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Zonca V, Marizzoni M, Saleri S, Zajkowska Z, Manfro PH, Souza L, Viduani A, Sforzini L, Swartz JR, Fisher HL, Kohrt BA, Kieling C, Riva MA, Cattaneo A, Mondelli V. Inflammation and immune system pathways as biological signatures of adolescent depression-the IDEA-RiSCo study. Transl Psychiatry 2024; 14:230. [PMID: 38824135 PMCID: PMC11144232 DOI: 10.1038/s41398-024-02959-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024] Open
Abstract
The biological mechanisms underlying the onset of major depressive disorder (MDD) have predominantly been studied in adult populations from high-income countries, despite the onset of depression typically occurring in adolescence and the majority of the world's adolescents living in low- and middle-income countries (LMIC). Taking advantage of a unique adolescent sample in an LMIC (Brazil), this study aimed to identify biological pathways characterizing the presence and increased risk of depression in adolescence, and sex-specific differences in such biological signatures. We collected blood samples from a risk-stratified cohort of 150 Brazilian adolescents (aged 14-16 years old) comprising 50 adolescents with MDD, 50 adolescents at high risk of developing MDD but without current MDD, and 50 adolescents at low risk of developing MDD and without MDD (25 females and 25 males in each group). We conducted RNA-Seq and pathway analysis on whole blood. Inflammatory-related biological pathways, such as role of hypercytokinemia/hyperchemokinemia in the pathogenesis of influenza (z-score = 3.464, p < 0.001), interferon signaling (z-score = 2.464, p < 0.001), interferon alpha/beta signaling (z-score = 3.873, p < 0.001), and complement signaling (z-score = 2, p = 0.002) were upregulated in adolescents with MDD compared with adolescents without MDD independently from their level of risk. The up-regulation of such inflammation-related pathways was observed in females but not in males. Inflammatory-related pathways involved in the production of cytokines and in interferon and complement signaling were identified as key indicators of adolescent depression, and this effect was present only in females.
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Affiliation(s)
- Valentina Zonca
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
| | - Moira Marizzoni
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - Samantha Saleri
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - Zuzanna Zajkowska
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Pedro H Manfro
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350-400N, Porto Alegre, RS, 90035-903, Brazil
| | - Laila Souza
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350-400N, Porto Alegre, RS, 90035-903, Brazil
| | - Anna Viduani
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350-400N, Porto Alegre, RS, 90035-903, Brazil
| | - Luca Sforzini
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Johnna R Swartz
- Department of Human Ecology, University of California, Davis, Davis, CA, 95616, USA
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Brandon A Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, School of Medicine and Health Sciences, The George Washington University, 2120 L St NW, Ste 600, Washington, DC, 20037D, USA
| | - Christian Kieling
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350-400N, Porto Alegre, RS, 90035-903, Brazil
| | - Marco Andrea Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - Annamaria Cattaneo
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - Valeria Mondelli
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, UK
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Sokolov AV, Lafta MS, Nordberg DOT, Jonsson J, Schiöth HB. Depression proteomic profiling in adolescents with transcriptome analyses in independent cohorts. Front Psychiatry 2024; 15:1372106. [PMID: 38812487 PMCID: PMC11133714 DOI: 10.3389/fpsyt.2024.1372106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Depression is a major global burden with unclear pathophysiology and poor treatment outcomes. Diagnosis of depression continues to rely primarily on behavioral rather than biological methods. Investigating tools that might aid in diagnosing and treating early-onset depression is essential for improving the prognosis of the disease course. While there is increasing evidence of possible biomarkers in adult depression, studies investigating this subject in adolescents are lacking. Methods In the current study, we analyzed protein levels in 461 adolescents assessed for depression using the Development and Well-Being Assessment (DAWBA) questionnaire as part of the domestic Psychiatric Health in Adolescent Study conducted in Uppsala, Sweden. We used the Proseek Multiplex Neuro Exploratory panel with Proximity Extension Assay technology provided by Olink Bioscience, followed by transcriptome analyses for the genes corresponding to the significant proteins, using four publicly available cohorts. Results We identified a total of seven proteins showing different levels between DAWBA risk groups at nominal significance, including RBKS, CRADD, ASGR1, HMOX2, PPP3R1, CD63, and PMVK. Transcriptomic analyses for these genes showed nominally significant replication of PPP3R1 in two of four cohorts including whole blood and prefrontal cortex, while ASGR1 and CD63 were replicated in only one cohort. Discussion Our study on adolescent depression revealed protein-level and transcriptomic differences, particularly in PPP3R1, pointing to the involvement of the calcineurin pathway in depression. Our findings regarding PPP3R1 also support the role of the prefrontal cortex in depression and reinforce the significance of investigating prefrontal cortex-related mechanisms in depression.
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Affiliation(s)
| | | | | | | | - Helgi B. Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
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Choi K, Lee J, Kim G, Lim Y, Kang HJ. Recovery of synaptic loss and depressive-like behavior induced by GATA1 through blocking of the neuroinflammatory response. Front Cell Neurosci 2024; 18:1369951. [PMID: 38784708 PMCID: PMC11112091 DOI: 10.3389/fncel.2024.1369951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024] Open
Abstract
GATA1, a member of the GATA transcription factor family, is a critical factor in hematopoietic system development. In a previous study, we demonstrated the increased expression of GATA1 in the dorsolateral prefrontal cortex (dlPFC) of patients suffering from depression and described its role as a transcriptional repressor of synapse-related genes. In this study, we investigated how GATA1 globally altered gene expression using multi-omics approaches. Through the combined analyses of ChIPseq, mRNAseq, and small RNAseq, we profiled genes that are potentially affected by GATA1 in cultured cortical neurons, and Gene Ontology (GO) analysis revealed that GATA1 might be associated with immune-related functions. We hypothesized that GATA1 induces immune activation, which has detrimental effects including synapse loss and depressive-like behavior. To test this hypothesis, we first performed a microglial morphometric analysis of a brain having overexpression of GATA1 because microglia are the resident immune cells of the central nervous system. Fractal analysis showed that the ramification and process length of microglia decreased in brains having GATA1 overexpression compared to the control, suggesting that GATA1 overexpression increases the activation of microglia. Through flow cytometry and immunohistochemical analysis, we found that activated microglia showed pro-inflammatory phenotypes characterized by the expression of CD86 and CD68. Finally, we demonstrated that the effects of GATA1 overexpression including synapse loss and depressive-like behavior could be blocked by inhibiting microglial activation using minocycline. These results will elucidate the regulatory mechanisms of GATA1 that affect pathophysiological conditions such as depression and provide a potential target for the treatment of depression.
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Affiliation(s)
| | | | | | | | - Hyo Jung Kang
- Department of Life Science, Chung-Ang University, Seoul, Republic of Korea
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Qiu R, Lin H, Jiang H, Shen J, He J, Fu J. Association of major depression, schizophrenia and bipolar disorder with thyroid cancer: a bidirectional two-sample mendelian randomized study. BMC Psychiatry 2024; 24:261. [PMID: 38594691 PMCID: PMC11003083 DOI: 10.1186/s12888-024-05682-7] [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: 11/30/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Major depressive disease (MDD), schizophrenia (SCZ), and bipolar disorder (BD) are common psychiatric disorders, and their relationship with thyroid cancer has been of great interest. This study aimed to investigate the potential causal effects of MDD, SCZ, BD, and thyroid cancer. METHODS We used publicly available summary statistics from large-scale genome-wide association studies to select genetic variant loci associated with MDD, SCZ, BD, and thyroid cancer as instrumental variables (IVs), which were quality controlled and clustered. Additionally, we used three Mendelian randomization (MR) methods, inverse variance weighted (IVW), MR-Egger regression and weighted median estimator (WME) methods, to estimate the bidirectional causal relationship between psychiatric disorders and thyroid cancer. In addition, we performed heterogeneity and multivariate tests to verify the validity of the IVs. RESULTS We used two-sample bidirectional MR analysis to determine whether there was a positive causal association between MDD and thyroid cancer risk. The results of the IVW analysis (OR = 3.956 95% CI = 1.177-13.299; P = 0.026) and the WME method (OR = 5.563 95% CI = 0.998-31.008; P = 0.050) confirmed that MDD may increase the risk of thyroid cancer. Additionally, our study revealed a correlation between genetic susceptibility to SCZ and thyroid cancer (OR = 1.532 95% CI = 1.123-2.088; P = 0.007). The results of the WME method analysis based on the median estimate (OR = 1.599 95% CI = 1.014-2.521; P = 0.043) also suggested that SCZ may increase the risk of thyroid cancer. Furthermore, our study did not find a causal relationship between BD and thyroid cancer incidence. In addition, the results of reverse MR analysis showed no significant causal relationships between thyroid cancer and MDD, SCZ, or BD (P > 0.05), ruling out the possibility of reverse causality. CONCLUSIONS This MR method analysis provides new evidence that MDD and SCZ may be positively associated with thyroid cancer risk while also revealing a correlation between BD and thyroid cancer. These results may have important implications for public health policy and clinical practice. Future studies will help elucidate the biological mechanisms of these associations and potential confounders.
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Affiliation(s)
- Rongliang Qiu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China
- Department of General Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361004, China
| | - Huihui Lin
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Hongzhan Jiang
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Jiali Shen
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Jiaxi He
- School of Medicine, Xiamen University, Xiamen, 361004, China
| | - Jinbo Fu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China.
- Department of General Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361004, China.
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Schumacher A, Muha J, Campisi SC, Bradley-Ridout G, Lee ACH, Korczak DJ. The Relationship between Neurobiological Function and Inflammation in Depressed Children and Adolescents: A Scoping Review. Neuropsychobiology 2024; 83:61-72. [PMID: 38574476 PMCID: PMC11210562 DOI: 10.1159/000538060] [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: 12/11/2023] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Neurobiological dysfunction is associated with depression in children and adolescents. While research in adult depression suggests that inflammation may underlie the association between depression and brain alterations, it is unclear if altered levels of inflammatory markers provoke neurobiological dysfunction in early-onset depression. The aim of this scoping review was to provide an overview of existing literature investigating the potential interaction between neurobiological function and inflammation in depressed children and adolescents. METHODS Systematic searches were conducted in six databases. Primary research studies that included measures of both neurobiological functioning and inflammation among children (≤18 years) with a diagnosis of depression were included. RESULTS Four studies (240 participants; mean age 16.0 ± 0.6 years, 62% female) meeting inclusion criteria were identified. Studies primarily examined the inflammatory markers interleukin 6, tumor necrosis factor alpha, C-reactive protein, and interleukin 1 beta. Exploratory whole brain imaging and analysis as well as region of interest approaches focused on the anterior cingulate cortex, basal ganglia, and white matter tracts were conducted. Most studies found correlations between neurobiological function and inflammatory markers; however, depressive symptoms were not observed to moderate these effects. CONCLUSIONS A small number of highly heterogeneous studies indicate that depression may not modulate the association between altered inflammation and neurobiological dysfunction in children and adolescents. Replication in larger samples using consistent methodological approaches (focus on specific inflammatory markers, examine certain brain areas) is needed to advance the knowledge of potential neuro-immune interactions early in the course of depression.
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Affiliation(s)
- Anett Schumacher
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada,
| | - Jessica Muha
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Susan C Campisi
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Andy C H Lee
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Liu L, Yang X, Yang C, Tian Y, Li W, Xia L, Liu H. Associations between insomnia symptoms and inflammatory cytokines in adolescents with first-episode and recurrent major depressive disorder. J Affect Disord 2024; 350:110-117. [PMID: 38220096 DOI: 10.1016/j.jad.2024.01.031] [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: 08/15/2023] [Revised: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Insomnia symptoms are often associated with increased levels of inflammatory biomarkers. However, such associations have not been adequately explored in adolescents with major depressive disorder (MDD). This study aimed to examine the associations between insomnia symptoms with inflammatory cytokines in adolescents with first-episode and recurrent MDD. METHODS From January to December 2021, this study included 164 adolescents with MDD and 76 healthy controls (HCs). The Center for Epidemiological Studies Depression Scale (CES-D) and the Insomnia Severity Index Scale (ISI) were used to assess depressive and insomnia symptoms, respectively. Also, plasma levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17 A and tumor necrosis factor-α (TNF-α) were measured. RESULTS The prevalence of mild, moderate and severe insomnia in adolescents with MDD was 40.24 %, 36.59 % and 6.71 %, respectively. The patients had higher levels of IL-1β, IL-6 and TNF-α than HCs (all p < 0.05). ISI score was positively correlated with CES-D score and levels of IL-1β, IL-6 and TNF-α in first-episode patients but not in recurrent patients. A further multivariate stepwise linear regression analysis showed that ISI score was independently associated with CES-D score (beta = 0.523, t = 5.833, p < 0.001) and TNF-α levels (beta = 0.254, t = 2.832, p = 0.006). LIMITATIONS The cross-sectional design leads to failure to make causal inferences. CONCLUSION Insomnia symptoms are common in adolescents with MDD and associated with elevated levels of inflammatory cytokines in first-episode patients. The findings suggest that inflammatory cytokines may relate to the pathogenesis of insomnia symptoms in adolescents with MDD, but further longitudinal studies are needed to explore the causal association between insomnia symptoms and inflammatory cytokines in MDD.
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Affiliation(s)
- Lewei Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230000, Anhui Province, China; Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, Anhui Province, China; Anhui Psychiatric Center, Anhui Medical University, Hefei 238000, Anhui Province, China
| | - Xiaoxue Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230000, Anhui Province, China; Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, Anhui Province, China; Anhui Psychiatric Center, Anhui Medical University, Hefei 238000, Anhui Province, China
| | - Cheng Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230000, Anhui Province, China; Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, Anhui Province, China; Anhui Psychiatric Center, Anhui Medical University, Hefei 238000, Anhui Province, China
| | - Yinghan Tian
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230000, Anhui Province, China; Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, Anhui Province, China; Anhui Psychiatric Center, Anhui Medical University, Hefei 238000, Anhui Province, China
| | - Wenzheng Li
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei 230000, Anhui Province, China
| | - Lei Xia
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230000, Anhui Province, China; Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, Anhui Province, China; Anhui Psychiatric Center, Anhui Medical University, Hefei 238000, Anhui Province, China.
| | - Huanzhong Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230000, Anhui Province, China; Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, Anhui Province, China; Anhui Psychiatric Center, Anhui Medical University, Hefei 238000, Anhui Province, China.
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Kouba BR, de Araujo Borba L, Borges de Souza P, Gil-Mohapel J, Rodrigues ALS. Role of Inflammatory Mechanisms in Major Depressive Disorder: From Etiology to Potential Pharmacological Targets. Cells 2024; 13:423. [PMID: 38474387 DOI: 10.3390/cells13050423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
The involvement of central and peripheral inflammation in the pathogenesis and prognosis of major depressive disorder (MDD) has been demonstrated. The increase of pro-inflammatory cytokines (interleukin (IL)-1β, IL-6, IL-18, and TNF-α) in individuals with depression may elicit neuroinflammatory processes and peripheral inflammation, mechanisms that, in turn, can contribute to gut microbiota dysbiosis. Together, neuroinflammation and gut dysbiosis induce alterations in tryptophan metabolism, culminating in decreased serotonin synthesis, impairments in neuroplasticity-related mechanisms, and glutamate-mediated excitotoxicity. This review aims to highlight the inflammatory mechanisms (neuroinflammation, peripheral inflammation, and gut dysbiosis) involved in the pathophysiology of MDD and to explore novel anti-inflammatory therapeutic approaches for this psychiatric disturbance. Several lines of evidence have indicated that in addition to antidepressants, physical exercise, probiotics, and nutraceuticals (agmatine, ascorbic acid, and vitamin D) possess anti-inflammatory effects that may contribute to their antidepressant properties. Further studies are necessary to explore the therapeutic benefits of these alternative therapies for MDD.
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Affiliation(s)
- Bruna R Kouba
- Department of Biochemistry, Center of Biological Sciences, Universidade Federal de Santa Catarina, Florianópolis 88040-900, SC, Brazil
| | - Laura de Araujo Borba
- Department of Biochemistry, Center of Biological Sciences, Universidade Federal de Santa Catarina, Florianópolis 88040-900, SC, Brazil
| | - Pedro Borges de Souza
- Department of Biochemistry, Center of Biological Sciences, Universidade Federal de Santa Catarina, Florianópolis 88040-900, SC, Brazil
| | - Joana Gil-Mohapel
- Island Medical Program, Faculty of Medicine, University of British Columbia, Victoria, BC V8P 5C2, Canada
- Division of Medical Sciences, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Ana Lúcia S Rodrigues
- Department of Biochemistry, Center of Biological Sciences, Universidade Federal de Santa Catarina, Florianópolis 88040-900, SC, Brazil
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Lindenmuth M, Hodes GE, Herd T, Casas B, Kim-Spoon J. Longitudinal associations between dimensions of maltreatment and internalizing symptoms in late adolescence: The role of inflammation during the COVID-19 pandemic. Brain Behav Immun Health 2024; 35:100719. [PMID: 38261884 PMCID: PMC10796806 DOI: 10.1016/j.bbih.2023.100719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Childhood adversity and depression have been linked with heightened inflammation. However, few longitudinal studies examine how dimensions of maltreatment (i.e., abuse and neglect) differentially impact pathways to heightened inflammation and internalizing symptoms. The present study examined effects of abuse and neglect on (1) internalizing symptoms through inflammation, and (2) on inflammation through internalizing symptoms across 3 years of adolescence in the context of the COVID-19 pandemic. In a sample of 78 adolescents, significant indirect effects revealed that childhood abuse, not neglect, significantly predicted future internalizing symptoms, which predicted future heighted C-reactive protein (CRP). Using prospective longitudinal data, these findings emphasize the importance of examining distinct forms of maltreatment in understanding the developmental pathways connecting early adversity, internalizing symptoms, and inflammation.
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Affiliation(s)
| | | | - Toria Herd
- College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Brooks Casas
- Fralin Biomedical Research Institute, Roanoke, VA, USA
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Zajkowska Z, Nikkheslat N, Manfro PH, Souza L, Rohrsetzer F, Viduani A, Pereira R, Piccin J, Zonca V, Walsh AEL, Gullett N, Fisher HL, Swartz JR, Kohrt BA, Kieling C, Mondelli V. Sex-specific inflammatory markers of risk and presence of depression in adolescents. J Affect Disord 2023; 342:69-75. [PMID: 37437730 DOI: 10.1016/j.jad.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Associations between inflammatory markers and depression are reported among adults; however, less is known in adolescent depression in particular whether these associations are sex-specific. We aimed to identify inflammatory markers of increased risk and presence of depression in adolescence and their association with severity of depressive symptoms in the entire cohort and separately in boys and girls. METHODS We measured serum cytokines using a Meso Scale Discovery electrochemiluminescence V-PLEX assay in a cohort of 150 adolescents stratified for risk/presence of depression. Risk group and sex-specific differences in inflammatory markers were assessed with 2-way mixed ANOVA, and sex-moderated associations between inflammatory markers and the severity of depressive symptoms were assessed with moderated multiple hierarchical regression analyses. RESULTS We found a significant interaction between biological sex and the risk group, where boys showed higher interleukin (IL)-2 levels among the depressed group compared with the low-risk group. The severity of depressive symptoms was associated with elevated levels of IL-2 in boys, and of IL-6 in girls. There was a significant moderating effect of sex on the relationship between IL-2 and the severity of depressive symptoms but not for IL-6. LIMITATIONS The cross-sectional design means that we cannot be certain about the direction of the associations. CONCLUSIONS Our findings suggest sex-specific associations between inflammatory markers and the development of adolescent depression, where IL-2 may increase risk for depression and severity of depressive symptoms in boys, but not in girls. However, IL-6 may increase risk for more severe depressive symptoms in girls.
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Affiliation(s)
- Zuzanna Zajkowska
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Naghmeh Nikkheslat
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Pedro H Manfro
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Laila Souza
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Fernanda Rohrsetzer
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Anna Viduani
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Rivka Pereira
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Jader Piccin
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Valentina Zonca
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Annabel E L Walsh
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Nancy Gullett
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Johnna R Swartz
- Department of Human Ecology, University of California, Davis, USA
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, 2120 L St NW, Ste 600, Washington, DC 20037, USA
| | - Christian Kieling
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Valeria Mondelli
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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10
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Chi S, Mok YE, Kang J, Gim JA, Han C, Lee MS. Cytokine levels reflect tic symptoms more prominently during mild phases. BMC Neurosci 2023; 24:57. [PMID: 37907857 PMCID: PMC10617191 DOI: 10.1186/s12868-023-00830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Abstract
Tic disorder is a neuropsychiatric condition that affects 3% of all children and can have a significant impact on their quality of life. Cytokines, interferons, interleukins, lymphokines, and tumor necrosis factors are involved in the neuroinflammatory circuitry of tic disorders. This study aimed to identify the cytokines involved in the pathogenesis of tic disorders. We enrolled 44 patients with tic disorder and 38 healthy controls. Patients were free of psychotropic medications for at least 3 weeks. Whole blood samples were analyzed using a Luminex® human cytokine multiplex assay kit. Patients were divided into groups with "mild tics" and "above moderate tics" based on Yale Global Tic Severity Scale (YGTSS) scores for comparison. The final analysis included 35 patients (28 male and 7 female) and 31 controls (20 male and 11 female). In the mild tic group, interleukin (IL)-12 p70 negatively correlated with motor tic scores. Granulocyte-macrophage colony-stimulating factor, IL-4, IL-8, and tumor necrosis factor (TNF)-α were positively correlated to phonic tic scores. IL-12 p40 and TNF-α were positively correlated to total tic scores. IL-12 p70 and IL-17a negatively correlated to impairment scores and total YGTSS scores. Tic disorder patients and healthy controls exhibit different cytokine profiles. Only patients with mild symptoms exhibit significant correlations, suggesting that the correlations between cytokine levels and tic symptoms are more relevant during the mild or remission phases. Our results present the importance of IL-1β and TNF-α, among others, but the identification of key cytokines are still necessary.
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Affiliation(s)
- SuHyuk Chi
- Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Young Eun Mok
- Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - June Kang
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Jeong-An Gim
- Medical Science Research Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Wunram HL, Kasparbauer AM, Oberste M, Bender S. [Movement as a Neuromodulator: How Physical Activity Influences the Physiology of Adolescent Depression]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 52:77-93. [PMID: 37851436 DOI: 10.1024/1422-4917/a000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Movement as a Neuromodulator: How Physical Activity Influences the Physiology of Adolescent Depression Abstract: In the context of adolescent depression, physical activity is becoming increasingly recognized for its positive effects on neuropathology. Current scientific findings indicate that physical training affects the biological effects of depression during adolescence. Yet the pathophysiology of adolescent depression is not yet fully understood. Besides psychosocial and genetic influences, various neurobiological factors are being discussed. One explanation model describes a dysfunction of the hypothalamus-pituitary-adrenal axis (HPA axis) with a sustained elevation in cortisol concentration. Recent studies highlight neuroimmunological processes and a reduced concentration of growth factors as causative factors. These changes appear to lead to a dysregulation of the excitation and inhibition balance of the cerebral cortex as well as to cerebral morphological alterations. Regular physical training can potentially counteract the dysregulation of the HPA axis and normalize cortisol levels. The release of proinflammatory cytokines is inhibited, and the expression of growth factors involved in adult neurogenesis is stimulated. One should ensure the synergistic interaction of biological and psychosocial factors when designing the exercise schedule (endurance or strength training, group or individual sports, frequency, duration, and intensity). Addressing these open questions is essential when integrating physical activity into the guidelines for treating depressive disorders in children and adolescents.
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Affiliation(s)
- Heidrun Lioba Wunram
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Kinderklinik Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Geteilte Erstautorenschaft
| | - Anna-Maria Kasparbauer
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Geteilte Erstautorenschaft
| | - Max Oberste
- Institut für Medizinische Statistik und Bioinformatik, Universität zu Köln, Deutschland
| | - Stephan Bender
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
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12
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Hu S, Li X, Yang L. Effects of physical activity in child and adolescent depression and anxiety: role of inflammatory cytokines and stress-related peptide hormones. Front Neurosci 2023; 17:1234409. [PMID: 37700748 PMCID: PMC10493323 DOI: 10.3389/fnins.2023.1234409] [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: 06/04/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
Depression and anxiety are the most common mental illnesses affecting children and adolescents, significantly harming their well-being. Research has shown that regular physical activity can promote cognitive, emotional, fundamental movement skills, and motor coordination, as a preventative measure for depression while reducing the suicide rate. However, little is known about the potential role of physical activity in adolescent depression and anxiety. The studies reviewed in this paper suggest that exercise can be an effective adjunctive treatment to improve depressive and anxiety symptoms in adolescents, although research on its neurobiological effects remains limited.
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Affiliation(s)
- Shaojuan Hu
- College of Physical Education and Sports Science, Hengyang Normal University, Hengyang, China
| | - Xinyuan Li
- College of Physical Education and Sports Science, Hengyang Normal University, Hengyang, China
| | - Luodan Yang
- College of Physical Education and Sport Science, South China Normal University, Guangzhou, China
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13
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Rengasamy M, Nance M, Eckstrand K, Forbes E. Splitting the reward: Differences in inflammatory marker associations with neural connectivity between reward anticipation and reward outcome in adolescents at high risk for depression. J Affect Disord 2023; 327:128-136. [PMID: 36736795 DOI: 10.1016/j.jad.2023.01.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adolescent depression is associated with both dysfunction in neural reward processing and peripheral inflammatory markers (PIMs), such as interleukin-6 (IL-6), C-reactive-protein (CRP), and tumor-necrosis factor alpha (TNFα). Few adolescent studies have examined neural-inflammatory marker associations and associated behavioral correlates, which would contribute to a better understanding of developmental processes linked to depression. METHODS 36 adolescents at high risk of depression completed an fMRI reward task (during anticipation and outcome), blood draw for PIMs (IL-6, CRP, and TNFα), and a behavioral task assessing motivation to expend effort. Analyses examined associations of task-dependent functional connectivity (FC; ventral striatum to frontal and default mode network brain regions), and if the interaction of PIMs and task-dependent FC predicted motivation to expend effort. RESULTS For anticipation contrast, TNFα was associated with increased task-dependent FC between the LVS and PCC/vmPFC. In moderation analyses, for anticipation contrasts, the combination of higher IL-6 and stronger FC (LVS-precuneus/PCC) was associated with lower motivation to expend effort, while for outcome contrasts, the combination of higher IL-6 and stronger FC (VS-precuneus/PCC) was associated with greater motivation to expend effort. CONCLUSIONS Our findings in adolescents during an important developmental time period suggest that PIMs are directly linked to greater FC between the VS and DMN brain regions during win anticipation, consistent with prior studies. Effects of PIMs on motivation to expend effort may vary the strength/type of neural reward processing (anticipation or outcome), which could guide better understanding how inflammatory markers and neural reward substrates contribute to development of depression in high-risk adolescents.
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Affiliation(s)
- Manivel Rengasamy
- University of Pittsburgh, Department of Psychiatry, United States of America.
| | - Melissa Nance
- University of Pittsburgh, Department of Psychiatry, United States of America
| | - Kristen Eckstrand
- University of Pittsburgh, Department of Psychiatry, United States of America
| | - Erika Forbes
- University of Pittsburgh, Department of Psychiatry, United States of America
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Dondanville AA, Pössel P, Fernandez-Botran GR. Relation Between the Negative Cognitive Triad, Perceived Everyday Discrimination, Depressive Symptoms, and TNF-⍺ in Adolescents. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01530-z. [PMID: 37009971 DOI: 10.1007/s10578-023-01530-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
Our study is guided by Beck's cognitive stress-vulnerability model of depression. We examined the associations between perceived everyday discrimination (PED) and TNF-⍺, an inflammatory biomarker associated with risk for severe illness, through the negative cognitive triad (NCT; negative thoughts about the self, world, and future) and depressive symptoms in adolescents. We utilized a sample of 99 adolescents (36.4% female; ages 13-16, M = 14.10, SD = 0.52) in our cross-sectional study. We used PROCESS and AMOS to compute regressions and direct, indirect, and total effects of PED, NCT aspects and depressive symptoms on TNF-⍺. Negative views of the self and world mediated between PED and depressive symptoms and that negative views of the self and future mediated between PED and TNF-⍺. In conclusion, Beck's theory can be expanded to physical health providing directions for addressing mental and physical health simultaneously by restructuring adolescents' negative view of the self.
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Affiliation(s)
- Ashley Ann Dondanville
- Department of Counseling and Human Development, University of Louisville, 2301 South Third Street, Louisville, KY, 40292, USA.
| | - Patrick Pössel
- Department of Counseling and Human Development, University of Louisville, 2301 South Third Street, Louisville, KY, 40292, USA
| | - G Rafael Fernandez-Botran
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY, 40292, USA
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Lee S, Lee KH, Park KM, Park SJ, Kim WJ, Lee J, Kronbichler A, Smith L, Solmi M, Stubbs B, Koyanagi A, Jacob L, Stickley A, Thompson T, Dragioti E, Oh H, Brunoni AR, Carvalho AF, Radua J, An SK, Namkoong K, Lee E, Shin JI, Fusar-Poli P. Impact of data extraction errors in meta-analyses on the association between depression and peripheral inflammatory biomarkers: an umbrella review. Psychol Med 2023; 53:2017-2030. [PMID: 34749836 DOI: 10.1017/s0033291721003767] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accumulating evidence suggests that alterations in inflammatory biomarkers are important in depression. However, previous meta-analyses disagree on these associations, and errors in data extraction may account for these discrepancies. METHODS PubMed/MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from database inception to 14 January 2020. Meta-analyses of observational studies examining the association between depression and levels of tumor necrosis factor-α (TNF-α), interleukin 1-β (IL-1β), interleukin-6 (IL-6), and C-reactive protein (CRP) were eligible. Errors were classified as follows: incorrect sample sizes, incorrectly used standard deviation, incorrect participant inclusion, calculation error, or analysis with insufficient data. We determined their impact on the results after correction thereof. RESULTS Errors were noted in 14 of the 15 meta-analyses included. Across 521 primary studies, 118 (22.6%) showed the following errors: incorrect sample sizes (20 studies, 16.9%), incorrect use of standard deviation (35 studies, 29.7%), incorrect participant inclusion (7 studies, 5.9%), calculation errors (33 studies, 28.0%), and analysis with insufficient data (23 studies, 19.5%). After correcting these errors, 11 (29.7%) out of 37 pooled effect sizes changed by a magnitude of more than 0.1, ranging from 0.11 to 1.15. The updated meta-analyses showed that elevated levels of TNF- α, IL-6, CRP, but not IL-1β, are associated with depression. CONCLUSIONS These findings show that data extraction errors in meta-analyses can impact findings. Efforts to reduce such errors are important in studies of the association between depression and peripheral inflammatory biomarkers, for which high heterogeneity and conflicting results have been continuously reported.
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Affiliation(s)
- San Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Mee Park
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Sung Jong Park
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Jae Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | | | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ontario, Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Louis Jacob
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Andrew Stickley
- Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge 141 89, Sweden
| | - Trevor Thompson
- Department of Psychology, University of Greenwich, London SE109LS, UK
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Hans Oh
- School of Social Work, University of Southern California, CA, USA
| | - Andre R Brunoni
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry, Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
- Departamento de Clínica Médica, Hospital Universitario, Faculdade de Medicina da USP, São Paulo, Brazil
| | - Andre F Carvalho
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kee Namkoong
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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Zwolińska W, Dmitrzak-Węglarz M, Słopień A. Biomarkers in Child and Adolescent Depression. Child Psychiatry Hum Dev 2023; 54:266-281. [PMID: 34590201 PMCID: PMC9867683 DOI: 10.1007/s10578-021-01246-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
Despite the significant prevalence of Major Depressive Disorder in the pediatric population, the pathophysiology of this condition remains unclear, and the treatment outcomes poor. Investigating tools that might aid in diagnosing and treating early-onset depression seems essential in improving the prognosis of the future disease course. Recent studies have focused on searching for biomarkers that constitute biochemical indicators of MDD susceptibility, diagnosis, or treatment outcome. In comparison to increasing evidence of possible biomarkers in adult depression, the studies investigating this subject in the youth population are lacking. This narrative review aims to summarize research on molecular and biochemical biomarkers in child and adolescent depression in order to advocate future directions in the research on this subject. More studies on depression involving the youth population seem vital to comprehend the natural course of the disease and identify features that may underlie commonly observed differences in treatment outcomes between adults and children.
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Affiliation(s)
- Weronika Zwolińska
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Szpitalna St. 27/33, 60-572, Poznan, Poland.
| | - Monika Dmitrzak-Węglarz
- grid.22254.330000 0001 2205 0971Department of Psychiatric Genetics, Medical Biology Center, Poznan University of Medical Sciences, Rokietnicka St. 8, 60-806 Poznan, Poland
| | - Agnieszka Słopień
- grid.22254.330000 0001 2205 0971Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Szpitalna St. 27/33, 60-572 Poznan, Poland
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Nguyen TNB, Ely BA, Pick D, Patel M, Xie H, Kim-Schulze S, Gabbay V. Clenbuterol attenuates immune reaction to lipopolysaccharide and its relationship to anhedonia in adolescents. Brain Behav Immun 2022; 106:89-99. [PMID: 35914697 PMCID: PMC9817216 DOI: 10.1016/j.bbi.2022.07.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023] Open
Abstract
While inflammation has been implicated in psychopathology, relationships between immune-suppressing processes and psychiatric constructs remain elusive. This study sought to assess whether β2-agonist clenbuterol (CBL) would attenuate immune activation in adolescents with mood and anxiety symptoms following ex vivo exposure of whole blood to lipopolysaccharide (LPS). Our focus on adolescents aimed to target a critical developmental period when psychiatric conditions often emerge and prior to chronicity effects. To capture a diverse range of immunologic and symptomatologic phenotypes, we included 97 psychotropic-medication free adolescents with mood and anxiety symptoms and 33 healthy controls. All participants had comprehensive evaluations and dimensional assessments of psychiatric symptoms. Fasting whole-blood samples were collected and stimulated with LPS in the presence and absence of CBL for 6 hours, then analyzed for 41 cytokines, chemokines, and hematopoietic growth factors. Comparison analyses used Bonferroni-corrected nonparametric tests. Levels of nine immune biomarkers-including IL-1RA, IL-1β, IL-6, IP-10, MCP-1, MIP-1α, MIP-1β, TGF-α, and TNF-α-were significantly reduced by CBL treatment compared to LPS alone. Exploratory factor analysis reduced 41 analytes into 5 immune factors in each experimental condition, and their relationships with psychiatric symptoms were examined as a secondary aim. CBL + LPS Factor 4-comprising EGF, PDGF-AA, PDGF-AB/BB, sCD40L, and GRO-significantly correlated with anticipatory and consummatory anhedonia, even after controlling for depression severity. This study supports the possible inhibitory effect of CBL on immune activation. Using a data-driven method, distinctive relationships between CBL-affected immune biomarkers and dimensional anhedonia were reported, further elucidating the role of β2-agonism in adolescent affective symptomatology.
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Affiliation(s)
- Tram N B Nguyen
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States.
| | - Benjamin A Ely
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States.
| | - Danielle Pick
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States.
| | - Manishkumar Patel
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Hui Xie
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Seunghee Kim-Schulze
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Vilma Gabbay
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States.
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18
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Ferencova N, Visnovcova Z, Ondrejka I, Funakova D, Hrtanek I, Kelcikova S, Tonhajzerova I. Evaluation of Inflammatory Response System (IRS) and Compensatory Immune Response System (CIRS) in Adolescent Major Depression. J Inflamm Res 2022; 15:5959-5976. [PMID: 36303711 PMCID: PMC9596279 DOI: 10.2147/jir.s387588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Nowadays, the role of two tightly interconnected systems, the inflammatory response system (IRS) and the compensatory immune response system (CIRS) in depression, is increasingly discussed. Various studies indicate pro-inflammatory activity in adolescent depression; however, there is an almost complete lack of findings about IRS and CIRS balance. Thus, we aimed to assess different IRS and CIRS indices, profiles, and IRS/CIRS ratios in drug-naïve MDD patients at adolescent age, with respect to sex. Patients and Methods One hundred MDD adolescents (40 boys, average age: 15.4±1.2 yrs.) and 60 controls (28 boys, average age: 15.3±1.5 yrs.) were examined. Evaluated parameters were 1. plasma levels of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon gamma, tumor necrosis factor alpha (TNF-α), soluble receptor of IL-6 (sIL-6R), soluble receptors of TNF-α (sTNF-R1, sTNF-R2); 2. profiles: IL-6 trans-signaling, M1 macrophage signaling, helper T lymphocytes (Th) 1 profile, regulatory T lymphocytes (Treg)+Th2, allIRS, and allCIRS; 3. IRS vs CIRS activity ratios: TNF-α/TNF-R1, TNF-α/TNF-R2, TNF-α/sTNF-Rs (ie sTNF-R1+sTNF-R2), Th1/Th2, Th1/Treg, Th1/Th2+Treg, M1/Th2, M1/Treg, M1/Treg+Th2, allIRS/allCIRS. Results MDD patients showed increased IL-4, IL-10, TNF-α, sIL-6R, Treg+Th2, allIRS, allCIRS, and TNF-α/sTNF-Rs, and decreased Th1/Th2+Treg. MDD females showed increased IL-10 and TNF-α compared to control females. MDD males showed increased IL-4, IL-10, sIL-6R, Treg+Th2, and TNF-α/TNF-R1 compared to control males. Increased sTNF-R1 was found in MDD males compared to MDD females. Positive correlations were found between CDI score and sIL-6R and IL-10 in the total group and between CDI score and IL-10 in adolescent males. Conclusion Our study for the first time extensively evaluated IRS and CIRS interactions revealing enhanced pro-inflammatory TNF-α signaling and IL-6 trans-signaling in association with increased IL-10- and IL-4-mediated anti-inflammatory activity in first-episode depression at the adolescent age. Moreover, results reflect the sex-specific simultaneous activation of IRS and CIRS pathways in adolescent depression.
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Affiliation(s)
- Nikola Ferencova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Zuzana Visnovcova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Igor Ondrejka
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovak Republic
| | - Dana Funakova
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovak Republic
| | - Igor Hrtanek
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovak Republic
| | - Simona Kelcikova
- Department of Midwifery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic,Correspondence: Ingrid Tonhajzerova, Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, Martin, Slovak Republic, Tel +421432633425, Email
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Cytokine alterations in pediatric internalizing disorders: Systematic review and exploratory multi-variate meta-analysis. Brain Behav Immun Health 2022; 24:100490. [PMID: 35880170 PMCID: PMC9307453 DOI: 10.1016/j.bbih.2022.100490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/16/2022] Open
Abstract
Pediatric internalizing disorders are prevalent and characterized by a maladaptive cognitive, emotional response to a perceived stressor. The hypothesized effect of this response is observable changes in behavior mediated by homeostatic inflammatory cytokines. The aim of this study was to synthesize the literature and analyze the effect of cytokines on pediatric internalizing disorders. Influential moderating variables, including mean body mass index, fasting status at blood collection, participant sex, cytokine type, mean age, percentage of sample medicated, and diagnosis, were also assessed. A systematic literature search was performed in electronic databases (Medline, PubMed, and PsycINFO) from January 1, 1980 to June 15, 2022. Case-control studies of pediatric internalizing disorders, specifically anxiety and depression, were reviewed for their association with peripheral cytokine levels. Meta-analyses were performed using a random effects multi-variate model and effect sizes were calculated using Hedge's g for IL-2, CRP, IL-6, TNF-α, IL-1β, IFN-γ, and IL-10. Thirty-three studies were reviewed and 28 studies were included in the meta-analysis (n = 1322 cases and n = 3617 controls). Peripheral cytokine levels were elevated in pediatric internalizing disorders compared to controls (Hedge's g = 0.19, p < 0.001). In the moderator analyses, depression diagnosis (Hedge's g = 0.18, p = 0.009) and non-fasting blood collection (Hedge's g = 0.20, p = 0.006) were significant. The meta-analytic findings are limited by methodological variation between studies, high heterogeneity, and low statistical power. Despite this, the findings suggest that elevated peripheral cytokine levels may play a role in the etiology and/or symptom maintenance of pediatric internalizing disorders. Depression diagnosis and non-fasting blood collection were observed to significantly influenced peripheral cytokine levels. No individual peripheral cytokines tested were associated with pediatric internalizing disorders. Overall, elevated peripheral cytokines were observed in pediatric internalizing disorders compared to controls.
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20
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Arrondo G, Solmi M, Dragioti E, Eudave L, Ruiz-Goikoetxea M, Ciaurriz-Larraz AM, Magallon S, Carvalho AF, Cipriani A, Fusar-Poli P, Larsson H, Correll CU, Cortese S. Associations between mental and physical conditions in children and adolescents: An umbrella review. Neurosci Biobehav Rev 2022; 137:104662. [PMID: 35427644 DOI: 10.1016/j.neubiorev.2022.104662] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 12/20/2022]
Abstract
We mapped the evidence on the type and strength of associations between a broad range of mental and physical conditions in children and adolescents, by carrying out an umbrella review, i.e., a quantitative synthesis of previous systematic reviews and meta-analyses. We also assessed to which extent the links between mental and physical conditions vary across disorders or, by contrast, are transdiagnostic. Based on a pre-established protocol, we retained 45 systematic reviews/meta-analyses, encompassing around 12.5 million of participants. In analyses limited to the most rigorous estimates, we found evidence for the following associations: ADHD-asthma, ADHD-obesity, and depression-asthma. A transdiagnostic association was confirmed between asthma and anxiety/ASD/depression/bipolar disorder, between obesity and ADHD/ASD/depression, and between dermatitis and ASD/ADHD. We conclude that obesity and allergic conditions are likely to be associated with mental disorders in children and adolescents. Our results can help clinicians explore potential links between mental and physical conditions in children/adolescent and provide a road map for future studies aimed at shading light on the underlying factors.
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Affiliation(s)
- Gonzalo Arrondo
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Marco Solmi
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden; Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Luis Eudave
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
| | | | | | - Sara Magallon
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Andrea Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Christoph U Correll
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, New York, NY, USA; Department of Psychiatry and Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitäts medizin, Berlin, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, US
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21
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Masi G. Controversies In The Pharmacotherapy Of Adolescent Depression. Curr Pharm Des 2022; 28:1975-1984. [PMID: 35619257 DOI: 10.2174/1381612828666220526150153] [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: 01/12/2022] [Accepted: 04/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although fluoxetine and, in the USA, escitalopram are approved for depression in adolescence, substantial concern surrounds antidepressant use in youth. Major controversies regarding efficacy and safety (increased suicidality). INTRODUCTION The cathegory of depression is very broad and overinclusive, in terms of etiology, role of psychosocial adversities severity, episodicity, presentation, relationship with bipolarity. This heterogeneity, not fully controlled considered in Randomized Controlled Trials (RCTs), may account for the disappointing results on both efficacy and safety. METHOD Based on the available literature, we will address the following topics: a) controversies regarding the definition of depression as a unique homogeneous condition with a unique type of pharmacological treatment; b) controversies about the interpretation of data from Randomized Controlled Trials (RCTs) on the efficacy of pharmacological treatments in adolescent depression; c) the interpretation of data regarding the safety of antidepressant treatment in adolescent depression, particularly in terms of increased suicidal risk. RESULTS According to RCTs, antidepressants are minimally to moderately more effective than placebo, principally based on very high placebo responses, and only fluoxetine showed more evidence of efficacy. These differences in meta-analyses are sometimes statistically, but not clinically significant. Depression is a heterogeneous condition in terms of etiology, role of psychosocial adversities severity, episodicity, presentation, relationship with bipolarity. This heterogeneity may partly explain the low drug-placebo difference and the high placebo response (possibly related to a high level of natural recovery of the adolescent depression). In the National Institute of Mental Health (NIMH)-funded studies, including a lower number of study sites and more reliable enrollment procedures, lower placebo response rates and greater group differences between medication and placebo were found. Robust evidence supports an increased risk of emergent suicidality after starting antidepressants. A clear age effect on suicidal risk after antidepressants is supported by a comprehensive meta-analysis, showing that suicidal risk increased with decreasing age, being markedly greater in subjects aged between 18 and 25 years. However, the term suicidality is too broad, as it includes suicidal ideation, suicidal attempts, and completed suicide, with a hugely wide range of severity and pervasiveness. If emergent suicidality should be actively and carefully explored, empirical evidence, albeit weak, suggests that combined pharmacotherapy (antidepressant and/or lithium) associated with psychotherapy may be helpful in reducing pretreatment suicidal ideation and suicidal risk. DISCUSSION Moderate to severe depression should be treated with psychotherapy and/or fluoxetine, the best-supported medication, and treatment-resistant adolescents should always receive combined treatment with psychotherapy. Suicidal ideation, particularly with a plan, should be actively explored before starting an antidepressant, as a reason for the closest monitoring. Emergent suicidality after starting antidepressants, as well as antidepressant-related activation, should also be closely monitored and may lead to antidepressant discontinuation. Although no response to pharmacotherapy and psychotherapy may occur in up to 40% of depressed adolescents, possible predictors or mediators of poorer response in adolescents are uncertain, and only a few studies support possible treatment strategies. Finally, studies exploring the efficacy of antidepressants in specific depression subtypes, i.e., based on prevalent psychopathological dimensions (apathy, withdrawal, impulsivity), are warranted.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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22
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Iob E, Lacey R, Giunchiglia V, Steptoe A. Adverse childhood experiences and severity levels of inflammation and depression from childhood to young adulthood: a longitudinal cohort study. Mol Psychiatry 2022; 27:2255-2263. [PMID: 35241782 PMCID: PMC9126802 DOI: 10.1038/s41380-022-01478-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 12/26/2022]
Abstract
Adverse childhood experiences (ACEs) are associated with depression and systemic inflammation in adults. However, limited longitudinal research has tested these relationships in children and young people, and it is unclear whether inflammation is an underlying mechanism through which ACEs influence depression. We examined the longitudinal associations of several ACEs across different early-life periods with longitudinal patterns of early-life inflammation and depression in young adulthood and assessed the mediating role of inflammation. The data came from the Avon Longitudinal Study of Parents and Children (N = 3931). ACEs from the prenatal period through to adolescence were operationalised using cumulative scores, single adversities, and dimensions derived through factor analysis. Inflammation (C-reactive protein) was measured on three occasions (9-18 years) and depressive symptoms were ascertained on four occasions (18-23 years). Latent class growth analysis was employed to delineate group-based trajectories of inflammation and depression. The associations between ACEs and the inflammation/depression trajectories were tested using multinomial logistic regression analysis. Most types of ACEs across all early-life periods were associated with elevated depression trajectories, with larger associations for threat-related adversities compared with other ACEs. Bullying victimisation and sexual abuse in late childhood/adolescence were associated with elevated CRP trajectories, while other ACEs were unrelated to inflammation. Inflammation was also unrelated to depression and did not mediate the associations with ACEs. These results suggest that ACEs are consistently associated with depression, whereas the associations of inflammation with ACEs and depression are weak in young people. Interventions targeting inflammation in this population might not offer protection against depression.
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Affiliation(s)
- Eleonora Iob
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Rebecca Lacey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Valentina Giunchiglia
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
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23
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The Immune Profile of Major Dysmood Disorder: Proof of Concept and Mechanism Using the Precision Nomothetic Psychiatry Approach. Cells 2022; 11:cells11071183. [PMID: 35406747 PMCID: PMC8997660 DOI: 10.3390/cells11071183] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 02/05/2023] Open
Abstract
Major depressive disorder and a major depressive episode (MDD/MDE) are characterized by activation of the immune-inflammatory response system (IRS) and the compensatory immune-regulatory system (CIRS). In MDD/MDE, recent precision nomothetic psychiatry studies discovered a new endophenotype class, namely major dysmood disorder (MDMD), a new pathway phenotype, namely reoccurrence of illness (ROI), and a new model of the phenome of depression. The aim of the present study is to examine the association between ROI, the phenome of depression, and MDMD’s features and IRS, CIRS, macrophages (M1), T helper (Th)1, Th2, Th17, T regulatory, and growth factor (GF) profiles. Culture supernatants of unstimulated and stimulated (5 μg/mL of PHA and 25 μg/mL of LPS) diluted whole blood of 30 MDD/MDE patients and 20 controls were assayed for cytokines/GF using the LUMINEX assay. MDMD was characterized by increased M1, Th1, Th2, Th17, Treg, IRS, CIRS, neurotoxicity, and GF profiles. Factor analysis shows that ROI features and immune-GF profiles may be combined into a new pathway phenotype (an extracted latent vector). ROI, lifetime and recent suicidal behaviors, and severity of depression are significantly associated with immunotoxicity and GF profiles. Around 80.0% of the variance in the phenome is predicted by ROI and neurotoxicity or the IRS/CIRS ratio. The molecular pathways underpinning ROI-associated sensitization of immune/growth networks are transmembrane receptor protein kinase-triggered STAT protein phosphorylation, TLR/NF-κB, JAK-STAT, and the main proliferation/survival PI3K/Akt/RAS/MAPK pathway. In conclusion, MDMD’s heightened immune responses are the consequence of ROI-associated sensitization combined with immunostimulatory triggers.
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24
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Linkas J, Ahmed LA, Csifcsak G, Emaus N, Furberg AS, Grimnes G, Pettersen G, Rognmo K, Christoffersen T. Are pro-inflammatory markers associated with psychological distress in a cross-sectional study of healthy adolescents 15-17 years of age? The Fit Futures study. BMC Psychol 2022; 10:65. [PMID: 35292108 PMCID: PMC8925220 DOI: 10.1186/s40359-022-00779-8] [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] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/10/2022] [Indexed: 12/17/2022] Open
Abstract
Background Inflammatory markers have been associated with depression and anxiety disorder in adolescents. Less is known about the association between inflammation and subclinical symptoms in the form of psychological distress. We investigated prevalence of psychological distress and examined the associations between common pro-inflammatory markers and psychological distress in an adolescent population sample.
Methods The study was based on data from 458 girls and 473 boys aged 15–17 years from the Fit Futures Study, a large-scale study on adolescent health, conducted in Northern Norway. Psychological distress was measured with the Hopkins Symptom Checklist (HSCL-10). Serum-levels of the following low-grade inflammatory markers were measured: C-reactive protein (CRP), interleukin 6 (IL-6), transforming growth factor-alpha (TGF-α), tumor necrosis factor alpha variant 1 (TRANCE) and tumor necrosis factor alpha variant 2 (TWEAK). Associations between quartiles of inflammatory markers and HSCL-10 were examined by logistic regression and adjusted for potential confounders in sex-stratified analyses. Results The proportion of psychological distress above cutoff were 26.9% and 10.8% among girls and boys, respectively. In both girls and boys, crude analysis showed positive associations between all inflammatory markers and HSCL-10, except for TWEAK and TRANCE in boys. However, none of these associations were statistically significant. Further, there were no significant findings in the adjusted analyses. Conclusion There was a higher prevalence of psychological distress in girls compared to boys. Pro-inflammatory markers were not significantly associated with psychological distress in data from healthy adolescents aged 15–17 years. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00779-8.
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Affiliation(s)
- Jonas Linkas
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Lodve Langesgate 2, 8514, Narvik, Norway.
| | - Luai Awad Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Gabor Csifcsak
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne-Sofie Furberg
- Faculty of Health and Care Sciences, Molde University College, Molde, Norway
| | - Guri Grimnes
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Gunn Pettersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kamilla Rognmo
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tore Christoffersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,School of Sport Sciences, UiT The Arctic University of Norway, Alta, Norway.,Finnmark Hospital Trust, Alta, Norway
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25
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Linkas J, Ahmed LA, Csifcsak G, Emaus N, Furberg AS, Grimnes G, Pettersen G, Rognmo K, Christoffersen T. C-Reactive Protein and TGF-α Predict Psychological Distress at Two Years of Follow-Up in Healthy Adolescent Boys: The Fit Futures Study. Front Psychol 2022; 13:823420. [PMID: 35360574 PMCID: PMC8963454 DOI: 10.3389/fpsyg.2022.823420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe scarcity of research on associations between inflammatory markers and symptoms of depression and anxiety during adolescence has yielded inconsistent results. Further, not all studies have controlled for potential confounders. We explored the associations between baseline inflammatory markers and psychological distress including moderators at follow-up in a Norwegian adolescent population sample.MethodsData was derived from 373 girls and 294 boys aged 15–18 years at baseline, in the Fit Futures Study, a large-scale 2-year follow-up study on adolescent health. Baseline data was gathered from 2010 to 2011 and follow-up data from 2012 to 2013. Psychological distress was measured with Hopkins Symptom Checklist (HSCL-10). Serum levels of the following inflammatory markers were measured: C-reactive protein (CRP), Interleukin 6 (IL-6), Transforming growth factor alpha (TGF-α), Tumor necrosis factor alpha variant 1 (TRANCE), and variant 2 (TWEAK). Independent associations between baseline inflammatory markers and HSCL-10 at follow-up were explored by linear regressions, in sex-stratified analyses.ResultsIn girls, analyses showed positive associations between all inflammatory markers and HSCL-10, except for TRANCE. However, all associations were non-significant in crude as well as in adjusted analyses. In boys, CRP (p = 0.03) and TGF-α (p < 0.01) showed significant associations with HSCL-10, that remained significant after adjustment. Additionally, moderators were found. In boys, CRP was associated with HSCL-10 in those with high body fat and those being physical inactive, and the association between TWEAK and HSCL-10 was dependent upon sleep duration.ConclusionThere were significant prospective associations between CRP, TFG-α, and HSCL-10 in boys aged 15–18 years at baseline.
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Affiliation(s)
- Jonas Linkas
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Narvik, Norway
- *Correspondence: Jonas Linkas,
| | - Luai Awad Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Gabor Csifcsak
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne-Sofie Furberg
- Faculty of Health and Care Sciences, Molde University College, Molde, Norway
| | - Guri Grimnes
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunn Pettersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kamilla Rognmo
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tore Christoffersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- School of Sport Sciences, UiT The Arctic University of Norway, Alta, Norway
- Department of Research and Development, Finnmark Hospital Trust, Alta, Norway
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26
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Skibinska M, Rajewska-Rager A, Dmitrzak-Weglarz M, Kapelski P, Lepczynska N, Kaczmarek M, Pawlak J. Interleukin-8 and tumor necrosis factor-alpha in youth with mood disorders-A longitudinal study. Front Psychiatry 2022; 13:964538. [PMID: 36032249 PMCID: PMC9403049 DOI: 10.3389/fpsyt.2022.964538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Bipolar disorder (BD) is one of the most disabling psychiatric illnesses. Over half of BD patients experienced early onset of the disease, and in most cases, it begins with a depressed mood episode. Up to 50% of adolescents initially diagnosed with major depressive disorder (MDD) convert to bipolar spectrum disorder. Diagnostic tools or biomarkers to facilitate the prediction of diagnosis conversion from MDD to BD are still lacking. Our study aimed to find biomarkers of diagnosis conversion in young patients with mood disorders. We performed a 2-year follow-up study on 69 adolescent patients diagnosed with MDD or BD. The control group consisted of 31 healthy youths. We monitored diagnosis change from MDD to BD. Impulsiveness was assessed using Barratt Impulsiveness Scale (BIS-11) and defense mechanisms using Defense Style Questionnaire (DSQ-40). According to the immunological hypothesis of mood disorders, we investigated baseline cytokines levels either in depressive or hypomanic/manic episodes. We correlated interleukin 8 (IL-8) and Tumor Necrosis Factor-alpha (TNF-alpha) levels with clinical factors. We detected higher IL-8 and TNF-alpha in patients in hypomanic/manic compared to depressed episodes. We found correlations of cytokine levels with immature defense style. We did not discover predictors of diagnosis conversion from MDD to BD.
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Affiliation(s)
- Maria Skibinska
- Protein Biomarkers Unit, Department of Psychiatric Genetics, Poznan University of Medical Sciences, Poznan, Poland.,Department of Psychiatric Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Pawel Kapelski
- Department of Psychiatric Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Natalia Lepczynska
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Kaczmarek
- Department of Cancer Immunology, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Pawlak
- Department of Psychiatric Genetics, Poznan University of Medical Sciences, Poznan, Poland
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27
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Could Anti-inflammatory Interventions Earlier in Development Confer Primary Prevention of Psychiatric Disorders? Harv Rev Psychiatry 2022; 30:4-7. [PMID: 34995031 DOI: 10.1097/hrp.0000000000000318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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28
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Toenders YJ, Laskaris L, Davey CG, Berk M, Milaneschi Y, Lamers F, Penninx BWJH, Schmaal L. Inflammation and depression in young people: a systematic review and proposed inflammatory pathways. Mol Psychiatry 2022; 27:315-327. [PMID: 34635789 DOI: 10.1038/s41380-021-01306-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
Depression onset peaks during adolescence and young adulthood. Current treatments are only moderately effective, driving the search for novel pathophysiological mechanisms underlying youth depression. Inflammatory dysregulation has been shown in adults with depression, however, less is known about inflammation in youth depression. This systematic review identified 109 studies examining the association between inflammation and youth depression and showed subtle evidence for inflammatory dysregulation in youth depression. Longitudinal studies support the bidirectional association between inflammation and depression in youth. We hypothesise multiple inflammatory pathways contributing to depression. More research is needed on anti-inflammatory treatments, potentially tailored to individual symptom profiles.
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Affiliation(s)
- Yara J Toenders
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Liliana Laskaris
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam UMC, Department of Amsterdam Public Health Research Institute and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Department of Amsterdam Public Health Research Institute and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Department of Amsterdam Public Health Research Institute and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
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29
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Specht HE, Mannig N, Belheouane M, Andreani NA, Tenbrock K, Biemann R, Borucki K, Dahmen B, Dempfle A, Baines JF, Herpertz-Dahlmann B, Seitz J. Lower serum levels of IL-1β and IL-6 cytokines in adolescents with anorexia nervosa and their association with gut microbiota in a longitudinal study. Front Psychiatry 2022; 13:920665. [PMID: 36061277 PMCID: PMC9433656 DOI: 10.3389/fpsyt.2022.920665] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is an often chronic and debilitating psychiatric disease whose etiology is not completely understood. Recently, a potential role of inflammation has emerged in other psychiatric diseases, such as depression, PTSD and schizophrenia. The first results in adults with AN seemed to confirm a low-grade proinflammatory state until recent studies presented more differential findings. Studying adolescents with a shorter illness duration and fewer confounding factors might help elucidate the role of inflammation in the underlying pathophysiology of AN; however, the few available studies in adolescents remain ambiguous, and no longitudinal data are available in this age range. METHODS We examined the proinflammatory cytokines Tumor Necrosis Factor-alpha (TNF-α), Interleukin (IL)-1β, IL-6, IL-15, and the cytokine-receptor IL-6 Receptor alpha (IL-6 Rα) in the serum of twenty-two hospitalized female adolescent patients with AN longitudinally at admission and discharge and compared their results to nineteen healthy controls (HC). We also collected clinical data and stool samples that were analyzed with 16S rRNA amplicon sequencing to explore potential influencing factors of cytokine changes. RESULTS TNF-α serum levels were significantly elevated in patients with AN at admission, while IL-1β and IL-6 levels were lower at admission and discharge than in HC. After treatment, we also found significantly elevated levels of IL-6 Rα compared to HC, while IL-15 did not show significant changes. Exploratory analyses revealed positive associations of cytokine and genus-level changes between admission and discharge for IL-1β (Bacteroides) and IL-15 (Romboutsia), and negative associations for IL-15 (Anaerostipes) and TNF-α (uncultured Lachnospiraceae). CONCLUSION We confirmed a previous finding of elevated levels of TNF-α also in adolescents with AN; however, the reduced IL-1β and IL-6 levels differed from the mostly increased levels found in adults. A mixed pro- and anti-inflammatory state appears to be present in adolescents, potentially due to their shorter illness duration. The gut microbiota, with its regulatory function on cytokine production, might play a role in mediating these inflammatory processes in AN and could offer targets for new therapeutic approaches.
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Affiliation(s)
- Hannah E Specht
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Nina Mannig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Meriem Belheouane
- Max Planck Institute for Evolutionary Biology, Plön, Germany.,Institute for Experimental Medicine, Kiel University, Kiel, Germany
| | - Nadia Andrea Andreani
- Max Planck Institute for Evolutionary Biology, Plön, Germany.,Institute for Experimental Medicine, Kiel University, Kiel, Germany
| | - Klaus Tenbrock
- Department of Pediatrics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Pediatrics, IZKF Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ronald Biemann
- Institute for Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Katrin Borucki
- Institute for Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | - John F Baines
- Max Planck Institute for Evolutionary Biology, Plön, Germany.,Institute for Experimental Medicine, Kiel University, Kiel, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
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Mondelli V, Cattaneo A, Nikkheslat N, Souza L, Walsh A, Zajkowska Z, Zonca V, Marizzoni M, Fisher HL, Kohrt BA, Kieling C, Di Meglio P. Exploring the role of immune pathways in the risk and development of depression in adolescence: Research protocol of the IDEA-FLAME study. Brain Behav Immun Health 2021; 18:100396. [PMID: 34927102 PMCID: PMC8648954 DOI: 10.1016/j.bbih.2021.100396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 10/29/2022] Open
Abstract
Extensive research suggests a role for the innate immune system in the pathogenesis of depression, but most of the studies are conducted in adult populations, in high-income countries and mainly focus on the study of inflammatory proteins alone, which provides only a limited understanding of the immune pathways involved in the development of depression. The IDEA-FLAME study aims to identify immune phenotypes underlying increased risk of developing depression in adolescence in a middle-income country. To this end, we will perform deep-immunophenotyping of peripheral blood mononuclear cells and RNA genome-wide gene expression analyses in a longitudinal cohort of Brazilian adolescents stratified for depression risk. The project will involve the 3-year follow-up of an already recruited cohort of 150 Brazilian adolescents selected for risk/presence of depression on the basis of a composite risk score we developed using sociodemographic characteristics (50 adolescents with low-risk and 50 with high-risk of developing depression, and 50 adolescents with a current major depressive disorder). We will 1) test whether the risk group classification at baseline is associated with differences in immune cell frequency, phenotype and functional status, 2) test whether baseline immune markers (cytokines and immune cell markers) are associated with severity of depression at 3-year follow-up, and 3) identify changes in gene expression of immune pathways over the 3-year follow-up in adolescents with increased risk and presence of depression. Because of the exploratory nature of the study, the findings would need to be replicated in a separate and larger sample. Ultimately, this research will contribute to elucidating key immune therapeutic targets and inform the development of interventions to prevent onset of depression among adolescents.
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Affiliation(s)
- Valeria Mondelli
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, London, UK.,National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Annamaria Cattaneo
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133, Milan, Italy.,Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Naghmeh Nikkheslat
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, London, UK
| | - Laila Souza
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Annabel Walsh
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, London, UK
| | - Zuzanna Zajkowska
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, London, UK
| | - Valentina Zonca
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, London, UK.,Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Moira Marizzoni
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Christian Kieling
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Paola Di Meglio
- St John's Institute of Dermatology, King's College London, London, UK.,National Institute for Health Research Mental Health Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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Zonca V. Preventive strategies for adolescent depression: What are we missing? A focus on biomarkers. Brain Behav Immun Health 2021; 18:100385. [PMID: 34825234 PMCID: PMC8604665 DOI: 10.1016/j.bbih.2021.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022] Open
Abstract
Adolescent depression is an important global issue with several unmet needs that still must be addressed and, to date, there are only few effective preventive strategies to reduce the burden of this disorder worldwide. In this mini-review, the evidence and potential ways to improve an early detection will be discussed as well as prompt interventions by focusing on a better understanding of the risks underlying the developing of adolescent depression from both a sociodemographic and a biological perspective.
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Affiliation(s)
- Valentina Zonca
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Biological Psychiatry Lab, IRCCS Istituto Centro San Giovanni di Dio, Brescia, Italy
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Zajkowska Z. In(s) and out(s) of adolescent depression - Trajectories of development and recovery. Brain Behav Immun Health 2021; 18:100382. [PMID: 34816138 PMCID: PMC8591391 DOI: 10.1016/j.bbih.2021.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 10/28/2022] Open
Abstract
While the role of biological markers in understanding major depressive disorder (MDD) in adults have been studied extensively, less has been done to identify the biomarkers of MDD development and recovery in adolescence. With the majority of mental health disorders starting in adolescence, identifying biomarkers of transition and recovery from MDD early in life is critical for developing effective prevention strategies. Considering most of the child and adolescent populations come from low-and-middle-income countries (LMICs), it is vital to focus on adolescent populations in these settings. With most studies coming from high-income countries (HICs), evidence suggests that elevated morning cortisol levels including cortisol awakening response (CAR), increased peripheral inflammation and brain abnormalities such as cortico-limbic dysregulation or blunted activity in reward related regions in response to positive information are associated with MDD and being at-risk for MDD development in adolescence. We also find that some of the biological mechanisms of recovery from MDD, mainly normalisation in the cortico-limbic dysregulation, are reported following psychological therapy, suggesting shared pathways leading to MDD vulnerability and recovery. Although, only a few studies include adolescent populations. Understanding molecular mechanisms through which psychological interventions are effective, as well as molecular markers of transition to depression in individuals at-risk, are important to inform effective prevention and intervention strategies.
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Affiliation(s)
- Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Rengasamy M, Marsland A, McClain L, Kovats T, Walko T, Pan L, Price RB. Linking childhood trauma and cytokine levels in depressed adolescents. Psychoneuroendocrinology 2021; 133:105398. [PMID: 34479104 PMCID: PMC8530984 DOI: 10.1016/j.psyneuen.2021.105398] [Citation(s) in RCA: 4] [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: 04/10/2021] [Revised: 07/28/2021] [Accepted: 08/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Evidence supports raised circulating levels of inflammatory mediators, such as interleukin-6 (IL-6) and tumor necrosis factor (TNFα), among clinically depressed adults, although preliminary findings in adolescents are mixed. Independently, meta-analyses identify correlations between childhood trauma and elevated cytokine levels in adulthood. Here, we examine the possible role of individual differences in exposure to childhood trauma in contributing to variability in cytokine levels in depressed adolescents. METHODS 52 depressed adolescents and 20 healthy adolescents completed measures of childhood trauma and provided blood for the assessment of plasma IL-6 and TNFα. Cross-sectional associations of childhood trauma and cytokine measures were assessed in both depressed and healthy adolescents, along with exploratory analysis of childhood trauma subtypes. Longitudinal relationships between childhood trauma and cytokine measures were also studied in an exploratory fashion within a subset of depressed participants (n = 36). RESULTS Higher childhood trauma (particularly emotional abuse) was positively associated with TNFα in depressed adolescents. Childhood trauma was not linked to longitudinal changes in cytokine levels. DISCUSSION In depressed adolescents, childhood trauma may relate to higher levels of the proinflammatory cytokine TNFα and contribute to heterogeneity in cytokine elevation among depressed adolescents. Such findings may ultimately help guide more effective individualized treatments for adolescents with depression.
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Affiliation(s)
- Manivel Rengasamy
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Lora McClain
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Tessa Kovats
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Thomas Walko
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Lisa Pan
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Rebecca B Price
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, USA
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Lee J, Chi S, Lee MS. Molecular Biomarkers for Pediatric Depressive Disorders: A Narrative Review. Int J Mol Sci 2021; 22:ijms221810051. [PMID: 34576215 PMCID: PMC8464852 DOI: 10.3390/ijms221810051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/05/2021] [Accepted: 09/14/2021] [Indexed: 01/31/2023] Open
Abstract
Depressive disorder in childhood and adolescence is a highly prevalent mood disorder that tends to recur throughout life. Untreated mood disorders can adversely impact a patient’s quality of life and cause socioeconomic loss. Thus, an accurate diagnosis and appropriate treatment is crucial. However, until now, diagnoses and treatments were conducted according to clinical symptoms. Objective and biological validation is lacking. This may result in a poor outcome for patients with depressive disorder. Research has been conducted to identify the biomarkers that are related to depressive disorder. Cumulative evidence has revealed that certain immunologic biomarkers including brain-derived neurotrophic factor (BDNF) and cytokines, gastrointestinal biomarkers, hormones, oxidative stress, and certain hypothalamus-pituitary axis biomarkers are associated with depressive disorder. This article reviews the biomarkers related to the diagnosis and treatment of pediatric depressive disorders. To date, clinical biomarker tests are not yet available for diagnosis or for the prediction of treatment prognosis. However, cytokines such as Interleukin-2, interferon-gamma, tumor necrosis factor-alpha, and BDNF have shown significant results in previous studies of pediatric depressive disorder. These biomarkers have the potential to be used for diagnosis, prognostic assessment, and group screening for those at high risk.
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Affiliation(s)
- Jongha Lee
- Department of Psychiatry, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - Suhyuk Chi
- Department of Psychiatry, Korea University Guro Hospital, Seoul 08308, Korea;
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, Seoul 08308, Korea;
- Correspondence: ; Tel.: +82-2-2626-3163; Fax: +82-2-852-1937
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Bickman L. Improving Mental Health Services: A 50-Year Journey from Randomized Experiments to Artificial Intelligence and Precision Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:795-843. [PMID: 32715427 PMCID: PMC7382706 DOI: 10.1007/s10488-020-01065-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This conceptual paper describes the current state of mental health services, identifies critical problems, and suggests how to solve them. I focus on the potential contributions of artificial intelligence and precision mental health to improving mental health services. Toward that end, I draw upon my own research, which has changed over the last half century, to highlight the need to transform the way we conduct mental health services research. I identify exemplars from the emerging literature on artificial intelligence and precision approaches to treatment in which there is an attempt to personalize or fit the treatment to the client in order to produce more effective interventions.
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Affiliation(s)
- Leonard Bickman
- Center for Children and Families; Psychology, Academic Health Center 1, Florida International University, 11200 Southwest 8th Street, Room 140, Miami, FL, 33199, USA.
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36
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Ely BA, Nguyen TNB, Tobe RH, Walker AM, Gabbay V. Multimodal Investigations of Reward Circuitry and Anhedonia in Adolescent Depression. Front Psychiatry 2021; 12:678709. [PMID: 34366915 PMCID: PMC8345280 DOI: 10.3389/fpsyt.2021.678709] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 02/01/2023] Open
Abstract
Depression is a highly prevalent condition with devastating personal and public health consequences that often first manifests during adolescence. Though extensively studied, the pathogenesis of depression remains poorly understood, and efforts to stratify risks and identify optimal interventions have proceeded slowly. A major impediment has been the reliance on an all-or-nothing categorical diagnostic scheme based solely on whether a patient endorses an arbitrary number of common symptoms for a sufficiently long period. This approach masks the well-documented heterogeneity of depression, a disorder that is highly variable in presentation, severity, and course between individuals and is frequently comorbid with other psychiatric conditions. In this targeted review, we outline the limitations of traditional diagnosis-based research and instead advocate an alternative approach centered around symptoms as unique dimensions of clinical dysfunction that span across disorders and more closely reflect underlying neurobiological abnormalities. In particular, we highlight anhedonia-the reduced ability to anticipate and experience pleasure-as a specific, quantifiable index of reward dysfunction and an ideal candidate for dimensional investigation. Anhedonia is a core symptom of depression but also a salient feature of numerous other conditions, and its severity varies widely within clinical and even healthy populations. Similarly, reward dysfunction is a hallmark of depression but is evident across many psychiatric conditions. Reward function is especially relevant in adolescence, a period characterized by exaggerated reward-seeking behaviors and rapid maturation of neural reward circuitry. We detail extensive work by our research group and others to investigate the neural and systemic factors contributing to reward dysfunction in youth, including our cumulative findings using multiple neuroimaging and immunological measures to study depressed adolescents but also trans-diagnostic cohorts with diverse psychiatric symptoms. We describe convergent evidence that reward dysfunction: (a) predicts worse clinical outcomes, (b) is associated with functional and chemical abnormalities within and beyond the neural reward circuitry, (c) is linked to elevated peripheral levels of inflammatory biomarkers, and (d) manifests early in the course of illness. Emphasis is placed on high-resolution neuroimaging techniques, comprehensive immunological assays, and data-driven analyses to fully capture and characterize the complex, interconnected nature of these systems and their contributions to adolescent reward dysfunction.
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Affiliation(s)
- Benjamin A. Ely
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tram N. B. Nguyen
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Russell H. Tobe
- Department of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Audrey M. Walker
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Vilma Gabbay
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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Wunram HL, Oberste M, Hamacher S, Neufang S, Grote N, Krischer MK, Bloch W, Schönau E, Bender S, Fricke O. Immunological Effects of an Add-On Physical Exercise Therapy in Depressed Adolescents and Its Interplay with Depression Severity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6527. [PMID: 34204400 PMCID: PMC8296386 DOI: 10.3390/ijerph18126527] [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] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pro-inflammatory cytokines (PICs) have gained attention in the pathophysiology and treatment of depressive disorders. At the same time, the therapeutic effect of physical activity seems to work via immunomodulatory pathways. The interventional study "Mood Vibes" analyzed the influence of exercise on depression severity (primary endpoint) in depressive adolescents; the influence of PICs on the clinical outcome was analyzed as a secondary endpoint. METHODS Clinically diagnosed depressed adolescents (N = 64; 28.1% male; mean age = 15.9; mean BMI = 24.6) were included and participated either in Whole Body Vibration (WBV) (n = 21) or bicycle ergometer training (n = 20) in addition to treatment-as-usual (TAU). Patients in the control treatment group received TAU only (n = 23). The PICs (interleukin-6-IL-6 and tumor necrosis factor-α-TNF-α) were analyzed before intervention, after 6 weeks of training (t1), and 8 weeks post-intervention (t2). The effects of the treatment on depression severity were rated by self-rating "Depression Inventory for Children and Adolescents" (DIKJ). RESULTS Basal IL-6 decreased in all groups from t0 to t1, but it increased again in WBV and controls at t2. TNF-α diminished in ergometer and controls from baseline to t1. PIC levels showed no correlation with depression severity at baseline. The influence on DIKJ scores over time was significant for IL-6 in the WBV group (p = 0.008). Sex had an impact on TNF-α (p < 0.001), with higher concentrations in male patients. Higher body mass index was associated with higher IL-6 concentrations over all measurement points (p < 0.001). CONCLUSIONS The positive effects of an intensive add-on exercise therapy on adolescent depression seem to be partly influenced by immunomodulation. A small sample size and non-randomized controls are limitations of this study.
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Affiliation(s)
- Heidrun Lioba Wunram
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, 50937 Cologne, Germany; (M.O.); (S.H.)
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, 50933 Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, 50937 Cologne, Germany; (M.O.); (S.H.)
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, 40225 Düsseldorf, Germany;
| | - Nils Grote
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Maya Kristina Krischer
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Wilhelm Bloch
- Institute of Movement and Neuroscience, German Sport University Cologne, 50933 Cologne, Germany;
| | - Eckhard Schönau
- Children’s Hospital, University Hospital of Cologne & UniReha, University Hospital of Cologne, 50933 Cologne, Germany;
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Oliver Fricke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology, Gemeinschaftskrankenhaus Herdecke & Chair of Child and Adolescent Psychiatry, Witten/Herdecke University, 58313 Witten/Herdecke, Germany;
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Zajkowska Z, Walsh A, Zonca V, Gullett N, Pedersen GA, Kieling C, Swartz JR, Karmacharya R, Fisher HL, Kohrt BA, Mondelli V. A systematic review of the association between biological markers and environmental stress risk factors for adolescent depression. J Psychiatr Res 2021; 138:163-175. [PMID: 33857787 DOI: 10.1016/j.jpsychires.2021.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Although the aetiology and pathophysiology of depression are multifactorial, to date most studies have examined either biological or environmental mechanisms without looking at the integration of both; with most studies conducted in high-income countries (HICs). Therefore, we conducted a systematic review of worldwide studies investigating the relationship between biological and environmental stress risk factors for major depressive disorder (MDD) in adolescence. METHODS We searched MEDLINE (via Ovid), PsycINFO, Cochrane Database of Systematic Reviews, Web of Science (Core Collection), Lilacs, African Journals Online and Global Health for prospective and cross-sectional studies that examined the association between biological markers and environmental stress risk factors in MDD during adolescence. FINDINGS Of 11,089 articles identified, 21 were included, with only two from middle-income countries. Increased inflammation, telomere length and brain abnormalities, including blunted reward-related activity, white matter disruptions, and altered volume of limbic brain regions, were associated with increased risk for MDD mainly in the context of early life adversity. There is little evidence suggesting that the neurobiological changes investigated were associated with MDD in the context of recent life stress. INTERPRETATION The developmental trajectory of depression appears to start with early life adversities and occurs in the context of immune and brain abnormalities. Understanding these biopsychosocial processes will help to improve our ability to detect individuals at risk of developing depression in adolescence. However, generalizability is limited by few studies examining both biological and environmental stress risk factors and a lack of studies on adolescents and young adults in low-and-middle-income countries (LMICs).
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Affiliation(s)
- Zuzanna Zajkowska
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Annabel Walsh
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Valentina Zonca
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Nancy Gullett
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Gloria A Pedersen
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, 2120 L St NW, Ste 600, Washington DC, 20037, USA.
| | - Christian Kieling
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350 - 400N, Porto Alegre, RS, 90035-903, Brazil.
| | - Johnna R Swartz
- University of California, Davis, Department of Human Ecology, 1 Shields Ave. University of California, Davis, CA, 95616, USA.
| | - Rakesh Karmacharya
- Harvard University, Center for Genomic Medicine, 185 Cambridge Street, Boston, MA, 02114, USA.
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, 2120 L St NW, Ste 600, Washington DC, 20037, USA.
| | - Valeria Mondelli
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, UK.
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The Effect of Omega-3 Fatty Acids on Thromboxane, Brain-Derived Neurotrophic Factor, Homocysteine, and Vitamin D in Depressive Children and Adolescents: Randomized Controlled Trial. Nutrients 2021; 13:nu13041095. [PMID: 33801688 PMCID: PMC8066966 DOI: 10.3390/nu13041095] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
In the DEPOXIN project, we have found that a high ratio of omega-6/omega-3 fatty acids (FA) is associated with worsening of depressive symptoms in children and adolescents with depressive disorder (DD) and that the 12-week omega-3 FA supplementation modulates DD symptoms. Here we present our results of the secondary outcomes: the levels of thromboxane (TXB), brain-derived neurotrophic factor (BDNF), homocysteine (HCy) and vitamin D. Fifty-eight patients were randomized into two arms. One group received a fish oil emulsion enriched with omega-3 FA, and the other received a sunflower oil emulsion containing omega-6 FA, for 12 weeks. Depressive symptoms were evaluated, using the Child's Depressive Inventory (CDI). The patients with DD had elevated TXB levels and decreased vitamin D levels, as compared to healthy controls. Both CDI and omega-6/omega-3 ratio correlated positively with TXB and negatively with BDNF at baseline. Compared to the omega-6 FA group, the supplementation with omega-3 FA for 12 weeks significantly reduced plasma TXB (p = 0.024) and increased BDNF (p = 0.011) levels. No changes in HCy and vitamin D were observed. Our results demonstrate the possible role of TXB and BDNF in the pathophysiology of DD and the benefits of omega-3 FA supplementation. The study was registered with the ISRCTN registry (ISRCTN81655012).
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Personalized Medicine Using Neuroimmunological Biomarkers in Depressive Disorders. J Pers Med 2021; 11:jpm11020114. [PMID: 33578686 PMCID: PMC7916349 DOI: 10.3390/jpm11020114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Major depressive disorder (MDD) is associated with increased suicidal risk and reduced productivity at work. Neuroimmunology, the study of the immune system and nervous system, provides further insight into the pathogenesis and outcome of MDD. Cytokines are the main modulators of neuroimmunology, and their levels are somewhat entangled in depressive disorders as they affect depressive symptoms and are affected by antidepressant treatment. The use of cytokine-derived medication as a treatment option for MDD is currently a topic of interest. Although not very promising, cytokines are also considered as possible prognostic or diagnostic markers for depression. The machine learning approach is a powerful tool for pattern recognition and has been used in psychiatry for finding useful patterns in data that have translational meaning and can be incorporated in daily clinical practice. This review focuses on the current knowledge of neuroimmunology and depression and the possible use of machine learning to widen our understanding of the topic.
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A pro-inflammatory phenotype is associated with behavioural traits in children with Prader-Willi syndrome. Eur Child Adolesc Psychiatry 2021; 30:899-908. [PMID: 32495042 PMCID: PMC8140962 DOI: 10.1007/s00787-020-01568-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022]
Abstract
Several lines of evidence indicate that immune-inflammatory alterations are widely observed in various mental disorders. Genetic syndromes with high risk of psychiatric disorders may constitute a model for studies investigating this phenomenon. One of such genetically determined neurodevelopmental disorders is the Prader-Willi syndrome (PWS). Therefore, we aimed to profile a broad panel of immune-inflammatory markers in patients with PWS, taking into account co-morbid psychopathology. Participants were 20 children with PWS, and 20 healthy children matched for age, sex and body mass index. Behavioural symptoms and co-occurring psychopathological symptoms were assessed using the Child Behaviour Checklist (CBCL). We found significantly elevated levels of interleukin (IL)-1β and IL-13 in patients with PWS. There were significant positive correlations between the levels of IL-1β and scores of the following externalizing and internalizing CBCL domains: withdrawn/depressed, social problems, thought problems, attention problems, delinquent and aggressive behaviour in PWS children. Moreover, higher levels of IL-13 were associated with more severe psychopathology in terms of social and attention problems as well as delinquent and aggressive behaviour. Our findings imply that subclinical inflammation, observed as elevated IL-1β and IL-13 levels, appears only in PWS patients and is correlated to several psychopathological symptoms.
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Rengasamy M, Marsland A, McClain L, Kovats T, Walko T, Pan L, Price RB. Longitudinal relationships of cytokines, depression and anhedonia in depressed adolescents. Brain Behav Immun 2021; 91:74-80. [PMID: 32919038 PMCID: PMC7952030 DOI: 10.1016/j.bbi.2020.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Depression has been associated with low-grade elevation of plasma cytokines (e.g. interleukin-6, IL-6; tumor necrosis factor alpha, TNFα) in both cross-sectional and longitudinal studies in adults. Preclinical and clinical studies also suggest that IL-6 and TNFα elevation are associated with anhedonia. However, few studies have examined longitudinal relationships between cytokines and depression/anhedonia in clinically depressed samples, particularly adolescents. METHODS Thirty-six adolescents with a depressive disorder receiving standard-of-care community treatment were assessed at a baseline and a follow-up timepoint. Self-report and clinical measures of depression and anhedonia, along with plasma IL-6 and TNFα levels, were obtained at both timepoints. Baseline cytokine measures were examined in association with baseline and follow-up clinical measures. On an exploratory basis, change in clinical measures over time was examined in relation to change in cytokine levels over time. RESULTS Higher baseline TNFα levels predicted higher follow-up depression severity after approximately four months (controlling for baseline depression). Higher baseline TNFα levels also associated positively with baseline anhedonia and predicted higher anhedonia at follow-up (controlling for baseline anhedonia). No association was found between change in clinical measures and change in cytokine levels over time. CONCLUSIONS Among adolescents receiving standard-of-care community treatment for depression, higher levels of TNFα predicted greater depressive symptoms at 4-month follow-up, suggesting this cytokine may be used to help identify patients in need of more intensive treatment. Elevated TNFα levels were also associated with concurrent and future anhedonia symptoms, suggesting a specific mechanism in which TNFα affects depression trajectories. Future studies should examine the relationships between cytokine levels and depression/anhedonia symptoms at multiple timepoints in larger cohorts of depressed adolescents.
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Affiliation(s)
- Manivel Rengasamy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Lora McClain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tessa Kovats
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas Walko
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Lisa Pan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca B Price
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, USA
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Colasanto M, Madigan S, Korczak DJ. Depression and inflammation among children and adolescents: A meta-analysis. J Affect Disord 2020; 277:940-948. [PMID: 33065836 DOI: 10.1016/j.jad.2020.09.025] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Increasing evidence suggests that youth with Major Depressive Disorder (MDD) exhibit early indicators of cardiovascular disease. A leading hypothesized mechanism of this association is via inflammatory pathways, however, results examining this direct association are mixed. Our objective was to synthesize and quantify observational studies examining the association of depression and inflammation among children and adolescents. METHODS Electronic searches were conducted in MEDLINE, Embase, PsycINFO, and Scopus, yielding 2,757 non-duplicate records from 1946 to 2019. The included studies measured depression or depressive symptoms and examined its association with inflammation in participants younger than 18 years. All relevant articles were reviewed and data extracted by two independent coders. Estimates were examined by using random-effects meta-analysis. RESULTS Twenty-two studies (20,791 participants) were included. Significant associations were observed between concurrent depression and CRP (n = 7; r = 0.12; 95% confidence interval [CI] = 0.04 to 0.19), and IL-6 (n = 7; r = 0.17; 95% CI= 0.10 to 0.24). Longitudinal analyses revealed that depression is a significant predictor of IL-6 (n = 3; r = 0.29; 95% CI= 0.04 to 0.50) and conversely, that inflammation (measured by CRP or IL-6) predicts future depression (n = 4; r = 0.04; 95% CI= 0.00 to 0.08). LIMITATIONS Results are limited by the small number of studies preventing examination of some moderator variables. Findings are correlational, not causal. CONCLUSION Depression is positively associated with concurrent and future inflammation among children and adolescents. Results suggest that bidirectional associations may exist between depression and a pro-inflammatory state.
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Affiliation(s)
- Marlena Colasanto
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sheri Madigan
- University of Calgary, Calgary, ON, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Daphne J Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Lee H, Song M, Lee J, Kim JB, Lee MS. Prospective study on cytokine levels in medication-naïve adolescents with first-episode major depressive disorder. J Affect Disord 2020; 266:57-62. [PMID: 32056928 DOI: 10.1016/j.jad.2020.01.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Evidence suggests that depression is correlated with immune-inflammatory responses, and efforts have been made to identify the relationships between depression and inflammatory markers. This study investigated the level of cytokines before and after treatment for major depressive disorder (MDD) in medication-naïve adolescents with first-episode MDD and compared them with the levels in healthy adolescents. The relationship between cytokine levels and the severity of depressive symptoms was also examined. METHODS Twenty-five adolescents with MDD and 25 healthy controls aged 13 to 18 years were included in the study. Blood samples were obtained, and depression severity was assessed twice in the MDD group before and after treatment and once in the healthy group. RESULTS When compared with healthy controls, adolescents with MDD had lower levels of interleukin 2 (IL-2), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α) and IL-10 before treatment and higher levels of IL-2, IFN-γ, and IL-10 after treatment. In addition, the IFN-γ levels correlated with depressive severity scores in both the Children's Depression Inventory (CDI) and Hamilton Depression Rating Scale (HDRS). The IL-10 level correlated with depressive severity only on the HDRS. LIMITATIONS The sample size was small, and the 12-week follow-up time after treatment was relatively short. CONCLUSION IL-2, IFN-γ, TNF-α, and IL-10 levels in medication-naïve adolescents with first-episode MDD differed from those in healthy controls. The levels of IL-2, IFN-γ, and IL-10 were altered after antidepressant treatment. Further, the IFN-γ and IL-10 levels correlated with the severity of depressive symptoms.
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Affiliation(s)
- Hojun Lee
- Department of Psychiatry, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Minjae Song
- Department of Child and Adolescent Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Jongha Lee
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, South Korea
| | - Jung-Bum Kim
- Department of Psychiatry, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Moon-Soo Lee
- Department of Child and Adolescent Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
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Novel Insight into Neuroimmune Regulatory Mechanisms and Biomarkers Linking Major Depression and Vascular Diseases: The Dilemma Continues. Int J Mol Sci 2020; 21:ijms21072317. [PMID: 32230840 PMCID: PMC7177743 DOI: 10.3390/ijms21072317] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023] Open
Abstract
Major depressive disorder (MDD) represents a serious health problem estimated to affect 350 million people globally. Importantly, MDD has repeatedly emerged as an etiological or prognostic factor in cardiovascular disease (CVD) development, including vascular pathology. Several linking pathomechanisms between MDD and CVD involve abnormal autonomic regulation, inflammation, and endothelial dysfunction as an early preclinical stage of atherosclerosis. However, the cause of accelerated atherosclerosis in MDD patients remains unclear. Recently, the causal relationships between MDD and mediator (e.g., inflammation and/or endothelial dysfunction), as well as the causal pathways from the mediator to atherosclerosis, were discussed. Specifically, MDD is accompanied by immune dysregulation, resulting in increased production of proinflammatory cytokines (e.g., interleukin (IL)-6 and tumor necrosis factor (TNF)-α), which could lead to depression-linked abnormalities in brain function. Further, MDD has an adverse effect on endothelial function; for example, circulating markers of endothelial dysfunction (e.g., soluble adhesion molecules, von Willebrand factor) have been linked with depression. Additionally, MDD-linked autonomic dysregulation, which is characterized by disrupted sympathovagal balance associated with excessive circulating catecholamines, can contribute to CVD. Taken together, activated inflammatory response, endothelial dysfunction, and autonomic dysregulation could affect gradual atherosclerosis progression, resulting in a higher risk of developing CVD in MDD. This review focused on the pathomechanisms linking MDD and CVD with respect to neuroimmune regulation, and the description of promising biomarkers, which is important for the early diagnosis and personalized prevention of CVD in major depression.
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