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Geoffroy PA, Schroder CM, Bourgin P, Maruani J, Lejoyeux M, d'Ortho MP, Couffignal C. Validation of a data collection set for the psychiatric, addiction, sleep and chronobiological assessments of patients with depression: A Delphi study for the SoPsy-depression French national cohort. L'ENCEPHALE 2023; 49:117-123. [PMID: 36257850 DOI: 10.1016/j.encep.2022.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Despite international efforts to identify biomarkers of depression, none has been transferred to clinical practice, neither for diagnosis, evolution, nor therapeutic response. This led us to build a French national cohort (through the clinical and research network named SoPsy within the French biological psychiatry society (AFPBN) and sleep society (SFRMS)), to better identify markers of sleep and biological rhythms and validate more homogeneous subgroups of patients, but also to specify the manifestations and pathogeneses of depressive disorders. Before inclusions, we sought to provide a predefined, standardized, and robust set of data to be collected in all centers. METHODS A Delphi process was performed to achieve consensus through the independent rating of invited experts, the SoPsy-depression co-investigators (n=34). The initial set open for vote included 94 questionnaires targeting adult and child psychiatry, sleep and addiction. RESULTS Two questionnaire rounds were completed with 94% participation in the first round and 100% participation in the second round. The results of the Delphi survey incorporated the consensus opinion of the 32 members who completed both rounds. Nineteen of the 94 questionnaires achieved consensus at the first round and seventy of 75 at the second round. The five remaining questionnaires were submitted to three experts involved in the steering committee during a dedicated meeting. At the end, 24 questionnaires were retained in the mandatory and 26 in the optional questionnaire set. CONCLUSIONS A validated data collection set of questionnaires is now available to assess psychiatry, addiction, sleep and chronobiology dimensions of depressive disorders.
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Affiliation(s)
- P A Geoffroy
- Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France; GHU Paris - psychiatry & neurosciences, 1, rue Cabanis, 75014 Paris, France; NeuroDiderot, Inserm, FHU I2-D2, université Paris Cité, 75019 Paris, France; CNRS UPR 3212, Institute for cellular and integrative neurosciences, 67000 Strasbourg, France.
| | - C M Schroder
- CNRS UPR 3212, Institute for cellular and integrative neurosciences, 67000 Strasbourg, France; Department of child and adolescent psychiatry, Strasbourg university and Strasbourg university hospitals, Strasbourg, France; Sleep disorders center & CIRCSom (International Research Center for ChronoSomnology), CHRU, Strasbourg, France
| | - P Bourgin
- CNRS UPR 3212, Institute for cellular and integrative neurosciences, 67000 Strasbourg, France; Sleep disorders center & CIRCSom (International Research Center for ChronoSomnology), CHRU, Strasbourg, France
| | - J Maruani
- Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France; GHU Paris - psychiatry & neurosciences, 1, rue Cabanis, 75014 Paris, France; NeuroDiderot, Inserm, FHU I2-D2, université Paris Cité, 75019 Paris, France
| | - M Lejoyeux
- Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France; GHU Paris - psychiatry & neurosciences, 1, rue Cabanis, 75014 Paris, France; NeuroDiderot, Inserm, FHU I2-D2, université Paris Cité, 75019 Paris, France
| | - M-P d'Ortho
- NeuroDiderot, Inserm, FHU I2-D2, université Paris Cité, 75019 Paris, France; Service de physiologie - explorations fonctionnelles, centre du sommeil, hôpital Bichat, AP-HP, 75018 Paris, France
| | - C Couffignal
- Département de biostatistique, épidémiologie et recherche clinique, Hôpital Bichat, université Paris Cité, AP-HP, 75018 Paris, France
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Development of Autonomic Nervous System Assays as Point-of-Care Tests to Supplement Clinical Judgment in Risk Assessment for Suicidal Behavior: A Review. Curr Psychiatry Rep 2022; 24:11-21. [PMID: 35076889 DOI: 10.1007/s11920-022-01315-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW A biomarker point-of-care (POC) test that supplements the psychiatric interview and improves detection of patients at risk for suicide would be of value, and assays of autonomic nervous system (ANS) activity would satisfy the logistical requirements for a POC test. We performed a selective review of the available literature of ANS assays related to risk for suicide. RECENT FINDINGS We searched PubMed and Web of Science with the strategy: "suicide OR suicidal" AND "electrodermal OR heart rate variability OR pupillometry OR pupillography." The search produced 119 items, 21 of which provided original data regarding ANS methods and suicide. These 21 studies included 6 for electrodermal activity, 14 for heart rate variability, and 1 for the pupillary light reflex. The 21 papers showed associations between ANS assays and suicide risk in a direction suggesting underlying hyperarousal in patients at risk for suicide. ANS assays show promise for future development as POC tests to supplement clinical decision making in estimating risk for suicide.
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Van De Poll MN, van Swinderen B. Balancing Prediction and Surprise: A Role for Active Sleep at the Dawn of Consciousness? Front Syst Neurosci 2021; 15:768762. [PMID: 34803618 PMCID: PMC8602873 DOI: 10.3389/fnsys.2021.768762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 11/14/2022] Open
Abstract
The brain is a prediction machine. Yet the world is never entirely predictable, for any animal. Unexpected events are surprising, and this typically evokes prediction error signatures in mammalian brains. In humans such mismatched expectations are often associated with an emotional response as well, and emotional dysregulation can lead to cognitive disorders such as depression or schizophrenia. Emotional responses are understood to be important for memory consolidation, suggesting that positive or negative 'valence' cues more generally constitute an ancient mechanism designed to potently refine and generalize internal models of the world and thereby minimize prediction errors. On the other hand, abolishing error detection and surprise entirely (as could happen by generalization or habituation) is probably maladaptive, as this might undermine the very mechanism that brains use to become better prediction machines. This paradoxical view of brain function as an ongoing balance between prediction and surprise suggests a compelling approach to study and understand the evolution of consciousness in animals. In particular, this view may provide insight into the function and evolution of 'active' sleep. Here, we propose that active sleep - when animals are behaviorally asleep but their brain seems awake - is widespread beyond mammals and birds, and may have evolved as a mechanism for optimizing predictive processing in motile creatures confronted with constantly changing environments. To explore our hypothesis, we progress from humans to invertebrates, investigating how a potential role for rapid eye movement (REM) sleep in emotional regulation in humans could be re-examined as a conserved sleep function that co-evolved alongside selective attention to maintain an adaptive balance between prediction and surprise. This view of active sleep has some interesting implications for the evolution of subjective awareness and consciousness in animals.
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Affiliation(s)
| | - Bruno van Swinderen
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
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4
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Bertrand L, d'Ortho MP, Reynaud E, Lejoyeux M, Bourgin P, Geoffroy PA. Polysomnography in seasonal affective disorder: A systematic review and meta-analysis. J Affect Disord 2021; 292:405-415. [PMID: 34144365 DOI: 10.1016/j.jad.2021.05.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/26/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND . Although sleep disturbances are ubiquitous in depression, studies assessing sleep architecture lead to conflicting results, possibly because of the heterogeneity in this disorder. We aimed to focus on Seasonal Affective Disorder (SAD), which is directly associated with circadian and sleep homeostasis impairments. METHODS . A systematic search was conducted in July 2019. Original papers reporting data about night sleep architecture using polysomnography (PSG), in SAD or remitted-SAD and controls, were included. RESULTS . Seven studies were retained and included 183 individuals, including 109 patients with SAD and 74 healthy controls. The random-effects meta-analysis showed that rapid eye movement sleep (REM) was significantly increased in SAD compared to controls (REM amount: SMD=1[0.11,1.88], p = 0.027; REM percentage: SMD=0.71[0.02,1.40], p = 0.045). Remitted SAD patients, compared to controls, also had a significantly increased REM sleep (REM amount: SMD=1.84[0.78,2.90], p<0.001; REM percentage: SMD=1.27[0.51,2.03], p = 0.001) and a significantly decreased REM latency (SMD=-0.93[-1.73,-0.13], p = 0.022). No differences were observed for total sleep time, sleep efficiency, and slow-wave-sleep. LIMITATIONS . Most studies had small sample size, with no placebo group and with open designs. CONCLUSIONS . REM sleep amount and latency appear altered both during the acute and remitted phase of SAD, representing trait markers with interesting diagnosis and therapeutic implications.
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Affiliation(s)
- Léa Bertrand
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hospital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Marie-Pia d'Ortho
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Department of Sleep Disorders, Physiology and Functionnal Explorations, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Eve Reynaud
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5 rue Blaise Pascal, 67000, Strasbourg, France
| | - Michel Lejoyeux
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hospital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Patrice Bourgin
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5 rue Blaise Pascal, 67000, Strasbourg, France; Sleep Disorders Center & CIRCSom (International Research Center for ChronoSomnology), Strasbourg University Hospital, 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre A Geoffroy
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hospital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5 rue Blaise Pascal, 67000, Strasbourg, France.
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5
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Venner A, Broadhurst RY, Sohn LT, Todd WD, Fuller PM. Selective activation of serotoninergic dorsal raphe neurons facilitates sleep through anxiolysis. Sleep 2021; 43:5573750. [PMID: 31553451 DOI: 10.1093/sleep/zsz231] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/18/2019] [Indexed: 11/12/2022] Open
Abstract
A role for the brain's serotoninergic (5HT) system in the regulation of sleep and wakefulness has been long suggested. Yet, previous studies employing pharmacological, lesion and genetically driven approaches have produced inconsistent findings, leaving 5HT's role in sleep-wake regulation incompletely understood. Here we sought to define the specific contribution of 5HT neurons within the dorsal raphe nucleus (DRN5HT) to sleep and arousal control. To do this, we employed a chemogenetic strategy to selectively and acutely activate DRN5HT neurons and monitored sleep-wake using electroencephalogram recordings. We additionally assessed indices of anxiety using the open field and elevated plus maze behavioral tests and employed telemetric-based recordings to test effects of acute DRN5HT activation on body temperature and locomotor activity. Our findings indicate that the DRN5HT cell population may not modulate sleep-wake per se, but rather that its activation has apparent anxiolytic properties, suggesting the more nuanced view that DRN5HT neurons are sleep permissive under circumstances that produce anxiety or stress.
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Affiliation(s)
- Anne Venner
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Rebecca Y Broadhurst
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lauren T Sohn
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - William D Todd
- Department of Zoology and Physiology, University of Wyoming, Laramie, WY.,Program in Neuroscience, University of Wyoming, Laramie, WY
| | - Patrick M Fuller
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Geoffroy PA, Palagini L. Biological rhythms and chronotherapeutics in depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110158. [PMID: 33152388 DOI: 10.1016/j.pnpbp.2020.110158] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Depressive syndromes are frequent and heterogeneous brain conditions with more than 90% of patients suffering from sleep complaints. Better characterizing this "sleep" domain may allow to both better treat acute episodes with existing chronotherapeutics, but also to prevent the manifestation or recurrences of mood disorders. This work aims to i) review theoretical and fundamental data of chronotherapeutics, and ii) provide practical recommendations. Light therapy (LT) can be used as a first-line monotherapy of moderate to severe depression of all subtypes. LT can be also used as a combination with antidepressant to maximize patients' response rates, which has a clear superiority to antidepressant alone. Sleep deprivation (SD) is a rapid and powerful chronotherapeutic with antidepressant responses within hours in 45-60% of patients with unipolar or bipolar depression. Different strategies should be combined to stabilize the SD antidepressant effect, including concomitant medications, repeated SD, combination with sleep phase advance and/or LT (triple chronotherapy). Melatonin treatment is of interest in remitted patients with mood disorder to prevent relapses or recurrences, if a complaint of insomnia, poor sleep quality or phase delay syndrome is associated. During the acute phase, melatonin could be used as an adjuvant treatment for symptoms of insomnia associated with depression. The cognitive behavioral therapy for insomnia (CBT-I) can be recommend to treat insomnia during euthymic phases. The Interpersonal and social rhythm therapy (IPSRT) is indicated for the acute treatment of bipolar depression and for the prevention of mood episodes. Chronotherapeutics should always be associated with behavioral measures for healthy sleep.
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Affiliation(s)
- Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018 Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France.
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa; Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy
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7
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Li M, Cui J, Xu B, Wei Y, Fu C, Lv X, Xiong L, Qin D. Sleep Disturbances and Depression Are Co-morbid Conditions: Insights From Animal Models, Especially Non-human Primate Model. Front Psychiatry 2021; 12:827541. [PMID: 35145441 PMCID: PMC8821160 DOI: 10.3389/fpsyt.2021.827541] [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: 12/02/2021] [Accepted: 12/31/2021] [Indexed: 02/05/2023] Open
Abstract
The incidence rates of depression are increasing year by year. As one of the main clinical manifestations of depression, sleep disorder is often the first complication. This complication may increase the severity of depression and lead to poor prognosis in patients. In the past decades, there have been many methods used to evaluate sleep disorders, such as polysomnography and electroencephalogram, actigraphy, and videography. A large number of rodents and non-human primate models have reproduced the symptoms of depression, which also show sleep disorders. The purpose of this review is to examine and discuss the relationship between sleep disorders and depression. To this end, we evaluated the prevalence, clinical features, phenotypic analysis, and pathophysiological brain mechanisms of depression-related sleep disturbances. We also emphasized the current situation, significance, and insights from animal models of depression, which would provide a better understanding for the pathophysiological mechanisms between sleep disturbance and depression.
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Affiliation(s)
- Meng Li
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Jieqiong Cui
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Bonan Xu
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yuanyuan Wei
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Chenyang Fu
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Xiaoman Lv
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Lei Xiong
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Dongdong Qin
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
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8
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Pandi-Perumal SR, Monti JM, Burman D, Karthikeyan R, BaHammam AS, Spence DW, Brown GM, Narashimhan M. Clarifying the role of sleep in depression: A narrative review. Psychiatry Res 2020; 291:113239. [PMID: 32593854 DOI: 10.1016/j.psychres.2020.113239] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 01/13/2023]
Abstract
It has been established that 4.4 to 20% of the general population suffers from a major depressive disorder (MDD), which is frequently associated with a dysregulation of normal sleep-wake mechanisms. Disturbances of circadian rhythms are a cardinal feature of psychiatric dysfunctions, including MDD, which tends to indicate that biological clocks may play a role in their pathophysiology. Thus, episodes of depression and mania or hypomania can arise as a consequence of the disruption of zeitgebers (time cues). In addition, the habit of sleeping at a time that is out of phase with the body's other biological rhythms is a common finding in depressed patients. In this review, we have covered a vast area, emerging from human and animal studies, which supports the link between sleep and depression. In doing so, this paper covers a broad range of distinct mechanisms that may underlie the link between sleep and depression. This review further highlights the mechanisms that may underlie such link (e.g. circadian rhythm alterations, melatonin, and neuroinflammatory dysregulation), as well as evidence for a link between sleep and depression (e.g. objective findings of sleep during depressive episodes, effects of pharmacotherapy, chronotherapy, comorbidity of obstructive sleep apnea and depression), are presented.
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Affiliation(s)
| | - Jaime M Monti
- Department of Pharmacology and Therapeutics, School of Medicine Clinics Hospital, University of the Republic, Montevideo 11600, Uruguay
| | - Deepa Burman
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Palestine, State of, United States
| | | | - Ahmed S BaHammam
- University of Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation, Saudi Arabia
| | | | - Gregory M Brown
- Centre for Addiction and Mental Health, University of Toronto, 250 College St, Toronto, ON, Canada
| | - Meera Narashimhan
- Department of Medicine, University of South Carolina, Columbia, SC, United States; Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, United States
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Abstract
AbstractRecent studies by Cloninger suggest that the temperament dimension of harm avoidance might be related to serotonergic activity. Since serotonergic mechanisms equally play a major role in sleep regulation, we decided to use Cloninger’s psychobiological model of temperament and character to assess whether there is a link between psychophysiologic insomnia and specific personality traits. Chronic insomnia is a common complaint in modern society, and it is still controversial whether insomniacs share specific personality traits. Thirty-two chronic insomniacs (<50 years) were studied. They underwent polysomnography for two consecutive nights and filled out the 226-item self-questionnaire of Temperament and Character Inventory as well as the Hospital Anxiety and Depression scale. (1) Harm avoidance for all subscores was significantly higher in insomniac patients when compared with controls; (2) self-directedness scores were lower in insomniacs; (3) sleep latency was positively correlated to harm avoidance; (4) HA1 (anticipatory worry) was negatively correlated to REM latency. Temperament and Character Inventory is a useful tool in the investigation of chronic insomnia. Serotonergic mechanisms might explain the high incidence of harm avoidance as personality trait in psychophysiologic insomniac patients. Further studies are needed to see whether harm avoidance could be a psychological vulnerability marker for primary insomnia and be used as predictor of SSRI treatment responders.
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Affiliation(s)
- Zara de Saint Hilaire
- Sleep Laboratory, University Hospital of Geneva, Belle-idée, 2 chemin Petit Bel-Air, 1225, Chêne-Bourg, Switzerland.
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Haberland L, Höllmer H, Schulz H, Spiegelhalder K, Gorzka R. Changes in sleep architecture in German Armed Forces personnel with posttraumatic stress disorder compared with depressed and healthy control subjects. PLoS One 2019; 14:e0215355. [PMID: 30995285 PMCID: PMC6469790 DOI: 10.1371/journal.pone.0215355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 03/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study compares the sleep architecture of patients with posttraumatic stress disorder (PTSD) with that of both patients with depression and subjects with no mental disorder. METHOD 45 German armed forces personnel with PTSD, 72 German armed forces personnel with depression and 24 healthy control subjects underwent 24-hour polysomnography. The effects of group membership, medication and the statistical interaction of group and medication were analysed for the following variables: sleep onset latency, REM sleep latency, slow-wave sleep and REM sleep percentages. RESULTS Sleep onset latency was significantly prolonged in both the PTSD and the depression group. Moreover, psychotropic medication was associated with significantly prolonged REM sleep latency. CONCLUSION The impact on sleep onset latency is of special clinical relevance in that according to preliminary studies, it is of major importance for subjective sleep quality. In contrast to the other parameters, an increase in sleep onset latency results in a subjective reduction in sleep quality which can lead to hyperarousal and increased preoccupation with sleep, which in turn may lead to dysfunctional sleep patterns.
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Affiliation(s)
- Laura Haberland
- German Armed Forces Hospital Hamburg, Centre for Mental Health, Hamburg, Germany
- * E-mail:
| | - Helge Höllmer
- German Armed Forces Hospital Hamburg, Centre for Mental Health, Hamburg, Germany
| | - Holger Schulz
- University Medical Centre Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Kai Spiegelhalder
- University Medical Centre Freiburg, Centre of Psychiatry and Psychotherapy, Freiburg, Germany
| | - Robert Gorzka
- German Armed Forces Hospital Hamburg, Centre for Mental Health, Hamburg, Germany
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11
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Herzog–Krzywoszanska R, Krzywoszanski L. Sleep Disorders in Huntington's Disease. Front Psychiatry 2019; 10:221. [PMID: 31031659 PMCID: PMC6474183 DOI: 10.3389/fpsyt.2019.00221] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Huntington's chorea (Huntington's disease, HD) is a genetic disorder caused by autosomal dominant mutation, leading to progressive neurodegenerative changes in the central nervous system. Involuntary movements such as chorea occur typically in HD patients, accompanied by progressive cognitive and psychiatric disturbances. Other common symptoms of HD are circadian and sleep abnormalities, which are observed from the earliest stages of the disease or even before the occurrence of clinical symptoms. The most common sleep problems reported by HD patients include insomnia, difficulties in falling asleep, frequent nocturnal awakenings, and excessive daytime sleepiness. Also, specific changes in sleep architecture have been identified in HD. In this paper, we review studies on sleep and circadian rhythm disorders in HD. We outline findings concerning sleep patterns and disturbances of circadian rhythms in HD patients, as well as the role of psychiatric disorders and motor disorders in HD patients' sleep problems. We also discuss problems related to the different methods of diagnosing sleep disorders in HD. Furthermore, the adverse effects of medication used for the treatment of core HD symptoms as one of the sources of sleep disturbances in HD are emphasized. In conclusion, the diversity and complexity of the determinants of sleep and circadian rhythm disorders in HD are highlighted. Finally, the relevance of effective treatment to improve patients' functioning and quality of life as well as the potential relief of their cognitive and emotional symptoms is addressed.
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Affiliation(s)
| | - Lukasz Krzywoszanski
- Neurocognitive Psychology Unit, Chair of Psychology, Faculty of Pedagogy, Pedagogical University of Krakow, Krakow, Poland
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12
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Kwon HB, Yoon H, Choi SH, Choi JW, Lee YJ, Park KS. Heart rate variability changes in major depressive disorder during sleep: Fractal index correlates with BDI score during REM sleep. Psychiatry Res 2019; 271:291-298. [PMID: 30513461 DOI: 10.1016/j.psychres.2018.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 11/10/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
We investigated the relationship between autonomic nervous system activity during each sleep stage and the severity of depressive symptoms in patients with major depressive disorder (MDD) and healthy control subjects. Thirty patients with MDD and thirty healthy control subjects matched for sex, age, and body mass index completed standard overnight polysomnography. Depression severity was assessed using the Beck Depression Inventory (BDI). Time- and frequency-domain, and fractal HRV parameters were derived from 5-min electrocardiogram segments during light sleep, deep sleep, rapid eye movement (REM) sleep, and the pre- and post-sleep wake periods. Detrended fluctuation analysis (DFA) alpha-1 values during REM sleep were significantly higher in patients with MDD than in control subjects, and a significant correlation existed between DFA alpha-1 and BDI score in all subjects. DFA alpha-1 was the strongest predictor for the BDI score, along with REM density as a covariate. This study found that compared with controls, patients with MDD show reduced complexity in heart rate during REM sleep, which may represent lower cardiovascular adaptability in these patients, and could lead to cardiac disease. Moreover, DFA alpha-1 values measured during REM sleep may be useful as an indicator for the diagnosis and monitoring of depression.
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Affiliation(s)
- Hyun Bin Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea
| | - Heenam Yoon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Republic of Korea
| | - Sang Ho Choi
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 03080, Republic of Korea
| | - Jae-Won Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul 01830, Republic of Korea
| | - Yu Jin Lee
- Department of Neuropsychiatry and the Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kwang Suk Park
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea.
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Heart rate variability in patients with major depressive disorder and healthy controls during non-REM sleep and REM sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:2312-2315. [PMID: 29060360 DOI: 10.1109/embc.2017.8037318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The objectives of this study are to investigate heart rate variability (HRV) in major depressive disorder patients (MDD) and healthy controls during different sleep stages, and to examine the association of HRV during sleep and depression severity. Polysomnography was recorded from 15 depressive patients with a higher beck depression inventory index (BDI > 25, H-BDI-D), 15 depressive patients with a lower BDI index (BDI ≤ 25, L-BDI-D) and 15 healthy controls. HRV was calculated during the first three rapid eye movements (REM) periods and non-REM stages (i.e. sleep stage 2 and 3) with time domain, power spectral and fractal analysis. As a result, H-BDI-D patients showed the highest short-term fractal alpha-1 exponent during first REM period and healthy controls had the lowest values. Our results suggest an association between the depression severity and the autonomic nerve function, especially during the first REM sleep. The pathophysiological analysis for this property should be conducted in future prospective studies.
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Zaki NFW, Spence DW, BaHammam AS, Pandi-Perumal SR, Cardinali DP, Brown GM. Chronobiological theories of mood disorder. Eur Arch Psychiatry Clin Neurosci 2018; 268:107-118. [PMID: 28894915 DOI: 10.1007/s00406-017-0835-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022]
Abstract
Major depressive disorder (MDD) remains the most prevalent mental disorder and a leading cause of disability, affecting approximately 100 million adults worldwide. The disorder is characterized by a constellation of symptoms affecting mood, anxiety, neurochemical balance, sleep patterns, and circadian and/or seasonal rhythm entrainment. However, the mechanisms underlying the association between chronobiological parameters and depression remain unknown. A PubMed search was conducted to review articles from 1979 to the present, using the following search terms: "chronobiology," "mood," "sleep," and "circadian rhythms." We aimed to synthesize the literature investigating chronobiological theories of mood disorders. Current treatments primarily include tricyclic antidepressants and selective serotonin reuptake inhibitors, which are known to increase extracellular concentrations of monoamine neurotransmitters. However, these antidepressants do not treat the sleep disturbances or circadian and/or seasonal rhythm dysfunctions associated with depressive disorders. Several theories associating sleep and circadian rhythm disturbances with depression have been proposed. Current evidence supports the existence of associations between these, but the direction of causality remains elusive. Given the existence of chronobiological disturbances in depression and evidence regarding their treatment in improving depression, a chronobiological approach, including timely use of light and melatonin agonists, could complement the treatment of MDD.
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Affiliation(s)
- Nevin F W Zaki
- Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | | | - Ahmed S BaHammam
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Daniel P Cardinali
- BIOMED-UCA-CONICET and Department of Teaching and Research, Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Gregory M Brown
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, M5T 1R8, Canada
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15
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Subjective perception of sleep benefit in Parkinson's disease: Valid or irrelevant? Parkinsonism Relat Disord 2017; 42:90-94. [DOI: 10.1016/j.parkreldis.2017.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/20/2017] [Accepted: 06/30/2017] [Indexed: 11/17/2022]
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Tanaka M, Wang X, Mikoshiba K, Hirase H, Shinohara Y. Rearing-environment-dependent hippocampal local field potential differences in wild-type and inositol trisphosphate receptor type 2 knockout mice. J Physiol 2017; 595:6557-6568. [PMID: 28758690 DOI: 10.1113/jp274573] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/25/2017] [Indexed: 12/30/2022] Open
Abstract
KEY POINTS Mice reared in an enriched environment are demonstrated to have larger hippocampal gamma oscillations than those reared in isolation, thereby confirming previous observations in rats. To test whether astrocytic Ca2+ surges are involved in this experience-dependent LFP pattern modulation, we used inositol trisphosphate receptor type 2 (IP3 R2)-knockout (KO) mice, in which IP3 /Ca2+ signalling in astrocytes is largely diminished. We found that this experience-dependent gamma power alteration persists in the KO mice. Interestingly, hippocampal ripple events, the synchronized events critical for memory consolidation, are reduced in magnitude and frequency by both isolated rearing and IP3 R2 deficiency. ABSTRACT Rearing in an enriched environment (ENR) is known to enhance cognitive and memory abilities in rodents, whereas social isolation (ISO) induces depression-like behaviour. The hippocampus has been documented to undergo morphological and functional changes depending on these rearing environments. For example, rearing condition during juvenility alters CA1 stratum radiatum gamma oscillation power in rats. In the present study, hippocampal CA1 local field potentials (LFP) were recorded from bilateral CA1 in urethane-anaesthetized mice that were reared in either an ENR or ISO condition. Similar to previous findings in rats, gamma oscillation power during theta states was higher in the ENR group. Ripple events that occur during non-theta periods in the CA1 stratum pyramidale also had longer intervals in ISO mice. Because astrocytic Ca2+ elevations play a key role in synaptic plasticity, we next tested whether these changes in LFP are also expressed in inositol trisphosphate receptor type 2 (IP3 R2)-knockout (KO) mice, in which astrocytic Ca2+ elevations are largely diminished. We found that the gamma power was also higher in IP3 R2-KO-ENR mice compared to IP3 R2-KO-ISO mice, suggesting that the rearing-environment-dependent gamma power alteration does not necessarily require the astrocytic IP3 /Ca2+ pathway. By contrast, ripple events showed genotype-dependent changes, as well as rearing condition-dependent changes: ISO housing and IP3 R2 deficiency both lead to longer inter-ripple intervals. Moreover, we found that ripple magnitude in the right CA1 tended to be smaller in IP3 R2-KO. Because IP3 R2-KO mice have been reported to have depression phenotypes, our results suggest that ripple events and the mood of animals may be broadly correlated.
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Affiliation(s)
| | | | - Katsuhiko Mikoshiba
- Laboratory for Developmental Neurobiology, RIKEN Brain Science Institute, Saitama, Japan
| | - Hajime Hirase
- Laboratory for Neuron-Glia Circuitry.,Brain and Body System Science Institute, Saitama University, Saitama, Japan
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Bostock ECS, Kirkby KC, Taylor BVM. The Current Status of the Ketogenic Diet in Psychiatry. Front Psychiatry 2017; 8:43. [PMID: 28373848 PMCID: PMC5357645 DOI: 10.3389/fpsyt.2017.00043] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/02/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The ketogenic diet (KD) has been used in treatment-resistant epilepsy since the 1920s. It has been researched in a variety of neurological conditions in both animal models and human trials. The aim of this review is to clarify the potential role of KD in psychiatry. METHODS Narrative review of electronic databases PubMED, PsychINFO, and Scopus. RESULTS The search yielded 15 studies that related the use of KD in mental disorders including anxiety, depression, bipolar disorder, schizophrenia, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). These studies comprised nine animal models, four case studies, and two open-label studies in humans. In anxiety, exogenous ketone supplementation reduced anxiety-related behaviors in a rat model. In depression, KD significantly reduced depression-like behaviors in rat and mice models in two controlled studies. In bipolar disorder, one case study reported a reduction in symptomatology, while a second case study reported no improvement. In schizophrenia, an open-label study in female patients (n = 10) reported reduced symptoms after 2 weeks of KD, a single case study reported no improvement. In a brief report, 3 weeks of KD in a mouse model normalized pathological behaviors. In ASD, an open-label study in children (n = 30) reported no significant improvement; one case study reported a pronounced and sustained response to KD. In ASD, in four controlled animal studies, KD significantly reduced ASD-related behaviors in mice and rats. In ADHD, in one controlled trial of KD in dogs with comorbid epilepsy, both conditions significantly improved. CONCLUSION Despite its long history in neurology, the role of KD in mental disorders is unclear. Half of the published studies are based on animal models of mental disorders with limited generalizability to the analog conditions in humans. The review lists some major limitations including the lack of measuring ketone levels in four studies and the issue of compliance to the rigid diet in humans. Currently, there is insufficient evidence for the use of KD in mental disorders, and it is not a recommended treatment option. Future research should include long-term, prospective, randomized, placebo-controlled crossover dietary trials to examine the effect of KD in various mental disorders.
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Affiliation(s)
| | - Kenneth C Kirkby
- Psychiatry, School of Medicine, University of Tasmania , Hobart, TAS , Australia
| | - Bruce V M Taylor
- Menzies Institute for Medical Research, Tasmania , Hobart, TAS , Australia
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Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, Reynolds CF, Riemann D. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull 2016; 142:969-990. [PMID: 27416139 PMCID: PMC5110386 DOI: 10.1037/bul0000053] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the "Comprehensive Meta-Analysis" and "R" software. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges' g). Sources of variability, that is, sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable. (PsycINFO Database Record
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Affiliation(s)
- Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Wolfram Regen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Christoph Nissen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | | | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
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Chang CH, Chen MC, Qiu MH, Lu J. Ventromedial prefrontal cortex regulates depressive-like behavior and rapid eye movement sleep in the rat. Neuropharmacology 2014; 86:125-32. [PMID: 25036609 PMCID: PMC4188719 DOI: 10.1016/j.neuropharm.2014.07.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 01/09/2023]
Abstract
Major depressive disorder (MDD) is a debilitating disease with symptoms like persistent depressed mood and sleep disturbances. The prefrontal cortex (PFC) has been implicated as an important structure in the neural circuitry of MDD, with pronounced abnormalities in blood flow and metabolic activity in PFC subregions, including the subgenual cingulate cortex (sgACC, or Brodmann area 25). In addition, deep brain stimulation in the sgACC has recently been shown to alleviate treatment-resistant depression. Depressed patients also show characteristic changes in sleep: insomnia, increased rapid-eye-movement (REM) sleep and shortened REM sleep latency. We hypothesized that sleep changes and depressive behavior may be a consequence of the abnormal PFC activity in MDD. The rat ventromedial PFC (vmPFC, prelimbic and infralimbic cortices) is considered to be the homolog of the human sgACC, so we examined the effect of excitotic lesions in the vmPFC on sleep-wake and depressive behavior. We also made lesions in the adjacent dorsal region (dmPFC) to compare the effect of this similar but distinct mPFC region. We found that both dmPFC and vmPFC lesions led to increased REM sleep, but only vmPFC-lesioned animals displayed increased sleep fragmentation, shortened REM latency and increased immobility in the forced swim test. Anatomic tracing suggests that the mPFC projects to the pontine REM-off neurons that interact with REM-on neurons in the dorsal pons. These results support our hypothesis that neuronal loss in the rat vmPFC resembles several characteristics of MDD and may be a critical area for modulating both mood and sleep.
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Affiliation(s)
- Celene H Chang
- Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Michael C Chen
- Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Mei Hong Qiu
- Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; State Key Laboratory of Medical Neurobiology and Department of Neurobiology, School of Basic Medical Science, Fudan University, Shanghai, China
| | - Jun Lu
- Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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Garcia-Rill E, Kezunovic N, D'Onofrio S, Luster B, Hyde J, Bisagno V, Urbano FJ. Gamma band activity in the RAS-intracellular mechanisms. Exp Brain Res 2014; 232:1509-22. [PMID: 24309750 PMCID: PMC4013218 DOI: 10.1007/s00221-013-3794-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/21/2013] [Indexed: 11/29/2022]
Abstract
Gamma band activity participates in sensory perception, problem solving, and memory. This review considers recent evidence showing that cells in the reticular activating system (RAS) exhibit gamma band activity, and describes the intrinsic membrane properties behind such manifestation. Specifically, we discuss how cells in the mesopontine pedunculopontine nucleus, intralaminar parafascicular nucleus, and pontine SubCoeruleus nucleus dorsalis all fire in the gamma band range when maximally activated, but no higher. The mechanisms involve high-threshold, voltage-dependent P/Q-type calcium channels, or sodium-dependent subthreshold oscillations. Rather than participating in the temporal binding of sensory events as in the cortex, gamma band activity in the RAS may participate in the processes of preconscious awareness and provide the essential stream of information for the formulation of many of our actions. We address three necessary next steps resulting from these discoveries: an intracellular mechanism responsible for maintaining gamma band activity based on persistent G-protein activation, separate intracellular pathways that differentiate between gamma band activity during waking versus during REM sleep, and an intracellular mechanism responsible for the dysregulation in gamma band activity in schizophrenia. These findings open several promising research avenues that have not been thoroughly explored. What are the effects of sleep or REM sleep deprivation on these RAS mechanisms? Are these mechanisms involved in memory processing during waking and/or during REM sleep? Does gamma band processing differ during waking versus REM sleep after sleep or REM sleep deprivation?
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Affiliation(s)
- E Garcia-Rill
- Department of Neurobiology and Developmental Sciences, Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Slot 847, 4301 West Markham St., Little Rock, AR, 72205, USA,
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21
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Schramm PJ, Poland RE, Rao U. Bupropion response on sleep quality in patients with depression: implications for increased cardiovascular disease risk. Eur Neuropsychopharmacol 2014; 24:207-14. [PMID: 24239431 PMCID: PMC3948318 DOI: 10.1016/j.euroneuro.2013.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 08/26/2013] [Accepted: 09/20/2013] [Indexed: 01/27/2023]
Abstract
Depression could be an independent risk factor for cardiovascular disease. We assessed bupropion response in depressed patients by polysomnography (PSG) and cardiopulmonary coupling (CPC) variables. Nineteen subjects participated in a two-session, two consecutive night PSG protocol. Participants received either placebo or bupropion-SR 150 mg, orally, in a randomized, double-blind cross-over fashion on night two. Outcome variables were: sleep stages, REM latency, stable, unstable sleep and very low frequency coupling (VLFC). CPC analysis uses heart rate variability and the electrocardiogram's R-wave amplitude fluctuations associated with respiration to generate frequency maps. Bupropion increased REM latency (p=0.043) but did not impact PSG sleep continuity, architecture and CPC variables. A trend (p=0.092) was observed towards increasing VLFC duration. Bupropion increased the number of stable-unstable sleep transitions (p=0.036). Moderate to strong correlations between PSG and CPC variables were found on placebo and bupropion nights. Limitations include a small sample size, limited power to detect CPC changes and lack of normal controls for comparison. Increased stable-unstable sleep transitions and VLFC duration may indicate vulnerability to cardiovascular disease due to their association with low heart rate variability that has been associated with increased mortality raising the question whether the beneficial effects of the antidepressant medication outweighs the impact on cardiopulmonary dynamics.
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Affiliation(s)
- Preetam J Schramm
- Arbeitsgemeinschaft Wissenschaftliche Psychotherapie-Freiburg, Immental Str. 11, 79104 Freiburg, Germany.
| | - Russell E Poland
- Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, TN, USA.
| | - Uma Rao
- Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, TN, USA; Center for Molecular and Behavioral Neuroscience, Meharry Medical College, Nashville, TN, USA; Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA; Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA.
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Ellis JG, Perlis ML, Bastien CH, Gardani M, Espie CA. The natural history of insomnia: acute insomnia and first-onset depression. Sleep 2014; 37:97-106. [PMID: 24470699 DOI: 10.5665/sleep.3316] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES While many studies have examined the association between insomnia and depression, no studies have evaluated these associations (1) within a narrow time frame, (2) with specific reference to acute and chronic insomnia, and (3) using polysomnography. In the present study, the association between insomnia and first-onset depression was evaluated taking into account these considerations. DESIGN A mixed-model inception design. SETTING Academic research laboratory. PARTICIPANTS Fifty-four individuals (acute insomnia [n = 33], normal sleepers [n = 21]) with no reported history of a sleep disorder, chronic medical condition, or psychiatric illness. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Participants were assessed at baseline (2 nights of polysomnography and psychometric measures of stress and mood) and insomnia and depression status were reassessed at 3 months. Individuals with acute insomnia exhibited more stress, poorer mood, worse subjective sleep continuity, increased N2 sleep, and decreased N3 sleep. Individuals who transitioned to chronic insomnia exhibited (at baseline) shorter REM latencies and reduced N3 sleep. Individuals who exhibited this pattern in the transition from acute to chronic insomnia were also more likely to develop first-onset depression (9.26%) as compared to those who remitted from insomnia (1.85%) or were normal sleepers (1.85%). CONCLUSION The transition from acute to chronic insomnia is presaged by baseline differences in sleep architecture that have, in the past, been ascribed to Major Depression, either as heritable traits or as acquired traits from prior episodes of depression. The present findings suggest that the "sleep architecture stigmata" of depression may actually develop over the course transitioning from acute to chronic insomnia.
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Affiliation(s)
- Jason G Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle, UK
| | | | | | - Maria Gardani
- Institute of Mental Health and Wellbeing, University of Glasgow, UK
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences/Sleep & Circadian Neuroscience Institute, University of Oxford, UK
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Vakalopoulos C. A cholinergic hypothesis of the unconscious in affective disorders. Front Neurosci 2013; 7:220. [PMID: 24319409 PMCID: PMC3837351 DOI: 10.3389/fnins.2013.00220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 11/03/2013] [Indexed: 12/24/2022] Open
Abstract
The interactions between distinct pharmacological systems are proposed as a key dynamic in the formation of unconscious memories underlying rumination and mood disorder, but also reflect the plastic capacity of neural networks that can aid recovery. An inverse and reciprocal relationship is postulated between cholinergic and monoaminergic receptor subtypes. M1-type muscarinic receptor transduction facilitates encoding of unconscious, prepotent behavioral repertoires at the core of affective disorders and ADHD. Behavioral adaptation to new contingencies is mediated by the classic prototype receptor: 5-HT1A (Gi/o) and its modulation of M1-plasticity. Reversal of learning is dependent on increased phasic activation of midbrain monoaminergic nuclei and is a function of hippocampal theta. Acquired hippocampal dysfunction due to abnormal activation of the hypothalamic-pituitary-adrenal (HPA) axis predicts deficits in hippocampal-dependent memory and executive function and further impairments to cognitive inhibition. Encoding of explicit memories is mediated by Gq/11 and Gs signaling of monoamines only. A role is proposed for the phasic activation of the basal forebrain cholinergic nucleus by cortical projections from the complex consisting of the insula and claustrum. Although controversial, recent studies suggest a common ontogenetic origin of the two structures and a functional coupling. Lesions of the region result in loss of motivational behavior and familiarity based judgements. A major hypothesis of the paper is that these lost faculties result indirectly, from reduced cholinergic tone.
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Kahn M, Sheppes G, Sadeh A. Sleep and emotions: Bidirectional links and underlying mechanisms. Int J Psychophysiol 2013; 89:218-28. [DOI: 10.1016/j.ijpsycho.2013.05.010] [Citation(s) in RCA: 283] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/11/2013] [Accepted: 05/16/2013] [Indexed: 11/26/2022]
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Abstract
There are a variety of noradrenergic antidepressants available, most of which act by inhibiting neuronal noradrenaline re-uptake, although few drugs are specific for this action. Where drugs have numerous actions the adverse effects of noradrenaline reuptake may be difficult to isolate, although in this respect the adverse effects of reboxetine, a specific noradrenaline re-uptake inhibitor, are illuminating. Noradrenergic antidepressants typically cause minor changes in blood and heart rate, sweating and insomnia. Other pharmacological actions shown by non-specific antidepressants may act to worsen or mitigate these adverse effects. Noradrenergic drugs are less likely than selective serotonin reuptake inhibitors (SSRIs) to cause sexual dysfunction but more likely to cause urinary hesitancy. Doubts remain over the relative propensity for antidepressants with different modes of action to cause diabetes and hyponatraemia. Noradrenergic actions do not seem to confer a risk of death in overdose.
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Affiliation(s)
- Eromona Whiskey
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
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26
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Paterson JL, Reynolds AC, Ferguson SA, Dawson D. Sleep and obsessive-compulsive disorder (OCD). Sleep Med Rev 2013; 17:465-74. [PMID: 23499210 DOI: 10.1016/j.smrv.2012.12.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/24/2012] [Accepted: 12/12/2012] [Indexed: 11/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic mental illness that can have a debilitating effect on daily functioning. A body of research reveals altered sleep behaviour in OCD sufferers; however, findings are inconsistent and there is no consensus on the nature of this relationship. Understanding sleep disturbance in OCD is of critical importance given the known negative consequences of disturbed sleep for mood and emotional wellbeing. A systematic literature search was conducted of five databases for studies assessing sleep in adults diagnosed with OCD. Fourteen studies met inclusion criteria and qualitative data analysis methods were used to identify common themes. There was some evidence of reduced total sleep time and sleep efficiency in OCD patients. Many of the sleep disturbances noted were characteristic of depression. However, some OCD sufferers displayed delayed sleep onset and offset and an increased prevalence of delayed sleep phase disorder (DSPD). Severe OCD symptoms were consistently associated with greater sleep disturbance. While the sleep of OCD patients has not been a major focus to date, the existing literature suggests that addressing sleep disturbance in OCD patients may ensure a holistic approach to treatment, enhance treatment efficacy, mitigate relapse and protect against the onset of co-morbid psychiatric illnesses.
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Affiliation(s)
- Jessica L Paterson
- Central Queensland University, Appleton Institute, PO Box 42, Goodwood SA 5034, Australia.
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Schredl M, Paul F, Reinhard I, Ebner-Priemer UW, Schmahl C, Bohus M. Sleep and dreaming in patients with borderline personality disorder: a polysomnographic study. Psychiatry Res 2012; 200:430-6. [PMID: 22657954 DOI: 10.1016/j.psychres.2012.04.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 04/26/2012] [Accepted: 04/29/2012] [Indexed: 10/28/2022]
Abstract
Previous research has demonstrated disturbances in sleep continuity in subjects with borderline personality disorders (BPD). Moreover, depression-like sleep abnormalities like reduced REM latency have been found in BPD subjects, even without comorbid major depression disorder. Yet it is still unknown what the effect is of co-morbid posttraumatic stress disorder on sleep continuity and dream content in BPD patients group. The present study compared 27 unmedicated female BPD subjects and healthy controls. The patients exhibited increased sleep fragmentation, increased REM density, and reduced REM latency. The findings were independent from co-morbid posttraumatic stress response (PTSD), which was present in 33% of the patient sample. Negatively toned dreams obtained by REM awakenings and nightmares were also reported more often by the patients-also irrespective of co-morbid PTSD-whereas dreams of specific BPD behavior, like self-mutilation, were rare. Taking these finding into account, one might productively investigate whether the sleep abnormalities improve during successful treatment of BPD and whether efficient methods for treating nightmares can be beneficial for this patient group.
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28
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Payne JD, Chambers AM, Kensinger EA. Sleep promotes lasting changes in selective memory for emotional scenes. Front Integr Neurosci 2012; 6:108. [PMID: 23181013 PMCID: PMC3503264 DOI: 10.3389/fnint.2012.00108] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/31/2012] [Indexed: 11/13/2022] Open
Abstract
Although we know that emotional events enjoy a privileged status in our memories, we still have much to learn about how emotional memories are processed, stored, and how they change over time. Here we show a positive association between REM sleep and the selective consolidation of central, negative aspects of complex scenes. Moreover, we show that the placement of sleep is critical for this selective emotional memory benefit. When testing occurred 24 h post-encoding, subjects who slept soon after learning (24 h Sleep First group) had superior memory for emotional objects compared to subjects whose sleep was delayed for 16 h post-encoding following a full day of wakefulness (24 h Wake First group). However, this increase in memory for emotional objects corresponded with a decrease in memory for the neutral backgrounds on which these objects were placed. Furthermore, memory for emotional objects in the 24 h Sleep First group was comparable to performance after just a 12 h delay containing a night of sleep, suggesting that sleep soon after learning selectively stabilizes emotional memory. These results suggest that the sleeping brain preserves in long-term memory only what is emotionally salient and perhaps most adaptive to remember.
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Affiliation(s)
- Jessica D. Payne
- Department of Psychology, University of Notre DameNotre Dame, IN, USA
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Elwan M, Rashed N, El Hamrawy L, Fekry M, Asaad T, Shalaby A. Polysomnographic assessment of patients with somatoform disorder in comparison with patients with major depressive disorder. MIDDLE EAST CURRENT PSYCHIATRY 2012. [DOI: 10.1097/01.xme.0000412996.88257.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Frey S, Birchler-Pedross A, Hofstetter M, Brunner P, Götz T, Münch M, Blatter K, Knoblauch V, Wirz-Justice, A, Cajochen C. Young Women With Major Depression Live on Higher Homeostatic Sleep Pressure Than Healthy Controls. Chronobiol Int 2012; 29:278-94. [DOI: 10.3109/07420528.2012.656163] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hollway JA, Aman MG. Sleep correlates of pervasive developmental disorders: a review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1399-1421. [PMID: 21570809 DOI: 10.1016/j.ridd.2011.04.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/01/2011] [Accepted: 04/02/2011] [Indexed: 05/30/2023]
Abstract
Sleep disturbance is a significant problem in the general pediatric population, and it occurs even more frequently in children with pervasive developmental disorders (PDDs). Much time and energy have been spent examining the characteristics that predispose children to insomnia and it is likely that equivalent factors influence sleep in PDDs. Though similarly affected, it is the unique set of characteristics incumbent in a diagnosis of PDD that has additive effects and increases the likelihood for developing other predisposing factors and subsequent sleep loss. This review summarized research that has explored the behavioral, cognitive, and emotional correlates of sleep disturbance in children with PDDs. The literature provided 38 sleep studies that used either subjective or objective sleep measures. Of these, 17 met criteria for inclusion. Studies were evaluated for their attempts at matching their study samples and adjusting for possible confounding variables. The results revealed that the combined effects of autism symptom severity, internalizing behavior, and externalizing behavior, were the main predisposing factors for the development of insomnia. Other factors included medical conditions, epilepsy, and medication use (likely a proxy for behavior difficulty and even sleep disorder). A bidirectional theoretical framework for sleep disturbance in children with PDDs has been posited as a conceptual guide for future study. Recommendations for future study designs are included.
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Affiliation(s)
- Jill A Hollway
- The Nisonger Center, The Ohio State University, Columbus, OH 43210, United States.
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Affiliation(s)
- V S Rotenberg
- Department of Psychiatry, Tel Aviv University, Tel Aviv, Israel.
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Kierlin L, Littner MR. Parasomnias and antidepressant therapy: a review of the literature. Front Psychiatry 2011; 2:71. [PMID: 22180745 PMCID: PMC3235766 DOI: 10.3389/fpsyt.2011.00071] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 11/22/2011] [Indexed: 11/13/2022] Open
Abstract
There exists a varying level of evidence linking the use of antidepressant medication to the parasomnias, ranging from larger, more comprehensive studies in the area of REM sleep behavior disorder to primarily case reports in the NREM parasomnias. As such, practice guidelines are lacking regarding specific direction to the clinician who may be faced with a patient who has developed a parasomnia that appears to be temporally related to use of an antidepressant. In general, knowledge of the mechanisms of action of the medications, particularly with regard to the impact on sleep architecture, can provide some guidance. There is a potential for selective serotonin reuptake inhibitors, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors to suppress REM, as well as the anticholinergic properties of the individual drugs to further disturb normal sleep architecture.
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Affiliation(s)
- Lara Kierlin
- David Geffen School of Medicine at University of California Los Angeles Los Angeles, CA, USA
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Pandi-Perumal SR, Trakht I, Srinivasan V, Spence DW, Poeggeler B, Hardeland R, Cardinali DP. The effect of melatonergic and non-melatonergic antidepressants on sleep: weighing the alternatives. World J Biol Psychiatry 2010; 10:342-54. [PMID: 18609422 DOI: 10.1080/15622970701625600] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In DSM-IV the occurrence of disturbed sleep is one of the principal diagnostic criteria for major depressive disorder (MDD). Further, there is evidence of reciprocity between the two conditions such that, even in the absence of current depressive symptoms, disturbed sleep often predicts their development. The present review discusses the effects of antidepressants on sleep and evaluates the use of the recently developed melatonin agonist-selective serotonin antagonists on sleep and depression. Although many antidepressants such as the tricyclics, monoamine oxidase inhibitors, serotonin-norepinephrine reuptake inhibitors, several serotonin receptor antagonists and selective serotonin reuptake inhibitors (SSRIs) have all been found successful in treating depression, their use is often associated with a disruptive effect on sleep. SSRIs, currently the most widely prescribed of the antidepressants, are well known for their instigation or exacerbation of insomnia. The recently introduced novel melatonin agonist and selective serotonin antagonist antidepressant, agomelatine, which has melatonin MT(1) and MT(2) receptor agonist and 5-HT(2c) antagonist properties, has been useful in treating patients with MDD. Its rapid onset of action and effectiveness in improving the mood of depressed patients has been attributed to its ability to improve sleep quality. These properties underline the use of melatonin analogues as a promising alternative for the treatment of depression.
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Affiliation(s)
- Seithikurippu R Pandi-Perumal
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
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Mendlewicz J. Sleep disturbances: core symptoms of major depressive disorder rather than associated or comorbid disorders. World J Biol Psychiatry 2010; 10:269-75. [PMID: 19921968 DOI: 10.3109/15622970802503086] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Depression is increasingly prevalent in Western countries. It has severe consequences and is associated with increased rates of disability, morbidity, and mortality. Despite numerous therapeutic options, a great number of depressed patients do not achieve full remission. In addition, despite good short-term outcomes, long-term therapeutic results remain disappointing and associated with a poor prognosis, raising significant concern in terms of public health. Impaired sleep - especially insomnia - may be at least partly responsible for this problem. Very close relationships between major depressive disorder (MDD) and sleep disorders have been observed. In particular, residual symptoms of sleep disturbance in a remitted patient may predict a relapse of the disease. However, most currently available antidepressants do not always take into consideration the sleep disturbances of depressed patients; some agents long used in clinical practice even appear to worsen them by their sleep-inhibiting properties. But some other new medications were shown to relieve early sleep disturbance in addition to alleviating other depression-related symptoms. This positive impact should promote compliance with medication and psychological treatments, and increase daytime performance and overall functioning. Complete remission of MDD appears therefore to depend on the relief of sleep disturbances, a core symptom of MDD that should be taken into consideration and treated early in depressed patients.
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Affiliation(s)
- Julien Mendlewicz
- Department of Psychiatry, Free University of Brussels, Brussels, Belgium.
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36
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Pandi-Perumal SR, Moscovitch A, Srinivasan V, Spence DW, Cardinali DP, Brown GM. Bidirectional communication between sleep and circadian rhythms and its implications for depression: Lessons from agomelatine. Prog Neurobiol 2009; 88:264-71. [DOI: 10.1016/j.pneurobio.2009.04.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 03/09/2009] [Accepted: 04/29/2009] [Indexed: 02/04/2023]
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Totterdell P. Effects of Depressed Affect on Diurnal and Ultradian Variations in Mood in a Healthy Sample. Chronobiol Int 2009. [DOI: 10.3109/07420529509057276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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38
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Doerr JP, Riemann D. [Tricyclic antidepressives as sleep aids. A medical treatment option for insomnia]. PHARMAZIE IN UNSERER ZEIT 2008; 37:226-232. [PMID: 18446906 DOI: 10.1002/pauz.200800266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- John Peter Doerr
- Abteilung für Psychiatrie und Psychotherapie der Universitätsklinik Freiburg, Hauptstr. 5, D-79104 Freiburg.
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Abstract
OBJECTIVE Self-reported sleep disturbances are present in over 80% of patients with depression. However, sleep electroencephalography (EEG) findings, based on overnight polysomnography have not always differentiated depressed patients from healthy individuals. METHOD The present paper will review the findings on sleep EEG studies in depression highlighting how recent technological and methodological advances have impacted on study outcomes. RESULTS The majority of studies, including our own work, do indicate that sleep homeostasis and sleep EEG rhythms are abnormal in depression, but the sleep disturbances were strongly moderated by gender and age. Melancholic features of depression correlated significantly with low slow-wave activity in depressed men, but not in depressed women. Women with depression showed low temporal coherence of sleep EEG rhythms but the presence or absence of melancholic features did not influence correlations. CONCLUSION Diagnostic classification schemas and clinical features of depression may influence sleep EEG findings, but gender may be a more important consideration.
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Affiliation(s)
- R Armitage
- Department of Psychiatry, University of Michigan, Ann Arbor 48105, USA.
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Heitkemper M, Jarrett M, Burr R, Cain KC, Landis C, Lentz M, Poppe A. Subjective and objective sleep indices in women with irritable bowel syndrome. Neurogastroenterol Motil 2005; 17:523-30. [PMID: 16078941 DOI: 10.1111/j.1365-2982.2005.00700.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with irritable bowel syndrome (IBS) commonly report sleep disturbances. This study examined self-report (Pittsburgh Sleep Quality Inventory) sleep quality and polysomnography (PSG) sleep variables in 18 women with mild-to-moderate IBS, 18 with severe IBS and 38 with age- and gender-matched controls. All women were studied on two consecutive nights in a sleep research laboratory where PSG data were collected. Retrospective and daily measures were obtained of self-reported sleep quality, psychological distress and gastrointestinal symptoms across one menstrual cycle. Self-report measures of psychological distress and sleep quality were significantly worse in the IBS-severe (IBS-S) group compared with controls. Rapid eye movement (REM) latency was higher in the two IBS groups on Night 1 than the control group (P = 0.06). Percentage time in REM was highest in the IBS-S on Night 2. All groups demonstrated greater sleep disruption on Night 1 (adaptation) when compared with Night 2. These results highlight the importance of considering the 'first-night effect' in those with IBS and the lack of concordance between self-report and objective indices of sleep in women with IBS.
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Affiliation(s)
- M Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA 357266, USA.
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Straube A, Förderreuther S. [Sleeping behaviour and headache attacks in cases of primary headache. Possible pathological mechanisms]. Schmerz 2004; 18:300-5. [PMID: 15309593 DOI: 10.1007/s00482-004-0311-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Headache is connected with sleep quality, e.g. hypnic headache and chronic paroxysmal headache attacks occur preferentially during REM sleep; this is possibly also true for cluster headache and migraine. REM sleep is typically characterized by the occurrence of ponto-geniculo-occipital spikes (PGOs). These PGOs should be able to trigger cortical spreading depression (CSD), which, although often clinically silent, is assumed to be an essential element of a migraine attack and possibly also of other forms of headache. CSDs are considered a correlate of migraine aura. They could lead to the secondary activation of trigeminovascular afferences, which would then induce a headache. Interestingly, illnesses that are comorbid with migraine cause an increase in the amount of REM sleep; conversely, various drugs administered prophylactically for these illnesses reduce the quantity of REM sleep.
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Affiliation(s)
- A Straube
- Neurologische Klinik der Universität München, Standort Grosshadern.
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Abstract
Sleep research on eating disorders has addressed two major questions: (1) the effects of chronic starvation in anorexia nervosa and of rapidly fluctuating eating patterns in bulimia nervosa on the sleep regulating processes and (2) the search for a significant neurobiological relationship between eating disorders and major depression. At present, the latter question appears to be resolved, since most of the available evidences clearly underline the notion that eating disorders (such as anorexia and bulimia nervosa) and affective disorders are two distinct entities. Regarding the effects of starvation on sleep regulation, recent research in healthy humans and in animals demonstrates that such a condition results in a fragmentation of sleep and a reduction of slow wave sleep. Although several peptides are supposed to be involved in these regulatory processes (i.e. CCK, orexin, leptin), their mode of action is still poorly understood. In opposite to these experimentally induced sleep disturbances are the findings that the sleep patterns in eating disorder patients per se do not markedly differ from those in healthy subjects. However, when focusing on the so-called restricting anorexics, who maintain their chronic underweight by strictly dieting, the expected effects of malnutrition on sleep can be ascertained. Furthermore, at least partial weight restoration results in a 'deepening' of nocturnal sleep in the anorexic patients. However, our knowledge about the neurobiological systems (as well as their circadian pattern of activity) that transmit the effects of starvation and of weight restoration on sleep is still limited and should be extended to metabolic signals mediating sleep.
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Affiliation(s)
- Christoph J Lauer
- Sleep Disorders Center, Clinic Angermuehle, Angermuehle 8a/b, 94469 Deggendorf, Germany.
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Lauer CJ, Modell S, Schreiber W, Krieg JC, Holsboer F. Prediction of the development of a first major depressive episode with a rapid eye movement sleep induction test using the cholinergic agonist RS 86. J Clin Psychopharmacol 2004; 24:356-7. [PMID: 15118498 DOI: 10.1097/01.jcp.0000125744.22031.3a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Armitage R, Husain M, Hoffmann R, Rush AJ. The effects of vagus nerve stimulation on sleep EEG in depression: a preliminary report. J Psychosom Res 2003; 54:475-82. [PMID: 12726905 DOI: 10.1016/s0022-3999(02)00476-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The present study evaluated the effects of vagus nerve stimulation (VNS) on sleep in seven treatment-resistant depressed outpatients. METHODS Sleep studies were conducted in the laboratory at baseline and 10-12 weeks after VNS implantation while the concomitant psychotropic medication regimen was unchanged. Standard sleep macroarchitecture based on visual stage and assessment of ultradian sleep electroencephalographic (EEG) rhythms were measured on all nights. RESULTS An overall significant treatment effect on sleep macroarchitecture was obtained by MANOVA. Decreased awake time, decreased Stage 1 sleep and increased Stage 2 sleep were evident post-VNS, although univariate analyses did not reach significance. In addition, the strength or amplitude of ultradian sleep EEG rhythms more than doubled on VNS and was restored to within normal range. CONCLUSION VNS improved the clinical symptoms of depression and sleep architecture. Results suggest that treatment-resistant depressed patients have dampened sleep EEG rhythms that are restored to near-normal amplitudes with VNS treatment.
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Affiliation(s)
- Roseanne Armitage
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9070, USA.
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Shaffery J, Hoffmann R, Armitage R. The neurobiology of depression: perspectives from animal and human sleep studies. Neuroscientist 2003; 9:82-98. [PMID: 12580343 DOI: 10.1177/1073858402239594] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reviews human and animal studies in the neurobiology of depression. The etiology of the illness, associated neurotransmitter dysregulation, sex steroids, the role of stress, and sleep regulation are discussed. It is suggested that the genesis of depression is related to homeostatic maladaptation that is sexually dimorphic. The authors propose that depressed females are hyperresponsive to stress, whereas depressed males are hyporesponsive to stress. This divergence reflects the exaggeration of naturally occurring differences between males and females, which are most obvious under challenge conditions. The authors conclude that future work in this area should fully evaluate sexual dimorphism, neural plasticity, critical periods, and individual differences in vulnerability.
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Garma L. Insomnias associated with psychiatric disorders. Sleep 2003. [DOI: 10.1007/978-1-4615-0217-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Riemann D, Feige B, Hornyak M, Koch S, Hohagen F, Voderholzer U. The tryptophan depletion test: impact on sleep in primary insomnia - a pilot study. Psychiatry Res 2002; 109:129-35. [PMID: 11927137 DOI: 10.1016/s0165-1781(02)00010-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The application of the tryptophan depletion test is based on the assumption that the decrease of plasma or serum tryptophan concentration following the ingestion of a tryptophan-free amino acid drink reflects a central nervous effect on serotonin metabolism. In the present study the impact of tryptophan depletion on polysomnographically recorded sleep in patients with primary insomnia was studied. Fifteen patients with primary insomnia slept for four nights in the sleep laboratory. Prior to the fourth night the tryptophan depletion test was applied. Sleep EEG variables served as outcome parameters. Patients with primary insomnia, compared to baseline values showed a highly significant decrease of serum tryptophan concentrations after the amino acid drink. Concerning sleep parameters, stage 1 (% sleep period time=SPT) was increased, whereas stage 2 (% SPT) was decreased. Indices of phasic activity of rapid eye movement (REM) sleep (REM density) were increased after the tryptophan depletion compared to baseline. The results suggest a negative impact of tryptophan depletion on sleep continuity and a stimulating effect on phasic measures of REM sleep in patients with primary insomnia.
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstrasse 5, Germany.
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Abstract
Despite clear evidence of an intimate connection between sleep, major depressive disorders (MDD) and gender, few studies have explored gender differences in either sleep or in wakefulness in patients as a means of better understanding the psychogenic components of MDD. Indeed, few sleep studies focus on characterising gender differences in any population. This paper will present a review of the literature on gender differences in sleep and depression. The theoretical and clinical implications of the findings will also be discussed. The premise of the present review is that there is an inherent increased vulnerability to depression in women that arises out of basic gender differences in brain organisation and state regulation, particularly in response to a "biological challenge" during sleep. It is argued that the inherent properties of organisation and regulation of sleep EEG in healthy men and women, elicited under challenge conditions, show gender-specific vulnerability to organisational abnormalities that model homeostatic abnormalities in depressed men and women and contribute to the genesis of depression. 2001 Harcourt Publishers Ltd
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Affiliation(s)
- Roseanne Armitage
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Staner L, Duval F, Calvi-Gries F, Mokrani MC, Bailey P, Hode Y, Toussaint M, Luthringer R, Muzet A, Macher JP. Morning and evening TSH response to TRH and sleep EEG disturbances in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25:535-47. [PMID: 11370996 DOI: 10.1016/s0278-5846(00)00185-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
1. The aim of this study was to investigate hypothalamo-pituitary-thyroid axis (HPTA) functioning and sleep EEG disturbances in major depressive disorder. 2. Thyroid function was evaluated by determination of TSH levels before and after 8 AM and 11 PM TRH administration on the same day in a sample of 113 consecutively-admitted DSM-IV major depressed inpatients (72 females aged 44.3 +/- 13.0 and 41 males aged 45.7 +/- 10.7) that underwent sleep EEG recordings. 3. A blunted TSH response occurred in 15.9% for 8 AM deltaTSH (maximum increment above baseline at the 8 AM TRH challenge), in 39.8% for 11 PM deltaTSH and in 77% for deltadeltaTSH (difference between 11 PM deltaTSH and 8 AM deltaTSH). A negative correlation between deltadeltaTSH and duration of awakenings after sleep onset, and a shorter sleep onset latency in patients with a blunted 11 PM deltaTSH were found, but these two significant relationships disappeared after controlling for the effects of gender and age. 4. The present findings do not support the hypothesis that, in major depression, HPTA dysfunctioning, as reflected in TSH response to TRH, may be related to sleep EEG disturbances.
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Affiliation(s)
- L Staner
- FORENAP - Institute for Research in Neurosciences, Neuropharmacology and Psychiatry, Centre Hospitalier, Rouffach, France.
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Krieg JC, Lauer CJ, Schreiber W, Modell S, Holsboer F. Neuroendocrine, polysomnographic and psychometric observations in healthy subjects at high familial risk for affective disorders: the current state of the 'Munich vulnerability study'. J Affect Disord 2001; 62:33-7. [PMID: 11172871 DOI: 10.1016/s0165-0327(00)00348-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present article summarizes the main results of the cross-sectional part of the 'Munich Vulnerability Study' in which healthy first-degree relatives of patients with an affective disorder were investigated by assessing their neuroendocrine, polysomnographic and psychometric status. As patients with an acute episode of a major depression, the group of the healthy relatives exhibited signs of a hyperactive hypothalamic-pituitary-adrenocortical system verified by the combined dexamethasone corticotropin-releasing hormone (DEX/CRH) test, as well as a slow wave sleep deficit in the first sleep cycle and an increased amount of rapid eye movements during REM sleep. The psychometric profile of the healthy relatives was characterised by elevated scores on the scales measuring 'Rigidity' and 'Autonomic Lability'. On a single-case level, 32% of the healthy first-degree relatives of patients with an affective disorder exhibited 'depression-like' features or conspicuous findings in at least two of the three (i.e. neuroendocrine, polysomnographic, psychometric) areas assessed. Whether the relatives with the neurobiological and psychometric abnormalities we identified have a higher risk for developing an affective disorder than those without has to be answered by the still ongoing prospective part of the study.
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Affiliation(s)
- J C Krieg
- Max-Planck-Institute of Psychiatry, Munich, Germany.
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