becker GA, Luthardt J, Zientek F, Patt M, Stoppe M, Schmidt E, Meyer K, Meyer PM, Orthgieß J, Blüher M, Kratzsch J, Ding YS, Then Bergh F, Sabri O. Central noradrenaline transporter availability is linked with HPA axis responsiveness and copeptin in human obesity and non-obese controls. Stress 2019; 22:93-102. [PMID: 30369292 DOI: 10.1080/10253890.2018.1511698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The central noradrenaline (NA) stress-response network co-mediates hypothalamic-pituitary-adrenal (HPA) axis activation and arginine-vasopressin (AVP) release. Dysregulation of these systems contributes to stress-related diseases such as human obesity, but their interrelation remains unclear. The study was aimed to test for the first time in vivo whether central noradrenergic activity quantitatively indexed by the availability of the presynaptic NA transporter (NAT) is associated with HPA axis responsiveness as measured with the combined dexamethasone suppression/corticotropin releasing hormone stimulation (dex/CRH) test and copeptin as a surrogate marker of the serum AVP tone in highly obese, otherwise, healthy individuals compared to age- and sex-matched non-obese, healthy controls. In order to assess central NAT availability, positron emission tomography (PET) was applied using the NAT-selective radiotracer S,S-[11C]O-methylreboxetine (MRB) and correlated with curve indicators derived from the dex/CRH test (maximum, MAX, and area under the curve, AUC, for cortisol and adrenocorticotropic hormone, ACTH) as well as with copeptin. In non-obese controls, positive correlations were found between the NAT distribution volume ratios (DVR) of the orbitofrontal cortex (OFC) and the amygdala with the HPA response (OFC: ACTHMAX r = 0.87, p = .001; cortisolMAX r = 0.86, p = .002; amygdala: ACTHMAX r = 0.86, p = .002; cortisolMAX r = 0.79, p = .006), while in obesity, the hypothalamic DVR correlated inversely with the HPA axis response (cortisolMAX, r = -0.66, p = .04) and with copeptin (r = -0.71, p = .02). This association of central NAT availability with HPA axis responsiveness and copeptin suggests a mechanistic interaction between noradrenergic transmission with HPA axis activity and the serum AVP system that differs between non-obese individuals with prefrontal-limbic involvement and obesity with a hypothalamic-centered relationship. Whether the latter finding contributes to obesogenic behavior needs to be further explored.
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Affiliation(s)
- Christian Schinke
- a Integrated Research and Treatment Center (IFB) Adiposity Diseases , Leipzig University Medical Center , Leipzig , Germany
- b Department of Neurology , University of Leipzig , Leipzig , Germany
- c Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Klinik und Hochschulambulanz für Neurologie , Berlin , Germany
| | - Swen Hesse
- a Integrated Research and Treatment Center (IFB) Adiposity Diseases , Leipzig University Medical Center , Leipzig , Germany
- d Department of Nuclear Medicine , University of Leipzig , Leipzig , Germany
| | - Michael Rullmann
- a Integrated Research and Treatment Center (IFB) Adiposity Diseases , Leipzig University Medical Center , Leipzig , Germany
- d Department of Nuclear Medicine , University of Leipzig , Leipzig , Germany
| | | | - Julia Luthardt
- d Department of Nuclear Medicine , University of Leipzig , Leipzig , Germany
| | - Franziska Zientek
- a Integrated Research and Treatment Center (IFB) Adiposity Diseases , Leipzig University Medical Center , Leipzig , Germany
- d Department of Nuclear Medicine , University of Leipzig , Leipzig , Germany
| | - Marianne Patt
- d Department of Nuclear Medicine , University of Leipzig , Leipzig , Germany
| | - Muriel Stoppe
- b Department of Neurology , University of Leipzig , Leipzig , Germany
- e Translational Centre for Regenerative Medicine , University of Leipzig , Leipzig , Germany
| | - Elisa Schmidt
- b Department of Neurology , University of Leipzig , Leipzig , Germany
| | - Klara Meyer
- b Department of Neurology , University of Leipzig , Leipzig , Germany
| | - Philipp M Meyer
- d Department of Nuclear Medicine , University of Leipzig , Leipzig , Germany
| | - Johannes Orthgieß
- b Department of Neurology , University of Leipzig , Leipzig , Germany
| | - Matthias Blüher
- f Department of Internal Medicine , University of Leipzig , Leipzig , Germany
| | - Jürgen Kratzsch
- g Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics , University of Leipzig , Leipzig , Germany
| | - Yu-Shin Ding
- h Departments of Radiology and Psychiatry , New York University School of Medicine , New York , USA
| | - Florian Then Bergh
- b Department of Neurology , University of Leipzig , Leipzig , Germany
- e Translational Centre for Regenerative Medicine , University of Leipzig , Leipzig , Germany
| | - Osama Sabri
- a Integrated Research and Treatment Center (IFB) Adiposity Diseases , Leipzig University Medical Center , Leipzig , Germany
- d Department of Nuclear Medicine , University of Leipzig , Leipzig , Germany
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12
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Nandam LS, Brazel M, Zhou M, Jhaveri DJ. Cortisol and Major Depressive Disorder-Translating Findings From Humans to Animal Models and Back. Front Psychiatry 2019; 10:974. [PMID: 32038323 PMCID: PMC6987444 DOI: 10.3389/fpsyt.2019.00974] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022] Open
Abstract
Major depressive disorder (MDD) is a global problem for which current pharmacotherapies are not completely effective. Hypothalamic-pituitary-adrenal (HPA) axis dysfunction has long been associated with MDD; however, the value of assessing cortisol as a biological benchmark of the pathophysiology or treatment of MDD is still debated. In this review, we critically evaluate the relationship between HPA axis dysfunction and cortisol level in relation to MDD subtype, stress, gender and treatment regime, as well as in rodent models. We find that an elevated cortisol response to stress is associated with acute and severe, but not mild or atypical, forms of MDD. Furthermore, the increased incidence of MDD in females is associated with greater cortisol response variability rather than higher baseline levels of cortisol. Despite almost all current MDD treatments influencing cortisol levels, we could find no convincing relationship between cortisol level and therapeutic response in either a clinical or preclinical setting. Thus, we argue that the absolute level of cortisol is unreliable for predicting the efficacy of antidepressant treatment. We propose that future preclinical models should reliably produce exaggerated HPA axis responses to acute or chronic stress a priori, which may, or may not, alter baseline cortisol levels, while also modelling the core symptoms of MDD that can be targeted for reversal. Combining genetic and environmental risk factors in such a model, together with the interrogation of the resultant molecular, cellular, and behavioral changes, promises a new mechanistic understanding of MDD and focused therapeutic strategies.
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Affiliation(s)
- L. Sanjay Nandam
- Mental Health Unit, Prince Charles Hospital, Brisbane, QLD, Australia
- *Correspondence: L. Sanjay Nandam, ; Dhanisha J. Jhaveri,
| | - Matthew Brazel
- Mental Health Unit, Prince Charles Hospital, Brisbane, QLD, Australia
- Department of Psychiatry, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Mei Zhou
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Dhanisha J. Jhaveri
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: L. Sanjay Nandam, ; Dhanisha J. Jhaveri,
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13
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Gavin KM, Shea KL, Gibbons E, Wolfe P, Schwartz RS, Wierman ME, Kohrt WM. Gonadotropin-releasing hormone agonist in premenopausal women does not alter hypothalamic-pituitary-adrenal axis response to corticotropin-releasing hormone. Am J Physiol Endocrinol Metab 2018; 315:E316-E325. [PMID: 29631362 PMCID: PMC6139491 DOI: 10.1152/ajpendo.00221.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sex hormones appear to play a role in the regulation of hypothalamic-pituitary-adrenal (HPA) axis activity. The objective was to isolate the effects of estradiol (E2) on central activation of the HPA axis. We hypothesized that the HPA axis response to corticotropin-releasing hormone (CRH) under dexamethasone (Dex) suppression would be exaggerated in response to chronic ovarian hormone suppression and that physiologic E2 add-back would mitigate this response. Thirty premenopausal women underwent 20 wk of gonadotropin-releasing hormone agonist therapy (GnRHAG) and transdermal E2 (0.075 mg per day, GnRHAG + E2, n = 15) or placebo (PL) patch (GnRHAG + PL, n = 15). Women in the GnRHAG + PL and GnRHAG + E2 groups were of similar age (38 (SD 5) yr vs. 36 (SD 7) yr) and body mass index (27 (SD 6) kg/m2 vs. 27 (SD 6) kg/m2). Serum E2 changed differently between the groups ( P = 0.01); it decreased in response to GnRHAG + PL (77.9 ± 17.4 to 23.2 ± 2.6 pg/ml; P = 0.008) and did not change in response to GnRHAG + E2 (70.6 ± 12.4 to 105 ± 30.4 pg/ml; P = 0.36). The incremental area under the curve (AUCINC) responses to CRH were different between the groups for total cortisol ( P = 0.03) and cortisone ( P = 0.04) but not serum adrenocorticotropic hormone (ACTH) ( P = 0.28). When examining within-group changes, GnRHAG + PL did not alter the HPA axis response to Dex/CRH, but GnRHAG + E2 decreased the AUCINC for ACTH (AUCINC, 1,623 ± 257 to 1,211 ± 236 pg/ml·min, P = 0.004), cortisone (1,795 ± 367 to 1,090 ± 281 ng/ml·min, P = 0.009), and total cortisol (7,008 ± 1,387 to 3,893 ± 1,090 ng/ml·min, P = 0.02). Suppression of ovarian hormones by GnRHAG therapy for 20 wk did not exaggerate the HPA axis response to CRH, but physiologic E2 add-back reduced HPA axis activity compared with preintervention levels.
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Affiliation(s)
- Kathleen M Gavin
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
- Geriatric Research, Education and Clinical Center, Veterans Affairs Eastern Colorado Heath Care System, Denver, Colorado
| | - Karen L Shea
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
- Geriatric Research, Education and Clinical Center, Veterans Affairs Eastern Colorado Heath Care System, Denver, Colorado
| | - Ellie Gibbons
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Pamela Wolfe
- Department of Preventative Medicine and Biostatistics, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Robert S Schwartz
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
- Geriatric Research, Education and Clinical Center, Veterans Affairs Eastern Colorado Heath Care System, Denver, Colorado
| | - Margaret E Wierman
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Wendy M Kohrt
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
- Geriatric Research, Education and Clinical Center, Veterans Affairs Eastern Colorado Heath Care System, Denver, Colorado
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14
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Hacimusalar Y, Eşel E. Suggested Biomarkers for Major Depressive Disorder. ACTA ACUST UNITED AC 2018; 55:280-290. [PMID: 30224877 DOI: 10.5152/npa.2017.19482] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/08/2017] [Indexed: 12/21/2022]
Abstract
Currently, the diagnosis of major depressive disorder (MDD) mainly relies on clinical examination and subjective evaluation of depressive symptoms. There is no non-invasive, quantitative test available today for the diagnosis of MDD. In MDD, exploration of biomarkers will be helpful in diagnosing the disorder as well as in choosing a treatment, and predicting the treatment response. In this article, it is aimed to review the findings of suggested biomarkers such as growth factors, cytokines and other inflammatory markers, oxidative stress markers, endocrine markers, energy balance hormones, genetic and epigenetic features, and neuroimaging in MDD and to evaluate how these findings contribute to the pathophysiology of MDD, the prediction of treatment response, severity of the disorder, and identification of subtypes. Among these, the findings related to the brain-derived neurotrophic factor, the hypothalamo-pituitary-adrenal axis, cytokines, and neuroimaging may be strong candidates for being biomarkers MDD, and may provide critical information in understanding biological etiology of depression. Although the findings are not sufficient yet, we think that the results of epigenetic studies will also provide very important contributions to the biomarker research in MDD. The availability of biomarkers in MDD will be an advancement that will facilitate the diagnosis of the disorder, treatment choices in the early stages, and prediction of the course of the disorder.
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Affiliation(s)
- Yunus Hacimusalar
- Department of Psychiatry, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ertuğrul Eşel
- Department of Psychiatry, Erciyes University Faculty of Medicine, Kayseri, Turkey
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15
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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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16
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Rampp C, Eichelkraut A, Best J, Czamara D, Rex-Haffner M, Uhr M, Binder EB, Menke A. Sex-related differential response to dexamethasone in endocrine and immune measures in depressed in-patients and healthy controls. J Psychiatr Res 2018; 98:107-115. [PMID: 29331929 DOI: 10.1016/j.jpsychires.2017.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/21/2017] [Accepted: 12/31/2017] [Indexed: 01/26/2023]
Abstract
Although sex differences in major depression have been reported repeatedly, the underlying mechanisms are still disputed. The rapidly changing gonadal steroid concentrations of the postpartum period or during menopause have been shown to be associated with depressive symptoms and to modulate the hypothalamic-pituitary-adrenal (HPA)-axis, which is implicated in depression. The sample comprised of 128 depressed in-patients (36.7% women) and 166 healthy controls (30.0% women). Blood was collected at baseline (at 6pm) and then 3 h as well as 21 h after ingestion of 1.5 mg dexamethasone for measurement of cortisol, ACTH and blood count. To further assess the function of the HPA-axis the dexamethasone/corticotrophin releasing hormone (Dex-CRH) test was performed in a subsample of 115 patients and 116 controls the following day. A significant interaction effect between sex, disease and ACTH concentrations over time after dexamethasone stimulation was observed, with men showing increased ACTH concentrations at baseline and after 21 h, while there was no difference after 3 h (p = .007). After separating for disease status this significant interaction effect was only observed in controls (p = .005). The cortisol response in the dex-CRH test was enhanced in female compared to male controls (p = .002). Leucocytes showed a stronger increase upon dexamethasone administration only in female compared to male controls (p = .023). These findings suggest a higher glucocorticoid receptor sensitivity following in-vivo glucocorticoid stimulation in healthy women that was absent in depressed patients. The sex-related differences in HPA-axis regulation and immune system function may contribute to the vulnerability of female sex to the development of depression.
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Affiliation(s)
- Carina Rampp
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich, 80804, Germany
| | - Andreas Eichelkraut
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich, 80804, Germany
| | - Johanna Best
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich, 80804, Germany
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich, 80804, Germany
| | - Monika Rex-Haffner
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich, 80804, Germany
| | - Manfred Uhr
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich, 80804, Germany
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich, 80804, Germany; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30307, USA
| | - 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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17
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Ferguson EH, Di Florio A, Pearson B, Putnam KT, Girdler S, Rubinow DR, Meltzer-Brody S. HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression. Arch Womens Ment Health 2017; 20:411-420. [PMID: 28251369 PMCID: PMC5441453 DOI: 10.1007/s00737-017-0716-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/10/2017] [Indexed: 12/29/2022]
Abstract
It is unclear whether women with a history of postpartum depression (PPD) have residual, abnormal hypothalamic-pituitary-adrenal (HPA) axis reactivity, as has been reported in major depression (MDD). Further unclear is whether the abnormalities in HPA axis reactivity associated with MDD represent a stable, underlying predisposition or a state-dependent phenomenon. This study sought the following: (1) to determine if euthymic postpartum women with a history of depression have an abnormal HPA axis reactivity to pharmacologic and psychological challenges and (2) to compare HPA reactivity in women with histories of PPD versus MDD. As a secondary objective, we wanted to determine the influence of trauma history on HPA axis function. Forty-five parous (12-24 months postpartum), euthymic women with history of MDD (n = 15), PPD (n = 15), and controls (n = 15) completed pharmacologic (dexamethasone/corticotropin-releasing hormone (CRH) test [DEX/CRH]) and psychological (Trier social stress test [TSST]) challenges during the luteal phase. Outcome measures were cortisol and adrenocorticotropic hormone (ACTH) response after DEX/CRH, and blood pressure, heart rate, epinephrine, norepinephrine, and cortisol response during the TSST. All groups had robust cortisol and ACTH response to DEX/CRH and cortisol response to TSST. Groups did not differ significantly in cortisol or ACTH response to DEX/CRH or in blood pressure, heart rate, epinephrine, norepinephrine, or cortisol response to TSST. Cortisol/ACTH ratio did not differ significantly between groups. Trauma history was associated with decreased cortisol response to DEX/CRH in women with histories of MDD, which was not significant after correction (F 8,125, p = 0.02, Greenhouse-Geisser corrected p = 0.11). Currently euthymic women with histories of MDD or PPD did not demonstrate residual abnormal stress responsivity following administration of either a pharmacologic or psychological stressor.
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Affiliation(s)
- Elizabeth H Ferguson
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.
| | - Arianna Di Florio
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Brenda Pearson
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
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18
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Argentieri MA, Nagarajan S, Seddighzadeh B, Baccarelli AA, Shields AE. Epigenetic Pathways in Human Disease: The Impact of DNA Methylation on Stress-Related Pathogenesis and Current Challenges in Biomarker Development. EBioMedicine 2017; 18:327-350. [PMID: 28434943 PMCID: PMC5405197 DOI: 10.1016/j.ebiom.2017.03.044] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 01/30/2023] Open
Abstract
HPA axis genes implicated in glucocorticoid regulation play an important role in regulating the physiological impact of social and environmental stress, and have become a focal point for investigating the role of glucocorticoid regulation in the etiology of disease. We conducted a systematic review to critically assess the full range of clinical associations that have been reported in relation to DNA methylation of CRH, CRH-R1/2, CRH-BP, AVP, POMC, ACTH, ACTH-R, NR3C1, FKBP5, and HSD11β1/2 genes in adults. A total of 32 studies were identified. There is prospective evidence for an association between HSD11β2 methylation and hypertension, and functional evidence of an association between NR3C1 methylation and both small cell lung cancer (SCLC) and breast cancer. Strong associations have been reported between FKBP5 and NR3C1 methylation and PTSD, and biologically-plausible associations have been reported between FKBP5 methylation and Alzheimer's Disease. Mixed associations between NR3C1 methylation and mental health outcomes have been reported according to different social and environmental exposures, and according to varying gene regions investigated. We conclude by highlighting key challenges and future research directions that will need to be addressed in order to develop both clinically meaningful prognostic biomarkers and an evidence base that can inform public policy practice.
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Affiliation(s)
- M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA
| | - Sairaman Nagarajan
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11218, USA
| | - Bobak Seddighzadeh
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA
| | - Andrea A Baccarelli
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W. 168th St., 11th Floor, New York, NY 10032, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
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Schinke C, Hesse S, Stoppe M, Meyer K, Schmidt E, Orthgiess J, Bechmann L, Bresch A, Rullmann M, Luthardt J, Sabri O, Blüher M, Kratzsch J, Then Bergh F. Post-dexamethasone serum copeptin corresponds to HPA axis responsiveness in human obesity. Psychoneuroendocrinology 2017; 78:39-47. [PMID: 28167369 DOI: 10.1016/j.psyneuen.2017.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/23/2016] [Accepted: 01/04/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT Increased activities of the arginine-vasopressin (AVP) system and the hypothalamic-pituitary-adrenal (HPA) axis were shown to be associated with human obesity, but relationships between these systems in obesity remain unclear. OBJECTIVES To assess HPA axis responsiveness and its relation to serum concentrations of the AVP-surrogate copeptin in subjects with obesity (OB) in comparison to non-obesity controls (NOC). METHODS In a cross-sectional monocentric study, thirty-nine OB (f/m 25/14; age 36.5±10.0years; body mass index, BMI, 41.5±4.7kg/m2) were compared to twenty-two NOC (f/m 12/10; age 35.3±8.5years; BMI 23.1±2.4kg/m2), matched for age and sex. All individuals underwent the combined dexamethasone/CRH test. MAIN OUTCOME MEASURES Plasma ACTH and cortisol curve indicators derived from the dex/CRH test (post-CRH concentrations 30min after 100μg CRH; maximum concentration, MAX; area-under-the-curve, AUC; ACTH/cortisol ratios). Copeptin was assessed in 1500h samples of the dex/CRH test (after 1.5mg of oral dexamethasone, prior to CRH administration). RESULTS Copeptin serum concentrations were higher in OB (median [IQR]: OB 4.62 [2.60-5.88] vs. NOC 3.04 [2.52-4.29] pmol/l, P=0.04). Correspondingly, OB showed higher post-CRH cortisol concentrations (OB: 51.5 [25.9-159.3] vs. NOC: 28.6 [20.0-41.6] nmol/l, P=0.01) and a lower post-CRH ACTH/cortisol ratio (OB: 0.028 [0.016-0.053] vs. NOC: 0.048 [0.034-0.070] pmol/nmol, P<0.01). Serum copeptin was significantly associated with HPA responsiveness in OB (post-CRH ACTH: R=0.42, P<0.01), driven by OB men (post-CRH ACTH: R=0.76, P<0.01, post-CRH cortisol: R=0.64, P=0.02). All associations withstand adjustments for BMI and age. CONCLUSIONS The association between increased copeptin with ACTH and cortisol release suggests a potential mechanistic interaction of the AVP system with HPA activation in human obesity. The relation of copeptin and HPA responsiveness should be further validated in situations with pronounced HPA activation, such as depression or multiple sclerosis.
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Affiliation(s)
- Christian Schinke
- Department of Neurology, University of Leipzig, Leipzig, Germany; Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Muriel Stoppe
- Department of Neurology, University of Leipzig, Leipzig, Germany; Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Klara Meyer
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Elisa Schmidt
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | | | - Lukas Bechmann
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Anke Bresch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Michael Rullmann
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Julia Luthardt
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany; Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Jürgen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Florian Then Bergh
- Department of Neurology, University of Leipzig, Leipzig, Germany; Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany.
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20
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Gonul AS, Cetinkalp S, Tunay S, Polat I, Simsek F, Aksoy B, Kizilates G, Erdogan Y, Coburn KL. Cortisol response patterns in depressed women and their healthy daughters at risk: Comparison with healthy women and their daughters. J Psychiatr Res 2017; 85:66-74. [PMID: 27837659 DOI: 10.1016/j.jpsychires.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/28/2016] [Accepted: 11/02/2016] [Indexed: 01/01/2023]
Abstract
A dysfunctional hypothalamic pituitary adrenal (HPA) axis is widely accepted as a significant pathophysiological aspect of Major Depressive Disorder (MDD). Despite studies suggesting that a dysfunctional HPA axis might be present before the clinical syndrome becomes apparent, the functioning of the HPA axis in high-risk populations has not been well defined. The aim of the present study was to investigate the HPA axis functioning of mothers suffering from MDD and their healthy daughters compared to age- and sex-matched healthy controls. This design allowed a comparison of HPA axis functional differences among daughter and mother groups. HPA axis function was evaluated with a modified dexamethasone/corticotropin-releasing hormone (Dex/CRH) test, which was performed after obtaining the diurnal adrenocorticotropic hormone (ACTH) and cortisol values at 8:00, 16:00, and 23:00 h. We found that MDD mothers and their daughters had low morning cortisol and the MDD mothers additionally had low-morning ACTH compared with controls. Dexamethasone suppressed both cortisol and ACTH in all groups and subsequent HPA axis stimulation by CRH-evoked a lower cortisol response but a higher ACTH response among subjects with MDD mothers. Although high-risk daughters had comparable cortisol levels after CRH infusion, the AUC for ACTH was greater than those of controls. These patterns of results suggest that multiple level HPA dysfunctions are present in both MDD patients and their high-risk carrying daughters. However, insufficient cortisol secretion was only present in MDD mothers, while the daughters could compensate cortisol levels during CRH challenge.
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Affiliation(s)
- Ali Saffet Gonul
- Ege University, School of Medicine, Department of Psychiatry, SoCAT LAB, Bornova, Izmir, Turkey; Mercer University School of Medicine, Department of Psychiatry and Behavioral Sciences, Macon, GA, USA.
| | - Sevki Cetinkalp
- Ege University, School of Medicine, Department of Internal Medicine, Bornova, Izmir, Turkey
| | - Sebnem Tunay
- Ege University, School of Medicine, Department of Psychiatry, SoCAT LAB, Bornova, Izmir, Turkey
| | - Irmak Polat
- Ege University, School of Medicine, Department of Psychiatry, SoCAT LAB, Bornova, Izmir, Turkey
| | - Fatma Simsek
- Ege University, School of Medicine, Department of Psychiatry, SoCAT LAB, Bornova, Izmir, Turkey
| | - Burcu Aksoy
- Ege University, School of Medicine, Department of Psychiatry, SoCAT LAB, Bornova, Izmir, Turkey; Ege University, Institute of Health Sciences, Department of Neuroscience, Bornova, Izmir, Turkey
| | - Gozde Kizilates
- Ege University, School of Medicine, Department of Psychiatry, SoCAT LAB, Bornova, Izmir, Turkey; Ege University, Institute of Health Sciences, Department of Neuroscience, Bornova, Izmir, Turkey
| | - Yigit Erdogan
- Ege University, School of Medicine, Department of Psychiatry, SoCAT LAB, Bornova, Izmir, Turkey; Ege University, Institute of Health Sciences, Department of Neuroscience, Bornova, Izmir, Turkey
| | - Kerry L Coburn
- Mercer University School of Medicine, Department of Psychiatry and Behavioral Sciences, Macon, GA, USA
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21
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Spencer RL, Deak T. A users guide to HPA axis research. Physiol Behav 2016; 178:43-65. [PMID: 27871862 DOI: 10.1016/j.physbeh.2016.11.014] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/19/2016] [Accepted: 11/16/2016] [Indexed: 12/18/2022]
Abstract
Glucocorticoid hormones (cortisol and corticosterone - CORT) are the effector hormones of the hypothalamic-pituitary-adrenal (HPA) axis neuroendocrine system. CORT is a systemic intercellular signal whose level predictably varies with time of day and dynamically increases with environmental and psychological stressors. This hormonal signal is utilized by virtually every cell and physiological system of the body to optimize performance according to circadian, environmental and physiological demands. Disturbances in normal HPA axis activity profiles are associated with a wide variety of physiological and mental health disorders. Despite numerous studies to date that have identified molecular, cellular and systems-level glucocorticoid actions, new glucocorticoid actions and clinical status associations continue to be revealed at a brisk pace in the scientific literature. However, the breadth of investigators working in this area poses distinct challenges in ensuring common practices across investigators, and a full appreciation for the complexity of a system that is often reduced to a single dependent measure. This Users Guide is intended to provide a fundamental overview of conceptual, technical and practical knowledge that will assist individuals who engage in and evaluate HPA axis research. We begin with examination of the anatomical and hormonal components of the HPA axis and their physiological range of operation. We then examine strategies and best practices for systematic manipulation and accurate measurement of HPA axis activity. We feature use of experimental methods that will assist with better understanding of CORT's physiological actions, especially as those actions impact subsequent brain function. This research approach is instrumental for determining the mechanisms by which alterations of HPA axis function may contribute to pathophysiology.
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Affiliation(s)
- Robert L Spencer
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.
| | - Terrence Deak
- Department of Psychology, Binghamton University - SUNY, Binghamton, NY, USA
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22
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Kinoshita S, Kanazawa T, Kikuyama H, Yoneda H. Clinical application of DEX/CRH test and multi-channel NIRS in patients with depression. Behav Brain Funct 2016; 12:25. [PMID: 27582123 PMCID: PMC5007847 DOI: 10.1186/s12993-016-0108-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background To reduce the number of patients with depression, biomarkers for clarifying psychiatric disorders are warranted. Numerous candidates have been proposed; however, near-infrared spectroscopy (NIRS) with multi-channel probes and a dexamethasone/corticotropin-releasing hormone (DEX/CRH) test are still surviving for practical demand. Thirty-one outpatients with depressed moods were analyzed using both biological tests. Results The non-suppressors, as indicated by the DEX/CRH test, exhibited a high severity on the Hamilton Depression Scale and severe anxiety on the State Trait Anxiety Scale. In addition, a unique response was identified via NIRS in the same group suggested by the DEX/CRH assessment. Conclusions The results obtained from these biological tests did not fit well with the category defined by operative diagnostic criteria, such as the Diagnostic and Statistical Manual of Mental Disorders or The International Classification of Diseases. Thus, it is critical that the utility evaluations of candidate biomarkers not be assessed by comparisons with the categorized criteria for a specific psychiatric disorder. Trial registration UMIN000013214, Registered 21 February 2014
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Affiliation(s)
- Shinya Kinoshita
- Department of Neuropsychiatry, Osaka Medical College, 2-7, Daigaku-Cho, Takatsuk, Osaka, 569-8686, Japan
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical College, 2-7, Daigaku-Cho, Takatsuk, Osaka, 569-8686, Japan.
| | - Hiroki Kikuyama
- Department of Neuropsychiatry, Osaka Medical College, 2-7, Daigaku-Cho, Takatsuk, Osaka, 569-8686, Japan.,Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
| | - Hiroshi Yoneda
- Department of Neuropsychiatry, Osaka Medical College, 2-7, Daigaku-Cho, Takatsuk, Osaka, 569-8686, Japan
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23
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Menke A, Arloth J, Best J, Namendorf C, Gerlach T, Czamara D, Lucae S, Dunlop BW, Crowe TM, Garlow SJ, Nemeroff CB, Ritchie JC, Craighead WE, Mayberg HS, Rex-Haffner M, Binder EB, Uhr M. Time-dependent effects of dexamethasone plasma concentrations on glucocorticoid receptor challenge tests. Psychoneuroendocrinology 2016; 69:161-71. [PMID: 27107207 DOI: 10.1016/j.psyneuen.2016.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 12/28/2022]
Abstract
Glucocorticoid challenge tests such as the dexamethasone suppression test (DST) and the combined dexamethasone/corticotropin-releasing hormone (dex-CRH) test are considered to be able to sensitively measure hypothalamic-pituitary-adrenal (HPA) axis activity in stress-related psychiatric and endocrine disorders. We used mass-spectrometry to assess the relationship of plasma dexamethasone concentrations and the outcome of these tests in two independent cohorts. Dexamethasone concentrations were measured after oral ingestion of 1.5mg dexamethasone in two cohorts that underwent a standard (dexamethasone at 23:00h) as well as modified (18:00h) DST and dex-CRH test. The first study population was a case/control cohort of 105 depressed patients and 133 controls in which peripheral blood mRNA expression was also measured. The second was a cohort of 261 depressed patients that underwent a standard dex-CRH test at baseline and after 12 weeks' treatment with cognitive-behavioral therapy or antidepressants. Dexamethasone concentrations explained significant proportions of the variance in the DST in both the first (24.6%) and the second (5.2%) cohort. Dexamethasone concentrations explained a higher proportion of the variance in the dex-CRH test readouts, with 41.9% of the cortisol area under the curve (AUC) in the first sample and 24.7% in the second sample. In contrast to these strong effects at later time points, dexamethasone concentrations did not impact cortisol or ACTH concentrations or mRNA expression 3hours after ingestion. In the second sample, dexamethasone concentrations at baseline and week 12 were highly correlated, independent of treatment type and response status. Importantly, a case/control effect in the Dex-CRH test was only apparent when controlling for dexamethasone concentrations. Our results suggest that the incorporation of plasma dexamethasone concentration or measures of earlier endocrine read-outs may help to improve the assessment of endocrine dysfunction in depression.
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Affiliation(s)
- Andreas Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Fuechsleinstr. 15, Wuerzburg 97080, Germany; Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany
| | - Janine Arloth
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany
| | - Johanna Best
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany
| | - Christian Namendorf
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany
| | - Tamara Gerlach
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany
| | - Susanne Lucae
- Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Tanja Mletzko Crowe
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Steven J Garlow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136, USA
| | - James C Ritchie
- Department of Clinical Pathology, Emory University, Atlanta, GA 30322, USA
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Monika Rex-Haffner
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30307, USA.
| | - Manfred Uhr
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, Munich 80804, Germany
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Barra de la Tremblaye P, Plamondon H. Alterations in the corticotropin-releasing hormone (CRH) neurocircuitry: Insights into post stroke functional impairments. Front Neuroendocrinol 2016; 42:53-75. [PMID: 27455847 DOI: 10.1016/j.yfrne.2016.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
Although it is well accepted that changes in the regulation of the hypothalamic-pituitary adrenal (HPA) axis may increase susceptibility to affective disorders in the general population, this link has been less examined in stroke patients. Yet, the bidirectional association between depression and cardiovascular disease is strong, and stress increases vulnerability to stroke. Corticotropin-releasing hormone (CRH) is the central stress hormone of the HPA axis pathway and acts by binding to CRH receptors (CRHR) 1 and 2, which are located in several stress-related brain regions. Evidence from clinical and animal studies suggests a role for CRH in the neurobiological basis of depression and ischemic brain injury. Given its importance in the regulation of the neuroendocrine, autonomic, and behavioral correlates of adaptation and maladaptation to stress, CRH is likely associated in the pathophysiology of post stroke emotional impairments. The goals of this review article are to examine the clinical and experimental data describing (1) that CRH regulates the molecular signaling brain circuit underlying anxiety- and depression-like behaviors, (2) the influence of CRH and other stress markers in the pathophysiology of post stroke emotional and cognitive impairments, and (3) context and site specific interactions of CRH and BDNF as a basis for the development of novel therapeutic targets. This review addresses how the production and release of the neuropeptide CRH within the various regions of the mesocorticolimbic system influences emotional and cognitive behaviors with a look into its role in psychiatric disorders post stroke.
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Affiliation(s)
- P Barra de la Tremblaye
- School of Psychology, Behavioral Neuroscience Program, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - H Plamondon
- School of Psychology, Behavioral Neuroscience Program, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Building, Ottawa, Ontario K1N 6N5, Canada.
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25
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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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26
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Chronic Fatigue Syndrome and DNA Hypomethylation of the Glucocorticoid Receptor Gene Promoter 1F Region: Associations With HPA Axis Hypofunction and Childhood Trauma. Psychosom Med 2015; 77:853-62. [PMID: 26230484 DOI: 10.1097/psy.0000000000000224] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Chronic fatigue syndrome (CFS) has been associated with hypothalamic-pituitary-adrenal axis hypofunction and enhanced glucocorticoid receptor (GR) sensitivity. In addition, childhood trauma is considered a major risk factor for the syndrome. This study examines DNA methylation of the GR gene (NR3C1) in CFS and associations with childhood sexual and physical trauma. METHODS Quantification of DNA methylation within the 1F promoter region of NR3C1 was performed in 76 female patients (46 with no/mild and 30 with moderate/severe childhood trauma) and 19 healthy controls by using Sequenom EpiTYPER. Further, we examined the association of NR3C1-1F promoter methylation with the outcomes of the low-dose (0.5 mg) dexamethasone/corticotropin-releasing factor test in a subset of the study population. Mann-Whitney U tests and Spearman correlations were used for statistical analyses. RESULTS Overall NR3C1-1F DNA methylation was lower in patients with CFS than in controls. After cytosine guanine dinucleotide (CpG)-specific analysis, CpG_1.5 remained significant after Bonferroni correction (adjusted p = .0014). Within the CFS group, overall methylation (ρ = 0.477, p = .016) and selective CpG units (CpG_1.5: ρ = 0.538, p = .007; CpG_12.13: ρ = 0.448, p = .025) were positively correlated with salivary cortisol after dexamethasone administration. There was no significant difference in NR3C1-1F methylation between traumatized and nontraumatized patients. CONCLUSIONS We found evidence of NR3C1 promoter hypomethylation in female patients with CFS and the functional relevance of these differences was consistent with the hypothalamic-pituitary-adrenalaxis hypofunction hypothesis (GR hypersuppression). However, we found no evidence of an additional effect of childhood trauma on CFS via alterations in NR3C1 methylation.
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27
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Iguchi Y, Kosugi S, Lin Z, Nishikawa H, Minabe Y, Toda S. Pre-stress performance in an instrumental training predicts post-stress behavioral alterations in chronically stressed rats. Front Behav Neurosci 2015; 9:119. [PMID: 26029067 PMCID: PMC4429589 DOI: 10.3389/fnbeh.2015.00119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 04/26/2015] [Indexed: 12/11/2022] Open
Abstract
Stress is a major factor in the development of major depressive disorder (MDD), but few studies have assessed individual risk based on pre-stress behavioral and cognitive traits. To address this issue, we employed appetitive instrumental lever pressing with a progressive ratio (PR) schedule to assess these traits in experimentally naïve Sprague-Dawley rats. Based on four distinct traits that were identified by hierarchical cluster analysis, the animals were classified into the corresponding four subgroups (Low Motivation, Quick Learner, Slow Learner, and Hypermotivation), and exposed to chronic unpredictable stress (CUS) before monitoring their post-stress responses for 4 weeks. The four subgroups represented the following distinct behavioral phenotypes after CUS: the Low Motivation subgroup demonstrated weight loss and a late-developing paradoxical enhancement in PR performance that may be related to inappropriate decision-making in human MDD. The Quick Learner subgroup exhibited a transient loss of motivation and the habituation of serum corticosterone (CORT) response to repeated stress. The Slow Learner subgroup displayed resistance to demotivation and a suppressed CORT response to acute stress. Finally, the Hypermotivation subgroup exhibited resistance to weight loss, habituated CORT response to an acute stress, and a long-lasting amotivation. Overall, we identified causal relationships between pre-stress traits in the performance of the instrumental training and post-stress phenotypes in each subgroup. In addition, many of the CUS-induced phenotypes in rats corresponded to or had putative relationships with representative symptoms in human MDD. We concluded that the consequences of stress may be predictable before stress exposure by determining the pre-stress behavioral or cognitive traits of each individual in rats.
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Affiliation(s)
- Yoshio Iguchi
- Department of Psychiatry and Neurobiology, Kanazawa University School of Medicine Kanazawa, Japan
| | - Sakurako Kosugi
- Department of Psychiatry and Neurobiology, Kanazawa University School of Medicine Kanazawa, Japan
| | - Ziqiao Lin
- Department of Psychiatry and Neurobiology, Kanazawa University School of Medicine Kanazawa, Japan
| | - Hiromi Nishikawa
- Department of Psychiatry and Neurobiology, Kanazawa University School of Medicine Kanazawa, Japan
| | - Yoshio Minabe
- Department of Psychiatry and Neurobiology, Kanazawa University School of Medicine Kanazawa, Japan ; Research Center for Child Mental Development, Kanazawa University Kanazawa, Japan
| | - Shigenobu Toda
- Department of Psychiatry and Neurobiology, Kanazawa University School of Medicine Kanazawa, Japan ; Research Center for Child Mental Development, Kanazawa University Kanazawa, Japan
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Yokoyama K, Yamada T, Mitani H, Yamada S, Pu S, Yamanashi T, Matsumura H, Nakagome K, Kaneko K. Relationship between hypothalamic-pituitary-adrenal axis dysregulation and insulin resistance in elderly patients with depression. Psychiatry Res 2015; 226:494-8. [PMID: 25757913 DOI: 10.1016/j.psychres.2015.01.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 01/09/2015] [Accepted: 01/19/2015] [Indexed: 12/22/2022]
Abstract
Cortisol dysregulation has been proposed to be involved in depression. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation associated with major depressive disorder (MDD) was previously reported to be higher in the elderly. Furthermore, insulin resistance and the prevalence of type 2 diabetes are known to increase with aging. The aim of the present study was to determine whether a relationship existed between plasma cortisol levels following the dexamethasone/corticotrophin-releasing hormone (DEX/CRH) test and insulin resistance evaluated by the homeostasis model assessment of insulin resistance (HOMA-R) in elderly MDD subjects. Fifteen unmedicated MDD inpatients and 17 age- and sex-matched healthy controls participated in this study. After overnight fasting, blood samples were collected to measure plasma glucose and insulin concentrations, estimate HOMA-R, and perform the DEX/CRH test to evaluate HPA axis function. The value of the area under the time curve of plasma cortisol concentrations (CortAUC) and peak cortisol values (Cortpeak) following the administration of DEX/CRH both correlated with HOMA-R in MDD group. In contrast, neither CortAUC nor Cortpeak correlated with HOMA-R in controls. This is the first study to directly demonstrate the relationship between HPA axis dysregulation assessed with the DEX/CRH test and the index of insulin resistance estimated as HOMA-R in elderly MDD patients.
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Affiliation(s)
- Katsutoshi Yokoyama
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan.
| | - Takeshi Yamada
- Division of Psychiatry, Kurayoshi Hospital, 43 Yamane, Kurayoshi, Japan
| | - Hideaki Mitani
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Sayaka Yamada
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Takehiko Yamanashi
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Hiroshi Matsumura
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Kazuyuki Nakagome
- National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
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Jacobson L. Hypothalamic-pituitary-adrenocortical axis: neuropsychiatric aspects. Compr Physiol 2014; 4:715-38. [PMID: 24715565 DOI: 10.1002/cphy.c130036] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence of aberrant hypothalamic-pituitary-adrenocortical (HPA) activity in many psychiatric disorders, although not universal, has sparked long-standing interest in HPA hormones as biomarkers of disease or treatment response. HPA activity may be chronically elevated in melancholic depression, panic disorder, obsessive-compulsive disorder, and schizophrenia. The HPA axis may be more reactive to stress in social anxiety disorder and autism spectrum disorders. In contrast, HPA activity is more likely to be low in PTSD and atypical depression. Antidepressants are widely considered to inhibit HPA activity, although inhibition is not unanimously reported in the literature. There is evidence, also uneven, that the mood stabilizers lithium and carbamazepine have the potential to augment HPA measures, while benzodiazepines, atypical antipsychotics, and to some extent, typical antipsychotics have the potential to inhibit HPA activity. Currently, the most reliable use of HPA measures in most disorders is to predict the likelihood of relapse, although changes in HPA activity have also been proposed to play a role in the clinical benefits of psychiatric treatments. Greater attention to patient heterogeneity and more consistent approaches to assessing treatment effects on HPA function may solidify the value of HPA measures in predicting treatment response or developing novel strategies to manage psychiatric disease.
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Matsuzaka H, Maeshima H, Kida S, Kurita H, Shimano T, Nakano Y, Baba H, Suzuki T, Arai H. Gender differences in serum testosterone and cortisol in patients with major depressive disorder compared with controls. Int J Psychiatry Med 2014; 46:203-21. [PMID: 24552043 DOI: 10.2190/pm.46.2.g] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Testosterone may have a role distinct from cortisol in the pathophysiology of depression. The hypothalamus-pituitary-adrenal (HPA) axis affects the functions of sex steroid hormones through interaction with corticotropin-releasing hormone (CRH) and gonadotropin-releasing hormone (GnRH). The objective of this study was to investigate differences in serum levels of testosterone and cortisol in male and female patients with major depressive disorder (MDD). METHODS Participants included 87 inpatients with MDD at Juntendo University Koshigaya Hospital. Serum levels of testosterone and cortisol were assessed at admission. Matched controls included 128 healthy individuals. Data from MDD patients and controls were compared separately for men and women. Correlations between serum hormone levels and scores on the Hamilton Rating Scale for Depression (HAM-D) of patients were assessed by sex. Effects of various factors on testosterone and cortisol were analyzed using multiple regression analysis. RESULTS In male patients with MDD, a significant negative correlation was seen between testosterone levels and the "retardation" score of HAM-D. However, serum testosterone levels were not significantly different in either male or female MDD patients compared with controls. Serum testosterone was negatively associated with the number of depressive episodes in male patients with MDD. Serum cortisol levels in female patients were significantly increased compared with female controls with no significant correlations between cortisol levels and HAM-D scores. CONCLUSIONS The negative correlation between the sub-score of the HAM-D and testosterone may be associated with the biological pathophysiology of male depression. Findings of serum cortisol levels in women may suggest distinct characteristics of these hormones in men and women with MDD.
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Affiliation(s)
| | | | - Sayaka Kida
- Juntendo University Koshigaya Hospital, Japan
| | | | | | | | - Hajime Baba
- Juntendo University Koshigaya Hospital, Japan
| | - Toshihito Suzuki
- Department of Psychiatry, Juntendo University Graduate School of Medicine and Juntendo University Koshigaya Hospital, Japan
| | - Heii Arai
- Department of Psychiatry, Juntendo University Graduate School of Medicine and Juntendo University Koshigaya Hospital, Japan
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Schüle C, Baghai TC, Eser D, Rupprecht R. Hypothalamic–pituitary–adrenocortical system dysregulation and new treatment strategies in depression. Expert Rev Neurother 2014; 9:1005-19. [DOI: 10.1586/ern.09.52] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hori H, Teraishi T, Ota M, Hattori K, Matsuo J, Kinoshita Y, Ishida I, Nagashima A, Koga N, Higuchi T, Kunugi H. Psychological coping in depressed outpatients: association with cortisol response to the combined dexamethasone/CRH test. J Affect Disord 2014; 152-154:441-7. [PMID: 24210627 DOI: 10.1016/j.jad.2013.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/08/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Depression is associated with dysfunctional coping styles and dysregulated hypothalamic-pituitary-adrenal (HPA) axis function. Studies have shown that maladaptive coping strategies relate to abnormal HPA axis function; however, such a relationship has been under-studied in patients with depression. We aimed to examine whether dysfunctional coping styles in depression would be associated with abnormal cortisol reactivity. METHODS Seventy-four outpatients with major depressive disorder and 133 age- and sex-matched healthy individuals were recruited. Coping was assessed by the Ways of Coping Checklist. Psychological distress was assessed by the Hopkins Symptom Checklist. Cortisol reactivity was measured by the combined dexamethasone/corticotropin-releasing hormone test. RESULTS Compared to healthy individuals, depressed patients demonstrated significantly less use of problem-solving, positive reappraisal and social support coping styles and more use of self-blame and wishful thinking styles. Such a pattern of coping styles was significantly associated with patients' greater distress. Partial correlation analysis in patients, controlling for age and sex, revealed a significant correlation between more use of escape-avoidance coping and lower levels of reactive cortisol measures. A stepwise multiple regression analysis predicting cortisol reactivity from age, sex, distress, symptom severity and coping styles revealed that escape-avoidance coping was a significant predictor. LIMITATIONS The neuroendocrine challenge test was administered only once, based on a simple test protocol. CONCLUSIONS More use of escape-avoidance coping in depressed patients was associated with less cortisol reactivity. Our findings shed light on the heterogeneity of depression in terms of low and high levels of avoidance associated with exaggerated and blunted HPA axis reactivity, respectively.
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Affiliation(s)
- Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo 187-8502, Japan; CREST (Core Research of Evolutional Science & Technology), JST (Japan Science and Technology Agency), Tokyo, Japan.
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Baes CVW, Martins CMS, Tofoli SMDC, Juruena MF. Early Life Stress in Depressive Patients: HPA Axis Response to GR and MR Agonist. Front Psychiatry 2014; 5:2. [PMID: 24478730 PMCID: PMC3900767 DOI: 10.3389/fpsyt.2014.00002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 01/04/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Evidence indicates that early life stress (ELS) can induce persistent changes in the hypothalamic-pituitary-adrenal (HPA) axis to respond to stress in the adult life that leads to depression. These appear to be related to the impairment of HPA hormones through binding to glucocorticoid (GR) and mineralocorticoid receptors (MR). The aim of this study was to evaluate the impact of ELS in HPA axis response to challenges with GR and MR agonists in depressed patients. METHODS We included 30 subjects, 20 patients with current major depression (HAM-D21 ≥ 17). Patients were recruited into two groups according to ELS history assessed by the Childhood Trauma Questionnaire (CTQ). The cortisol measures in the saliva and plasma were evaluated after using (at 10:00 p.m.) placebo, fludrocortisone (MR agonist), or dexamethasone (GR agonist). RESULTS Depressed patients showed a significantly lower salivary cortisol upon waking after placebo compared with controls. Moreover, cortisol awakening responses (CAR) after MR agonist were found to be lower in depressed patients than in controls. With CTQ scores, HAM-D21, body mass index and CAR after placebo, GR agonist, MR agonist we found in a Linear Regression model that depressive patients with ELS (p = 0.028) show differences between placebo vs. MR agonist (R = 0.51; p < 0.05) but not after GR agonist; in depressive patients, without ELS the data show differences between placebo vs. MR agonist (R = 0.69; p < 0.05); but now as well placebo vs. GR agonist (R = 0.53; p < 0.05). CONCLUSION Our findings indicate that MR activity is impaired in depressed patients compared with controls. Furthermore, in spite of the previous limitations described, in depressed patients with ELS, there was suppression by MR agonist, indicating that patients with ELS are sensitive to MR agonists. In contrast with depressed patients without ELS, we find suppression after both MR and GR agonist. These data suggested that in ELS an imbalance exists between MR and GR with MR dysfunction.
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Affiliation(s)
- Cristiane von Werne Baes
- Stress and Affective Disorders – SAD Program, Mental Health Graduate Program, Department of Neuroscience and Behaviour, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Camila Maria Severi Martins
- Stress and Affective Disorders – SAD Program, Mental Health Graduate Program, Department of Neuroscience and Behaviour, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Sandra Márcia de Carvalho Tofoli
- Stress and Affective Disorders – SAD Program, Mental Health Graduate Program, Department of Neuroscience and Behaviour, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Mário Francisco Juruena
- Stress and Affective Disorders – SAD Program, Mental Health Graduate Program, Department of Neuroscience and Behaviour, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
- Institute of Psychiatry, King’s College London, London, UK
- *Correspondence: Mário Francisco Juruena, Saude Mental, University of São Paulo, Avenue Tenente Catão Roxo, 2650, Ribeirão Preto, São Paulo CEP: 14051-140, Brazil e-mail:
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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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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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Pintor L, Torres X, Bailles E, Navarro V, de Osaba MJM, Belmonte A, Gastó C. CRF test in melancholic depressive patients with partial versus complete relapses: a 2-year follow-up study. Nord J Psychiatry 2013; 67:177-84. [PMID: 22808936 DOI: 10.3109/08039488.2012.700733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with depressive disorders present abnormalities in the hypothalamic pituitary adrenal (HPA) axis. The effects of a partial relapse with regard to HPA axis has not been studied so far. AIM To assess whether patients with partial relapse have a different neuroendocrine profile compared with those with complete relapse and with those without relapse over a 2-year follow-up. METHODS The adrenocorticotropin hormone (ACTH) and cortisol responses to corticotrophin releasing factor (CRF) stimulation was assessed in 62 outpatients diagnosed with unipolar depressive disorder with melancholic features according to DSM-IV. Twenty-three healthy controls were included in the study for comparison. Monthly follow-up visits were performed over a 2-year period after remission; partial and complete relapses were established using the Hamilton Depression Rating Scale (HDRS) and according to Frank's criteria. Fifty-four patients completed the study. A comparative statistical analysis was performed. RESULTS Stratifying the net area under cortisol curve (NAUCC) (µg/ml/min) at three levels-< 150, 150-350 and ≤ 350-significant differences appear between the three depressive groups of patients (non-relapsers, partial relapsers and complete relapsers). Particularly, there are more patients with a NAUCC ≤ 350 who show partial or complete relapses than patients with a NAUCC ≤ 350 who do not relapse (P ≤ 0.05). CONCLUSIONS Our results show an increasingly altered HPA axis in those depressive patients with complete or partial relapses compared with those who did not relapse or with healthy controls, but there are not differences in HPA axis between partial and complete relapsers.
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Affiliation(s)
- Luis Pintor
- Psychiatry Department, Neurosciences Institute, Hospital Clínico de Barcelona, C/Roselló 140, 08036 Barcelona, Spain.
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Hori H, Teraishi T, Sasayama D, Hattori K, Hashikura M, Higuchi T, Kunugi H. Relationship of temperament and character with cortisol reactivity to the combined dexamethasone/CRH test in depressed outpatients. J Affect Disord 2013. [PMID: 23178186 DOI: 10.1016/j.jad.2012.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence shows that depression is associated with hypothalamic-pituitary-adrenal (HPA) axis hyperactivation, although such findings are not entirely unequivocal. In contrast, various psychiatric conditions, including atypical depression, are associated with hypocortisolism. Another line of research has demonstrated that personality is associated with HPA axis alteration. It is thus hypothesized that different personality pathology in depression would be associated with distinct cortisol reactivity. METHODS Eighty-seven outpatients with DSM-IV major depressive disorder were recruited. Personality was assessed by the temperament and character inventory (TCI). HPA axis reactivity was measured by the combined dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test. According to our previous studies, two subgroups were considered based on their cortisol responses to the DEX/CRH test: incomplete-suppressors whose cortisol response was exaggerated and enhanced-suppressors whose cortisol response was blunted. RESULTS The analysis of covariance, controlling for age, gender and symptom severity, revealed that incomplete-suppressors scored significantly higher on cooperativeness than enhanced-suppressors (p=0.002). A multivariate stepwise logistic regression analysis predicting the cortisol suppression pattern from the seven TCI dimensions, controlling for age, gender and symptom severity, revealed that lower cooperativeness (p=0.001) and higher reward dependence (p=0.018) were significant predictors toward enhanced suppression. LIMITATIONS The neuroendocrine challenge test was administered only once, based on a simple test protocol. CONCLUSIONS Our findings suggest that (personality-related) subtypes of depression might be differentiated based on the different pattern of cortisol reactivity. Future studies are warranted to further characterize the HPA axis alteration in relation to various subtypes of depression.
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Affiliation(s)
- Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo 187-8502, Japan.
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Menke A, Klengel T, Rubel J, Brückl T, Pfister H, Lucae S, Uhr M, Holsboer F, Binder EB. Genetic variation in FKBP5 associated with the extent of stress hormone dysregulation in major depression. GENES BRAIN AND BEHAVIOR 2013; 12:289-96. [PMID: 23406438 DOI: 10.1111/gbb.12026] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/18/2013] [Accepted: 02/05/2013] [Indexed: 01/05/2023]
Abstract
The FK506 binding protein 51 or FKBP5 has been implicated in the regulation of glucocorticoid receptor (GR) sensitivity, and genetic variants in this gene have been associated with mood and anxiety disorders. GR resistance and associated stress hormone dysregulation are among the most robust biological findings in major depression, the extent of which may be moderated by FKBP5 polymorphisms. FKBP5 mRNA expression in peripheral blood cells (baseline and following in vivo GR stimulation with 1.5 mg dexamethasone p.o.) was analyzed together with plasma cortisol, ACTH, dexamethasone levels and the FKBP5 polymorphism rs1360780 in 68 depressed patients and 87 healthy controls. We observed a significant (P = 0.02) interaction between disease status and FKBP5 risk allele carrier status (minor allele T) on GR-stimulated FKBP5 mRNA expression. Patients carrying the risk T allele, but not the CC genotype, showed a reduced induction of FKBP5 mRNA. This FKBP5 polymorphism by disease status interaction was paralleled by the extent of plasma cortisol and ACTH suppression following dexamethasone administration, with a reduced suppression only observed in depressed patients carrying the T allele. Only depressed patients carrying the FKBP5 rs1360780 risk allele showed significant GR resistance compared with healthy controls, as measured by dexamethasone-induced FKBP5 mRNA induction in peripheral blood cells and suppression of plasma cortisol and ACTH concentrations. This finding suggests that endocrine alterations in depressed patients are determined by genetic variants and may allow identification of specific subgroups.
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Affiliation(s)
- A Menke
- Department of Molecular Genetics of Affective Disorders, Max Planck Institute of Psychiatry, D-80804 Munich, Germany.
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Behnken A, Bellingrath S, Symanczik JP, Rieck MJ, Zavorotnyy M, Domschke K, Arolt V, Zwanzger P. Associations between cognitive performance and cortisol reaction to the DEX/CRH test in patients recovered from depression. Psychoneuroendocrinology 2013; 38:447-54. [PMID: 22840287 DOI: 10.1016/j.psyneuen.2012.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/18/2012] [Accepted: 07/07/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in major depression (MDD) is one of the most reliably reported neurobiological characteristics of affective disorders. Whether these alterations in HPA axis regulation are limited to the acute stage of MDD or whether they persist after recovery, remains ambiguous. A relationship between hypercortisolemia and cognitive dysfunction in acutely depressed patients has been repeatedly observed and it was also demonstrated in a number of studies that a discrete cognitive impairment often persists in the remitted state of depression. In the present study we were interested, whether these subtle impairments in cognitive functioning observed in patients recovered from depression compared to healthy control subjects are associated with HPA axis feedback sensitivity. METHODS In 20 recovered patients and 20 matched healthy controls we assessed HPA axis feedback sensitivity with the combined dexamethasone suppression/corticotropin-releasing-hormone (DEX/CRH) challenge test. Furthermore cognitive performance was investigated with respect to the following domains: verbal memory (Auditory Verbal Learning Test, VLMT), attention and executive control (Trail Making Test, TMT-A/B) as well as verbal fluency (Controlled Oral Word Association Test, COWAT). RESULTS Recovered patients showed a significantly poorer cognitive performance compared to healthy controls (all p<.05). With regard to HPA-axis activity, no overall difference was observed in the DEX/CRH test between recovered patients and controls. In recovered patients however, a significant association was observed between cortisol response and verbal memory (main effect VLMT trial 1-5: p=.046), attention (main effect TMT-A: p=.015) and executive functioning in terms of set shifting (interaction samples*TMT-B: p=.018). Poorer test performance was related to increased cortisol levels in response to challenge. CONCLUSIONS The present findings suggest that patients recovered from MDD are especially vulnerable toward detrimental effects of subtle HPA axis disturbances on cognitive performance.
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Affiliation(s)
- Andreas Behnken
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany
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Joëls M, Sarabdjitsingh RA, Karst H. Unraveling the Time Domains of Corticosteroid Hormone Influences on Brain Activity: Rapid, Slow, and Chronic Modes. Pharmacol Rev 2012; 64:901-38. [DOI: 10.1124/pr.112.005892] [Citation(s) in RCA: 305] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Petrowski K, Wintermann GB, Kirschbaum C, Bornstein SR. Dissociation between ACTH and cortisol response in DEX-CRH test in patients with panic disorder. Psychoneuroendocrinology 2012; 37:1199-208. [PMID: 22277728 DOI: 10.1016/j.psyneuen.2011.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/14/2011] [Accepted: 12/14/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Panic disorder (PD) has been associated with the altered circadian rhythm of the hypothalamic-pituitary-adrenocortical (HPA) axis. The findings regarding the stress-specific functioning of the HPA-system are inconsistent. It is also unclear whether the HPA-system response after the Corticotropin-Releasing-Hormone (CRH) challenge becomes altered. METHODS For this study, the dexamethasone-corticotropin-releasing-hormone (DEX-CRH) test was implemented to assess the HPA-axis reactivity indicated by the plasma adreno-corticotropin-hormone (ACTH) and the cortisol release. The sample included 32 patients diagnosed with PD in a Structured Clinical Interview (SCID). Fourteen male and eighteen female patients, [mean age = 33.50 years, SD = 12.76] were matched with 32 healthy controls by age and gender. Moreover, a sample of patients with unipolar depression (n = 21, ten females) was examined as a clinical control group. RESULTS In healthy controls as well as in patients with PD and patients with unipolar depression, the ACTH and the cortisol response increased significantly due to the CRH injection after dexamethasone pre-treatment. There were differences between the healthy controls and the patients with PD in the plasma cortisol response pattern, however, not in the ACTH. The patients with PD showed a decreased CRH-induced plasma cortisol response. A median-split gave evidence that patients suffering from PD longer than two years showed a remarkably higher HPA-axis reactivity under CRH-injection than patients suffering from PD two years or less. CONCLUSION These findings provide strong evidence that patients with PD show some dissociation between ACTH and cortisol response under the DEX-CRH test with strong indicators that the length of the duration of the psychopathology is a risk factor for an increased reactivity of the HPA-axis in patients with PD.
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Affiliation(s)
- Katja Petrowski
- Institute of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
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Douglas KM, Porter RJ. Associations between hypothalamic-pituitary-adrenal axis function and facial emotion processing in depressed and control participants. Psychiatry Clin Neurosci 2012; 66:442-50. [PMID: 22834663 DOI: 10.1111/j.1440-1819.2012.02364.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The current study examined the relation between facial emotion processing accuracy and an aspect of hypothalamic-pituitary-adrenal axis function in 64 inpatients with major depression and 49 healthy controls over a 2-week period. METHODS The Dexamethasone Suppression Test and a Facial Expression Recognition Task were completed at baseline and 10-14 days after baseline. Treatment response was determined 6 weeks after baseline by change in the Montgomery-Asberg Depression Rating Scale. RESULTS Increased cortisol response to dexamethasone was significantly correlated with reduced ability to recognize facial expressions of anger, sadness and disgust within the total sample, but these correlations did not remain significant at 10-14 days. Surprisingly, cortisol response to dexamethasone was comparable in acutely depressed inpatients and healthy controls, and did not change over time in relation to treatment response. CONCLUSION The study findings provide preliminary evidence that hypothalamic-pituitary-adrenal axis functioning and processing threat-related facial expressions are related, perhaps through involvement of the amygdala.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
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Ishitobi Y, Nakayama S, Yamaguchi K, Kanehisa M, Higuma H, Maruyama Y, Ninomiya T, Okamoto S, Tanaka Y, Tsuru J, Hanada H, Isogawa K, Akiyoshi J. Association of CRHR1 and CRHR2 with major depressive disorder and panic disorder in a Japanese population. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:429-36. [PMID: 22467522 DOI: 10.1002/ajmg.b.32046] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 03/01/2012] [Indexed: 12/19/2022]
Abstract
Major depressive disorder (MDD) and panic disorder (PD) are common and disabling medical disorders with stress and genetic components. Dysregulation of the stress response of the hypothalamic-pituitary-adrenal axis, including the corticotrophin-releasing hormone (CRH) signaling via primary receptors (CRHR1 and CRHR2), is considered to play a major role for onset and recurrence in MDD and PD. To confirm the association of CRHR1 and CRHR2 with MDD and PD, we investigated 12 single nucleotide polymorphisms (SNPs) (rs4076452, rs7209436, rs110402, rs242924, rs242940, and rs173365 for CRHR1 and rs4722999, rs3779250, rs2267710, rs1076292, rs2284217, and rs226771 for CRHR2) in MDD patients (n = 173), PD patients (n = 180), and healthy controls (n = 285). The SNP rs110402 and rs242924 in the CRHR1 gene and the rs3779250 in the CRHR2 gene were associated with MDD. The SNP rs242924 in the CRHR1 gene was also associated with PD. The T-A-T-G-G haplotype consisting of rs7209436 and rs173365 in CRHR1 was positively associated with MDD. The T-A haplotype consisting of rs7209436 and rs110402 in CRHR1 was positively associated with MDD. The C-C haplotype consisting of rs4722999 and rs37790 in CRHR1 was associated with PD. These results provide support for an association of CRHR1 and CRHR2 with MDD and PD.
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Affiliation(s)
- Yoshinobu Ishitobi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Yufu-Shi, Oita, Japan
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Post RM, Fleming J, Kapczinski F. Neurobiological correlates of illness progression in the recurrent affective disorders. J Psychiatr Res 2012; 46:561-73. [PMID: 22444599 DOI: 10.1016/j.jpsychires.2012.02.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/02/2012] [Accepted: 02/09/2012] [Indexed: 11/19/2022]
Abstract
Some clinical aspects of affective illness progression, such as episode-, stress-, and substance-induced sensitization, have been well documented in the literature, but others have received less attention. These include cognitive deficits, treatment-refractoriness, and neurobiological correlates of illness progression, which are the primary focus of this paper. We review the evidence that cognitive dysfunction, treatment resistance, medical comorbidities, and neurobiological abnormalities increase as a function of the number of prior episodes or duration of illness in the recurrent unipolar and bipolar disorders. Substantial evidence supports the view that cognitive dysfunction and vulnerability to a diagnosis of dementia in old age increases as a function of number of prior mood episodes as does non-response to many therapeutic interventions as well as naturalistic treatment. Neurobiological abnormalities that correlate with the number of mood episodes or duration of illness include: anatomical, functional, and biochemical deficits in the prefrontal cortex and hippocampus, as well as amygdala hyperactivity and cortisol hyper-secretion. Some neurotrophic factors and inflammatory markers may also change with greater illness burden. Causality cannot be inferred from these correlative relationships. Nonetheless, given the potentially grave consequences of episode recurrence and progression for morbidity and treatment non-responsiveness, it is clinically wise to assume episodes are causing some of the progressive cognitive and neurobiological abnormalities. As such, earlier and more sustained long-term prophylaxis to attempt to reduce these adverse outcomes is indicated.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, 5415 W Cedar Lane, Suite 201-B, Bethesda, MD 20814, United States.
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Dexamethasone stimulated gene expression in peripheral blood is a sensitive marker for glucocorticoid receptor resistance in depressed patients. Neuropsychopharmacology 2012; 37:1455-64. [PMID: 22237309 PMCID: PMC3327850 DOI: 10.1038/npp.2011.331] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although gene expression profiles in peripheral blood in major depression are not likely to identify genes directly involved in the pathomechanism of affective disorders, they may serve as biomarkers for this disorder. As previous studies using baseline gene expression profiles have provided mixed results, our approach was to use an in vivo dexamethasone challenge test and to compare glucocorticoid receptor (GR)-mediated changes in gene expression between depressed patients and healthy controls. Whole genome gene expression data (baseline and following GR-stimulation with 1.5 mg dexamethasone p.o.) from two independent cohorts were analyzed to identify gene expression pattern that would predict case and control status using a training (N=18 cases/18 controls) and a test cohort (N=11/13). Dexamethasone led to reproducible regulation of 2670 genes in controls and 1151 transcripts in cases. Several genes, including FKBP5 and DUSP1, previously associated with the pathophysiology of major depression, were found to be reliable markers of GR-activation. Using random forest analyses for classification, GR-stimulated gene expression outperformed baseline gene expression as a classifier for case and control status with a correct classification of 79.1 vs 41.6% in the test cohort. GR-stimulated gene expression performed best in dexamethasone non-suppressor patients (88.7% correctly classified with 100% sensitivity), but also correctly classified 77.3% of the suppressor patients (76.7% sensitivity), when using a refined set of 19 genes. Our study suggests that in vivo stimulated gene expression in peripheral blood cells could be a promising molecular marker of altered GR-functioning, an important component of the underlying pathology, in patients suffering from depressive episodes.
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O'Brien FE, Dinan TG, Griffin BT, Cryan JF. Interactions between antidepressants and P-glycoprotein at the blood-brain barrier: clinical significance of in vitro and in vivo findings. Br J Pharmacol 2012; 165:289-312. [PMID: 21718296 DOI: 10.1111/j.1476-5381.2011.01557.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The drug efflux pump P-glycoprotein (P-gp) plays an important role in the function of the blood-brain barrier by selectively extruding certain endogenous and exogenous molecules, thus limiting the ability of its substrates to reach the brain. Emerging evidence suggests that P-gp may restrict the uptake of several antidepressants into the brain, thus contributing to the poor success rate of current antidepressant therapies. Despite some inconsistency in the literature, clinical investigations of potential associations between functional single nucleotide polymorphisms in ABCB1, the gene which encodes P-gp, and antidepressant response have highlighted a potential link between P-gp function and treatment-resistant depression (TRD). Therefore, co-administration of P-gp inhibitors with antidepressants to patients who are refractory to antidepressant therapy may represent a novel therapeutic approach in the management of TRD. Furthermore, certain antidepressants inhibit P-gp in vitro, and it has been hypothesized that inhibition of P-gp by such antidepressant drugs may play a role in their therapeutic action. The present review summarizes the available in vitro, in vivo and clinical data pertaining to interactions between antidepressant drugs and P-gp, and discusses the potential relevance of these interactions in the treatment of depression.
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Affiliation(s)
- Fionn E O'Brien
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
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Lenz B, Müller CP, Stoessel C, Sperling W, Biermann T, Hillemacher T, Bleich S, Kornhuber J. Sex hormone activity in alcohol addiction: integrating organizational and activational effects. Prog Neurobiol 2011; 96:136-63. [PMID: 22115850 DOI: 10.1016/j.pneurobio.2011.11.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 11/03/2011] [Accepted: 11/08/2011] [Indexed: 01/06/2023]
Abstract
There are well-known sex differences in the epidemiology and etiopathology of alcohol dependence. Male gender is a crucial risk factor for the onset of alcohol addiction. A directly modifying role of testosterone in alcohol addiction-related behavior is well established. Sex hormones exert both permanent (organizational) and transient (activational) effects on the human brain. The sensitive period for these effects lasts throughout life. In this article, we present a novel early sex hormone activity model of alcohol addiction. We propose that early exposure to sex hormones triggers structural (organizational) neuroadaptations. These neuroadaptations affect cellular and behavioral responses to adult sex hormones, sensitize the brain's reward system to the reinforcing properties of alcohol and modulate alcohol addictive behavior later in life. This review outlines clinical findings related to the early sex hormone activity model of alcohol addiction (handedness, the second-to-fourth-finger length ratio, and the androgen receptor and aromatase) and includes clinical and preclinical literature regarding the activational effects of sex hormones in alcohol drinking behavior. Furthermore, we discuss the role of the hypothalamic-pituitary-adrenal and -gonadal axes and the opioid system in mediating the relationship between sex hormone activity and alcohol dependence. We conclude that a combination of exposure to sex hormones in utero and during early development contributes to the risk of alcohol addiction later in life. The early sex hormone activity model of alcohol addiction may prove to be a valuable tool in the development of preventive and therapeutic strategies.
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Affiliation(s)
- Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany.
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Hori H, Teraishi T, Ozeki Y, Hattori K, Sasayama D, Matsuo J, Kawamoto Y, Kinoshita Y, Higuchi T, Kunugi H. Schizotypal personality in healthy adults is related to blunted cortisol responses to the combined dexamethasone/ corticotropin-releasing hormone test. Neuropsychobiology 2011; 63:232-41. [PMID: 21494051 DOI: 10.1159/000322146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 10/16/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Schizotypy is viewed as a dimensional trait ranging from healthy people to schizophrenic spectrum patients. Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, and accumulated evidence suggests that schizophrenia is associated with altered HPA axis function; however, HPA axis function in relation to schizotypal personality has not been well documented. METHODS We examined the relationship between schizotypal traits as assessed with the Schizotypal Personality Questionnaire (SPQ) and cortisol responses to the combined dexamethasone/corticotropin- releasing hormone test in 141 healthy volunteers. Subjects were divided into three groups based on their cortisol responses to the dexamethasone/corticotropin-releasing hormone test: incomplete suppressors, moderate suppressors, and enhanced suppressors. SPQ scores were compared between these three groups using the analysis of covariance, controlling for age and sex. RESULTS The analysis of covariance showed significant main effects of the suppressor status on the ideas of reference and suspiciousness/paranoid ideation subscales and cognitive-perceptual factor. Post-hoc analyses with Bonferroni correction revealed that the enhanced suppressors scored significantly higher than the moderate suppressors on these SPQ indices. CONCLUSION These results indicate that nonclinical schizotypal traits in healthy adults are associated with blunted cortisol reactivity, potentially suggesting a shared neuroendocrinological mechanism across schizophrenia spectrum pathology.
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Affiliation(s)
- Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.
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Poor sleep is associated with exaggerated cortisol response to the combined dexamethasone/CRH test in a non-clinical population. J Psychiatr Res 2011; 45:1257-63. [PMID: 21527190 DOI: 10.1016/j.jpsychires.2011.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/29/2011] [Accepted: 04/04/2011] [Indexed: 02/02/2023]
Abstract
Although sleep disturbance has been shown to be associated with psychological distress and the hypothalamic-pituitary-adrenal (HPA) axis function, the simultaneous relationship between sleep, distress and HPA axis function is less clear. Here we examined the relationship between sleep quality as assessed with the Pittsburgh Sleep Quality Index, psychological distress as assessed with the Hopkins Symptom Checklist, and cortisol responses to the dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test in 139 non-clinical volunteers. Poor sleep was significantly correlated with greater cortisol response to the combined DEX/CRH challenge, but not with the cortisol level just before CRH challenge. When subjects were divided into three groups based on the suppression pattern of cortisol (i.e., incomplete-, moderate-, and enhanced-suppressors), poor sleep was significantly associated with the incomplete suppression in women while no significant association was found between sleep and the enhanced suppression. The association between poor sleep and exaggerated cortisol response to the CRH challenge became more clear in the regression analysis where the confounding effect of psychological distress was taken into consideration. These results indicate that poor sleep would be associated with exaggerated cortisol reactivity. The observed association of poor sleep with reactive cortisol indices to the CRH challenge, but not with the cortisol level after DEX administration alone, might add to the well-established evidence demonstrating the role of CRH in the regulation of sleep. Our findings further suggest that the mediation model would work better than the bivariate approach in investigating the relationship between sleep, distress and HPA axis reactivity.
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50
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Schosser A, Butler AW, Ising M, Perroud N, Uher R, Ng MY, Cohen-Woods S, Craddock N, Owen MJ, Korszun A, Jones L, Jones I, Gill M, Rice JP, Maier W, Mors O, Rietschel M, Lucae S, Binder EB, Preisig M, Perry J, Tozzi F, Muglia P, Aitchison KJ, Breen G, Craig IW, Farmer AE, Müller-Myhsok B, McGuffin P, Lewis CM. Genomewide association scan of suicidal thoughts and behaviour in major depression. PLoS One 2011; 6:e20690. [PMID: 21750702 PMCID: PMC3130038 DOI: 10.1371/journal.pone.0020690] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 05/07/2011] [Indexed: 11/19/2022] Open
Abstract
Background Suicidal behaviour can be conceptualised as a continuum from suicidal ideation, to suicidal attempts to completed suicide. In this study we identify genes contributing to suicidal behaviour in the depression study RADIANT. Methodology/Principal Findings A quantitative suicidality score was composed of two items from the SCAN interview. In addition, the 251 depression cases with a history of serious suicide attempts were classified to form a discrete trait. The quantitative trait was correlated with younger onset of depression and number of episodes of depression, but not with gender. A genome-wide association study of 2,023 depression cases was performed to identify genes that may contribute to suicidal behaviour. Two Munich depression studies were used as replication cohorts to test the most strongly associated SNPs. No SNP was associated at genome-wide significance level. For the quantitative trait, evidence of association was detected at GFRA1, a receptor for the neurotrophin GDRA (p = 2e-06). For the discrete trait of suicide attempt, SNPs in KIAA1244 and RGS18 attained p-values of <5e-6. None of these SNPs showed evidence for replication in the additional cohorts tested. Candidate gene analysis provided some support for a polymorphism in NTRK2, which was previously associated with suicidality. Conclusions/Significance This study provides a genome-wide assessment of possible genetic contribution to suicidal behaviour in depression but indicates a genetic architecture of multiple genes with small effects. Large cohorts will be required to dissect this further.
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Affiliation(s)
- Alexandra Schosser
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Amy W. Butler
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
- Department of Psychiatry, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Marcus Ising
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Nader Perroud
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Rudolf Uher
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Mandy Y. Ng
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Sarah Cohen-Woods
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Nick Craddock
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Michael J. Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Ania Korszun
- Barts and The London Medical School, Queen Mary University of London, London, United Kingdom
| | - Lisa Jones
- Department of Psychiatry, Neuropharmacology and Neurobiology Section, University of Birmingham, Birmingham, United Kingdom
| | - Ian Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Michael Gill
- Department of Psychiatry, Trinity Centre for Health Science, Dublin, Ireland
| | - John P. Rice
- Department of Psychiatry, Washington University, St. Louis, Missouri, United States of America
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Ole Mors
- Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
| | - Marcella Rietschel
- Division of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | | | | | - Martin Preisig
- University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Julia Perry
- GlaxoSmithKline Research & Development, Stockley Park, United Kingdom
| | | | - Pierandrea Muglia
- GlaxoSmithKline Research & Development, Verona, Italy
- Department of Psychiatry, University of Toronto, Toronto, Canada
- NeuroSearch A/S, Ballerup, Denmark
| | - Katherine J. Aitchison
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Gerome Breen
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, London, United Kingdom
| | - Ian W. Craig
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Anne E. Farmer
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | | | - Peter McGuffin
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Cathryn M. Lewis
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
- * E-mail:
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