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Zhao H, Shi H, Chen C, Ren Z, He M, Li X, Li Y, Pu Y, Cui L, Wang S, Zhao J, Liu H, Zhang X. Association between pregnant specific stress and depressive symptoms in the late pregnancy of Chinese women: the moderate role of family relationship and leisure hobbies. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 32:1-12. [PMID: 36588662 PMCID: PMC9795448 DOI: 10.1007/s10389-022-01806-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
Background Little research has been conducted on the association between pregnant specific stress and depressive symptoms, and whether family relationship and leisure hobbies moderate the association. Methods A cross-sectional survey of 647 pregnant women was conducted in Shenyang City, Liaoning Province of China. Pregnancy Pressure Scale (PPS), Edinburgh Postnatal Depression Scale (EPDS) and two single items were used to assess stress, perinatal depressive symptoms, family relationship and leisure hobbies, respectively. The analysis included χ2-test, Fisher's exact test, and binary logistic regression. Results The prevalence of perinatal depressive symptoms was 22.9% among the participants. After adjustment, four dimensions of pregnancy stress were found to increase the risk of depressive symptoms, and odds ratios (ORs) were 4.175 (95% confidence interval (CI) = 2.240, 7.779), 5.947 (95% CI = 2.624, 13.478), 3.907 (95% CI = 2.375, 6.425), and 8.534 (95% CI = 4.588, 15.873) for factors 1, 2, 3, and 4 (recognition of the role of parents, worrying about maternal and child health and safety, the changes in body shape and physical activity level, as well as child care and marriage), respectively. In addition, significant interactions were found between factor 2, factor 4 and family relationship, leisure hobbies with depressive symptoms, respectively (interaction P < 0.10). Conclusion Tailored stress-overcoming programs, as well as health services, are needed to relieve women's pregnancy stress and prevent them from depressive symptoms. Clinical practice should conduct family relationship-oriented interventions and women themselves can cultivate extensive leisure hobbies in the period of pregnancy preparation.
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Affiliation(s)
- Hanfang Zhao
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Hong Shi
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Chen Chen
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
- Shenyang Women’s and Children’s Hospital, Shenyang, 110011 China
| | - Zheng Ren
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Minfu He
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Xiangrong Li
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Yuyu Li
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Yajiao Pu
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Li Cui
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Shixun Wang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Jieyu Zhao
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
| | - Hongjian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021 China
| | - Xiumin Zhang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, 130021 China
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2
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Zhang CC, Zhu LX, Shi HJ, Zhu LJ. The Role of Vesicle Release and Synaptic Transmission in Depression. Neuroscience 2022; 505:171-185. [DOI: 10.1016/j.neuroscience.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
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Kim S, Oh J, Yun B, Cho A, Sim J, Yoon JH. Secondhand Smoke in the Workplace Is Associated With Depression in Korean Workers. Front Public Health 2022; 10:802083. [PMID: 35558545 PMCID: PMC9087188 DOI: 10.3389/fpubh.2022.802083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Smoking negatively affects health, and previous studies argue that secondhand smoke (SHS) has a significantly negative health effect. We investigated whether SHS in the workplace influences workers' depression. Methods Three years of data (2014, 2016, and 2018) from the Korean National Health and Nutrition Examination Survey were analyzed. Participants who were not current smokers were classified into the occupational SHS exposed and non-exposed groups. Multivariate logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) by adjusting various covariates. Stratified analysis with variables, such as year, sex, occupational classification, average working hours, was additionally performed. Results The crude ORs of depression was 1.51 (95% CI: 1.27–1.80), and the fully adjusted OR with all the covariates was 1.57 (95% CI: 1.30–1.88). This indicated a significant relationship between occupational SHS and depression. The ORs increased every 2 years: 1.07 (95% CI: 0.79–1.44) in 2014, 1.88 (95% CI: 1.34–2.64) in 2016, and 2.07 (95% CI: 1.43–2.99) in year 2018. Stratification analysis also showed a significant association between SHS and depression among those in the prolonged work hours group and male employees, as well as blue- and white-collar workers. Conclusion SHS in the workplace was significantly associated with workers' depression. Our study provides insights into the impact of exposure to SHS for workers and provides a basis for further research and policy-making in this field.
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Affiliation(s)
- Seunghan Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Juyeon Oh
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
| | - Byungyoon Yun
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Ara Cho
- Department of Occupational Health, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Juho Sim
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
| | - Jin-Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, South Korea
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4
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Heo S, Sung Y, Lee SW. Effects of subclinical depression on prefrontal-striatal model-based and model-free learning. PLoS Comput Biol 2021; 17:e1009003. [PMID: 33989284 PMCID: PMC8153417 DOI: 10.1371/journal.pcbi.1009003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 05/26/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Depression is characterized by deficits in the reinforcement learning (RL) process. Although many computational and neural studies have extended our knowledge of the impact of depression on RL, most focus on habitual control (model-free RL), yielding a relatively poor understanding of goal-directed control (model-based RL) and arbitration control to find a balance between the two. We investigated the effects of subclinical depression on model-based and model-free learning in the prefrontal-striatal circuitry. First, we found that subclinical depression is associated with the attenuated state and reward prediction error representation in the insula and caudate. Critically, we found that it accompanies the disrupted arbitration control between model-based and model-free learning in the predominantly inferior lateral prefrontal cortex and frontopolar cortex. We also found that depression undermines the ability to exploit viable options, called exploitation sensitivity. These findings characterize how subclinical depression influences different levels of the decision-making hierarchy, advancing previous conflicting views that depression simply influences either habitual or goal-directed control. Our study creates possibilities for various clinical applications, such as early diagnosis and behavioral therapy design.
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Affiliation(s)
- Suyeon Heo
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Brain and Cognitive Engineering Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Yoondo Sung
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Sang Wan Lee
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Brain and Cognitive Engineering Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- KAIST Institute for Artificial Intelligence, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- KAIST Center for Neuroscience-inspired AI, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
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5
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Costanzi M, Cianfanelli B, Santirocchi A, Lasaponara S, Spataro P, Rossi-Arnaud C, Cestari V. Forgetting Unwanted Memories: Active Forgetting and Implications for the Development of Psychological Disorders. J Pers Med 2021; 11:jpm11040241. [PMID: 33810436 PMCID: PMC8066077 DOI: 10.3390/jpm11040241] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
Intrusive memories are a common feature of many psychopathologies, and suppression-induced forgetting of unwanted memories appears as a critical ability to preserve mental health. In recent years, biological and cognitive studies converged in revealing that forgetting is due to active processes. Recent neurobiological studies provide evidence on the active role of main neurotransmitter systems in forgetting, suggesting that the brain actively works to suppress retrieval of unwanted memories. On the cognitive side, there is evidence that voluntary and involuntary processes (here termed "intentional" and "incidental" forgetting, respectively) contribute to active forgetting. In intentional forgetting, an inhibitory control mechanism suppresses awareness of unwanted memories at encoding or retrieval. In incidental forgetting, retrieval practice of some memories involuntarily suppresses the retrieval of other related memories. In this review we describe recent findings on deficits in active forgetting observed in psychopathologies, like post-traumatic stress disorder, depression, schizophrenia, and obsessive-compulsive disorder. Moreover, we report studies in which the role of neurotransmitter systems, known to be involved in the pathogenesis of mental disorders, has been investigated in active forgetting paradigms. The possibility that biological and cognitive mechanisms of active forgetting could be considered as hallmarks of the early onset of psychopathologies is also discussed.
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Affiliation(s)
- Marco Costanzi
- Department of Human Sciences, Lumsa University, 00193 Rome, Italy; (B.C.); (S.L.)
- Correspondence:
| | - Beatrice Cianfanelli
- Department of Human Sciences, Lumsa University, 00193 Rome, Italy; (B.C.); (S.L.)
| | - Alessandro Santirocchi
- Department of Psychology, Sapienza University, 00185 Rome, Italy; (A.S.); (C.R.-A.); (V.C.)
| | - Stefano Lasaponara
- Department of Human Sciences, Lumsa University, 00193 Rome, Italy; (B.C.); (S.L.)
- Department of Psychology, Sapienza University, 00185 Rome, Italy; (A.S.); (C.R.-A.); (V.C.)
| | - Pietro Spataro
- Department of Economy, Universitas Mercatorum, 00100 Rome, Italy;
| | - Clelia Rossi-Arnaud
- Department of Psychology, Sapienza University, 00185 Rome, Italy; (A.S.); (C.R.-A.); (V.C.)
| | - Vincenzo Cestari
- Department of Psychology, Sapienza University, 00185 Rome, Italy; (A.S.); (C.R.-A.); (V.C.)
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6
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Saied NM, Georgy GS, Hussien RM, Hassan WA. Neuromodulatory effect of curcumin on catecholamine systems and inflammatory cytokines in ovariectomized female rats. Clin Exp Pharmacol Physiol 2020; 48:337-346. [PMID: 33098686 DOI: 10.1111/1440-1681.13427] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022]
Abstract
Anti-inflammatory products may represent the future for depressive disorder therapies. Curcumin (CUR) is a polyphenol and an active component of the turmeric plant Curcuma longa. The aim of this study was to investigate the impact of CUR, as a natural anti-inflammatory agent, on neuro-inflammation related to depression and compare it with the effects of fluoxetine (FLX) and estradiol (E2 ) in ovariectomized (OVX) rats. The experimental animals were divided into the following five treatment groups (n = 10): sham-operated, OVX, OVX-E2 (100 μg/kg, im, every other day), OVX-FLX (20 mg/kg, ip, daily), and OVX-CUR (100 mg/kg, po, daily). The results indicated that CUR improved the animals' performances in the open field test and modulated dopamine (DA) and norepinephrine levels in several brain regions compared with the OVX group. CUR resulted in the down-regulation of monoamine oxidase b and up-regulation of tyrosine hydroxylase, as well asDA receptor mRNA in the limbic region. In addition, CUR significantly attenuated the production of serum corticosterone hormone, tumour necrosis factor-alpha, interleukin-β1, interleukin-6, and nitric oxide in the limbic system. Furthermore, CUR normalized malondialdehyde levels and led to a significant upsurge in total antioxidant capacity, compared with the OVX group. Consequently, CUR, besides being harmless, was efficient against inflammation and oxidative-nitrosative stress, showing a greater effect on DA receptor expression than FLX and E2 in OVX rats.
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Affiliation(s)
- Nashwa M Saied
- Department of Hormone, National Organization for Drug Control and Research, Giza, Egypt
| | - Gehan S Georgy
- Department of Pharmacology, National Organization for Drug Control and Research, Giza, Egypt
| | - Rokaya M Hussien
- Department of Hormone, National Organization for Drug Control and Research, Giza, Egypt
| | - Wafaa A Hassan
- Department of Hormone, National Organization for Drug Control and Research, Giza, Egypt
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7
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Understanding the effects of chronic benzodiazepine use in depression: a focus on neuropharmacology. Int Clin Psychopharmacol 2020; 35:243-253. [PMID: 32459725 DOI: 10.1097/yic.0000000000000316] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Benzodiazepines are frequently prescribed on an ongoing basis to individuals with depression, mainly to alleviate anxiety or insomnia, despite current guideline recommendations that continuous use should not exceed 4 weeks. Currently, there are no efficacy trials published beyond 8 weeks. Several antidepressant trials demonstrate that the concomitant use of a benzodiazepine is associated with poorer depressive outcomes and functional status; however, it is unclear why this is the case. Patients with depression receiving a benzodiazepine may reflect a more ill or high anxiety group, although even within anxiety disorders, the use of a benzodiazepine is associated with poorer outcomes. The neuroadaptive consequences of long-term benzodiazepine use may be a factor underlying these findings. Chronic benzodiazepine use results in decreased gamma-aminobutyric acid and monoaminergic function, as well as interference with neurogenesis, which are all purported to play a role in antidepressant efficacy. This review will discuss the oppositional neuropharmacological interactions between chronic benzodiazepine use and antidepressant mechanism of action, which could result in reduced antidepressant efficacy and function in depression.
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8
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Peng Y, Su Y, Jiang Y. Effect of the warming and tonifying kidney- yang recipe on monoamine neurotransmitters and pathological morphology of hippocampus tissue in depression model rats. Technol Health Care 2020; 28:237-244. [PMID: 32364156 PMCID: PMC7369113 DOI: 10.3233/thc-209024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE: To study the molecular mechanism of warming and tonifying kidney-yang recipe (WTKYR) in the treatment of depression. METHODS: SD rats were divided into a control group, model group, WTKYR group, and fluoxetine group. Each group consisted of 21 rats. The chronic unpredictable mild stress model was used. Body weighing and SPT were performed regularly. After treatment, histopathology of the brain tissue was performed, and concentrations of 5-HT (5-hydroxytryptamine), NE (norepinephrine), and DA (dopamine) in the hippocampus were determined. RESULTS: The WTKYR group showed higher body weight and sucrose consumption than the control groups. Moreover, the concentrations of 5-HT, NE, and DA in the hippocampus were significantly different in the WTKYR group in comparison to those in the other groups. The hippocampus histomorphology of the WTKYR group exhibited less dematous pyramidal cells and mild inflammatory cell infiltration. CONCLUSION: The treatment effect of WTKYR in depression may be based on improvement in the content of 5-HT, NE, and DA in the hippocampus, extenuating edema of the cortical surface and pyramidal cells and decreasing the infiltration of inflammatory cells into hippocampus tissue.
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Affiliation(s)
| | | | - Yong Jiang
- Corresponding author: Yong Jiang, Basic Medical College, Chengdu University of Traditional Chinese Medicine, Twelve Bridges 37, Chengdu, Sichuan, China. E-mail:
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9
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Noguchi T, Nakagawa-Senda H, Tamai Y, Nishiyama T, Watanabe M, Hosono A, Shibata K, Ichikawa M, Wakabayashi R, Nagaya K, Ema K, Okamoto N, Tsujimura S, Fujita H, Kamiya M, Kondo F, Yamada T, Suzuki S. Association Between Second-hand Smoke Exposure and Depressive Symptoms Among Japanese Adults: A Cross-sectional Study. J Epidemiol 2019; 30:566-573. [PMID: 31813893 PMCID: PMC7661331 DOI: 10.2188/jea.je20190146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Second-hand smoke exposure has been associated with poor mental health. However, among Japanese adults, little is known about the association between second-hand smoking and depressive symptoms. We examined this association in a cross-sectional study among a Japanese general adult population sample. Methods Japanese adults were recruited from the Japan Multi-Institutional Collaborative Cohort Study in the Okazaki area between 2012 and 2017. Second-hand smoke exposure and smoking status were assessed using a self-administered questionnaire. Based on their frequency of exposure to second-hand smoke, non-smokers and smokers were categorized as “almost never,” “sometimes,” and “almost every day”. Depressive symptoms were defined by a Kessler 6 score ≥5 points. We performed a multivariable Poisson regression analysis to obtain adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for depressive symptoms. Results Overall, 5,121 participants (4,547 non-smokers and 574 smokers) were included whose mean age was 63.6 (standard deviation [SD], 10.3) years for non-smokers and 59.33 (SD, 10.2) years for smokers. The association between second-hand smoking and depressive symptoms was significant among non-smokers, but not among smokers. Among non-smokers, PRs compared with “almost never” were 1.25 (95% CI, 1.09–1.42) for “sometimes” and 1.41 (95% CI, 1.09–1.84) for “almost every day” (P for trend <0.001); among smokers, PRs compared with “almost never” were 1.30 (95% CI, 0.82–2.06) for “sometimes” and 1.44 (95% CI, 0.90–2.33) for “almost every day” (P for trend = 0.144). Conclusions Second-hand smoking and depressive symptoms were associated among non-smokers. Our findings indicate the importance of tobacco smoke control for mental health.
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Affiliation(s)
- Taiji Noguchi
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Social Science, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology
| | - Hiroko Nakagawa-Senda
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Yuya Tamai
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Ministry of Health, Labour and Welfare
| | - Takeshi Nishiyama
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Miki Watanabe
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Akihiro Hosono
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Atsuta Public Health Center, City of Nagoya
| | - Kiyoshi Shibata
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Health and Nutritional Sciences, Nagoya Keizai University
| | - Mari Ichikawa
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Ryozo Wakabayashi
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Kenji Nagaya
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Kanae Ema
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Naoko Okamoto
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Health Nutritional Sciences, Osaka Shoin Women's University
| | - Shoko Tsujimura
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Health Sciences, Toyohashi Sozo University
| | - Hitomi Fujita
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Health Sciences, Nihon Fukushi University
| | - Mayumi Kamiya
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Nursing, Chukyo Gakuin University
| | - Fumi Kondo
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Tamaki Yamada
- Okazaki City Medical Association, Public Health Center
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
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10
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Blake MJ, Trinder JA, Allen NB. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions. Clin Psychol Rev 2018; 63:25-40. [PMID: 29879564 DOI: 10.1016/j.cpr.2018.05.006] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/05/2018] [Accepted: 05/26/2018] [Indexed: 11/27/2022]
Abstract
There is robust evidence of an association between insomnia, anxiety, and depression in adolescence. The aim of this review is to describe and synthesize potential mechanisms underlying this association and explore implications for the design of adolescent behavioral sleep interventions. Specifically, we examine whether insomnia symptoms are a mechanism for the development of internalizing symptoms in adolescence and whether sleep interventions are an effective treatment for both insomnia and internalizing symptoms in adolescence because they target the shared mechanisms underlying these disorders. Research using different methodologies points to the role of sequential, parallel, and interacting mechanisms. In this paper, we review a wide range of relevant biological (i.e., polymorphisms and dysregulation in serotonin, dopamine, and circadian clock genes; alterations in corticolimbic and mesolimbic brain circuits; cortisol reactivity to stress; inflammatory cytokine dysregulation; biased memory consolidation; changes in sleep architecture), psychological (i.e., cognitive inflexibility, interpretational biases, judgment biases, negative attribution styles, worry, rumination, biased attention to threat, dysfunctional beliefs and attitudes about sleep, misperception of sleep deficit), and social mechanisms (i.e., reduced and impaired social interactions, unhelpful parenting behaviors, family stress) and propose an integrative multilevel model of how these phenomena may interact to increase vulnerability to both insomnia and internalizing disorders. Several 'biopsychosocial' mechanisms hold promise as viable treatment targets for adolescent behavioral sleep interventions, which may reduce both insomnia and internalizing symptoms.
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Affiliation(s)
- Matthew J Blake
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - John A Trinder
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia; Department of Psychology, University of Oregon, Eugene, OR 97403-1227, USA.
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12
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Cantisani A, Stegmayer K, Bracht T, Federspiel A, Wiest R, Horn H, Müller TJ, Schneider C, Höfle O, Strik W, Walther S. Distinct resting-state perfusion patterns underlie psychomotor retardation in unipolar vs. bipolar depression. Acta Psychiatr Scand 2016; 134:329-38. [PMID: 27497085 DOI: 10.1111/acps.12625] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Psychomotor abnormalities characterize both unipolar (UP) depression and bipolar (BP) depression. We aimed to assess their neurobiological correlates in terms of motor activity (AL) and resting-state cerebral blood flow (rCBF) and investigate their association in BP, UP, and healthy controls (HC). METHOD We enrolled 42 depressed patients (22 BP, 20 UP) and 19 HC matched for age, gender, education, income. AL and rCBF were objectively assessed with the use of wrist actigraphy and arterial spin labeling. Group differences and the association of AL and rCBF were computed. RESULTS Activity level was significantly reduced in patients, but no difference was found between BP and UP. Increased perfusion was found in BP compared with UP and HC, in multiple brain areas. We found positive correlations of rCBF and AL in BP and UP, in different parts of the insula and frontal regions. Only BP showed a cluster in the left precentral gyrus. In HC, only inverse correlations of AL and rCBF were found. CONCLUSION The differences in rCBF and in the localization of the clusters of positive AL/rCBF correlations between BP and UP suggest that different neural impairments may underlie motor symptoms in the two disorders, but finally converge in phenotypically similar manifestations.
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Affiliation(s)
- A Cantisani
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland. , .,NeuroFarBa Department, University of Florence, Florence, Italy. ,
| | - K Stegmayer
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
| | - T Bracht
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
| | - A Federspiel
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
| | - R Wiest
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - H Horn
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
| | - T J Müller
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
| | - C Schneider
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
| | - O Höfle
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - W Strik
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
| | - S Walther
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
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13
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Rizvi SJ, Sproule BA, Gallaugher L, McIntyre RS, Kennedy SH. Correlates of benzodiazepine use in major depressive disorder: The effect of anhedonia. J Affect Disord 2015; 187:101-5. [PMID: 26331683 DOI: 10.1016/j.jad.2015.07.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/22/2015] [Accepted: 07/29/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Current treatment guidelines emphasize the limited role of benzodiazepines in Major Depressive Disorder (MDD), mainly due to the absence of long-term data, risk of abuse and potential adverse effects. However, benzodiazepines continue to be prescribed for long-term use in a significant number of patients. This study sought to evaluate benzodiazepine use in a large sample of MDD patients seen at a tertiary care clinic, and determine whether use is related to illness severity or complexity, as well as to identify the clinical predictors of benzodiazepine use. METHODS This was a naturalistic cross-sectional study conducted in MDD patients seen at the Mood Disorders Pyschopharmacology Unit at the University Health Network (N=326). Detailed information on current medication regimens was collected. A structured diagnostic interview, in addition to measures of symptom severity, quality of life, and personality were administered. Participants were grouped according to the presence or absence of prescribed benzodiazepines for daily use. RESULTS The prevalence of regular benzodiazepine use was 25%. Benzodiazepine users were more likely to be female, unemployed, have a history of child abuse, and have comorbid panic disorder. Depression and anxiety scores were not significantly different between groups, although anhedonia was greater in the benzodiazepine group. A logistic regression revealed anhedonia was the strongest predictor of regular benzodiazepine use. CONCLUSION The groups were similar in clinical profile suggesting benzodiazepine use is not necessarily linked to greater illness complexity or severity. Benzodiazepine use appears to be associated with specific diagnostic and symptom characteristics, possibly providing insight into the potential pharmacodynamic and neurobiological effects of frequent use.
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Affiliation(s)
- Sakina J Rizvi
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.
| | - Beth A Sproule
- Department of Pharmacy, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Laura Gallaugher
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Jung SJ, Shin A, Kang D. Active smoking and exposure to secondhand smoke and their relationship to depressive symptoms in the Korea national health and nutrition examination survey (KNHANES). BMC Public Health 2015; 15:1053. [PMID: 26468075 PMCID: PMC4606499 DOI: 10.1186/s12889-015-2402-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between tobacco smoking, including secondhand smoking, and depression has been assessed. The purpose of this study was to evaluate the association between secondhand smoking among current, former and never smokers and depressive symptoms. For secondhand smoking, gender differences and sources of exposure were examined. METHODS Data from 34,693 participants from the fourth and fifth Korean Health and Nutritional Examination Survey (2007-2012) were analyzed in 2014. Self-reported exposure to active (current, former or never) and secondhand smoking and depressive symptoms experienced during the past year were analyzed using logistic regression. The dose-response relationship between duration of secondhand smoke exposure and depression was assessed with stratification by gender and sources of exposure (at home only, at the workplace only or both). RESULTS Regardless of their smoking status, all women who had secondhand smoke exposure at home reported more depressive symptoms than non-smoking women without any exposure to secondhand cigarette smoking (OR 1.43, 95 % CI 1.04-1.96 for current smokers; OR 2.32, 95 % CI 1.04-5.16 for former smokers; OR 1.25, 95 % CI 1.08-1.43 for never smokers). There was also a significant dose-response pattern (p-trend <0.001) for the duration of secondhand smoke exposure at home among women. No significant association was found between smoking and depressive symptoms in men. CONCLUSIONS There was a significant association between secondhand smoke exposure at home and depressive symptoms in women. Secondhand smoke exposure at home was associated with depressive symptoms in a dose-response manner.
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Affiliation(s)
- Sun Jae Jung
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea.
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Daehee Kang
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
- Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea.
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15
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Rizvi SJ, Quilty LC, Sproule BA, Cyriac A, Michael Bagby R, Kennedy SH. Development and validation of the Dimensional Anhedonia Rating Scale (DARS) in a community sample and individuals with major depression. Psychiatry Res 2015; 229:109-19. [PMID: 26250147 DOI: 10.1016/j.psychres.2015.07.062] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/16/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
Abstract
Anhedonia, a core symptom of Major Depressive Disorder (MDD), is predictive of antidepressant non-response. In contrast to the definition of anhedonia as a "loss of pleasure", neuropsychological studies provide evidence for multiple facets of hedonic function. The aim of the current study was to develop and validate the Dimensional Anhedonia Rating Scale (DARS), a dynamic scale that measures desire, motivation, effort and consummatory pleasure across hedonic domains. Following item selection procedures and reliability testing using data from community participants (N=229) (Study 1), the 17-item scale was validated in an online study with community participants (N=150) (Study 2). The DARS was also validated in unipolar or bipolar depressed patients (n=52) and controls (n=50) (Study 3). Principal components analysis of the 17-item DARS revealed a 4-component structure mapping onto the domains of anhedonia: hobbies, food/drink, social activities, and sensory experience. Reliability of the DARS subscales was high across studies (Cronbach's α=0.75-0.92). The DARS also demonstrated good convergent and divergent validity. Hierarchical regression analysis revealed the DARS showed additional utility over the Snaith-Hamilton Pleasure Scale (SHAPS) in predicting reward function and distinguishing MDD subgroups. These studies provide support for the reliability and validity of the DARS.
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Affiliation(s)
- Sakina J Rizvi
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada; Departments of Pharmaceutical Sciences and Neuroscience, University of Toronto, Toronto, Ontario, Canada.
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Beth A Sproule
- Department of Clinical Pharmacy, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Anna Cyriac
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - R Michael Bagby
- Department of Psychiatry, University of Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada; Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
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Clinical trials of N-acetylcysteine in psychiatry and neurology: A systematic review. Neurosci Biobehav Rev 2015; 55:294-321. [PMID: 25957927 DOI: 10.1016/j.neubiorev.2015.04.015] [Citation(s) in RCA: 269] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/30/2015] [Accepted: 04/25/2015] [Indexed: 01/19/2023]
Abstract
N-acetylcysteine (NAC) is recognized for its role in acetaminophen overdose and as a mucolytic. Over the past decade, there has been growing evidence for the use of NAC in treating psychiatric and neurological disorders, considering its role in attenuating pathophysiological processes associated with these disorders, including oxidative stress, apoptosis, mitochondrial dysfunction, neuroinflammation and glutamate and dopamine dysregulation. In this systematic review we find favorable evidence for the use of NAC in several psychiatric and neurological disorders, particularly autism, Alzheimer's disease, cocaine and cannabis addiction, bipolar disorder, depression, trichotillomania, nail biting, skin picking, obsessive-compulsive disorder, schizophrenia, drug-induced neuropathy and progressive myoclonic epilepsy. Disorders such as anxiety, attention deficit hyperactivity disorder and mild traumatic brain injury have preliminary evidence and require larger confirmatory studies while current evidence does not support the use of NAC in gambling, methamphetamine and nicotine addictions and amyotrophic lateral sclerosis. Overall, NAC treatment appears to be safe and tolerable. Further well designed, larger controlled trials are needed for specific psychiatric and neurological disorders where the evidence is favorable.
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Abstract
Many patients with major depressive disorder (MDD) only partially respond, and some have no clinically meaningful response, to current widely used antidepressant drugs. Due to the purported role of dopamine in the pathophysiology of depression, triple-reuptake inhibitors (TRIs) that simultaneously inhibit serotonin (5-HT), norepinephrine (NE) and dopamine reuptake could be a useful addition to the armamentarium of treatments for MDD. A TRI should more effectively activate mesolimbic dopamine-related reward-networks, restore positive mood and reduce potent 5-HT reuptake blockade associated "hypodopaminergic" adverse effects of decreased libido, weight gain and "blunting" of emotions. On the other hand, dopaminergic effects raise concern over abuse liability and TRIs may have many of the cardiovascular effects associated with NET inhibition. Several clinical development programs for potential TRI antidepressants have failed to demonstrate significantly greater efficacy than placebo or standard of care. Successful late-stage clinical development of a TRI is more likely if experimental research studies in the target population of depressed patients have demonstrated target engagement that differentially and dose-dependently improves assessments of reward-network dysfunction relative to existing antidepressants. TRI treatment could be individualized on the basis of predictive markers such as the burden of decreased positive mood symptoms and/or neuroimaging evidence of reward network dysfunction. This review focuses on how the next generation of monoamine-based treatments could be efficiently developed to address unmet medical need in MDD.
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Fonoff FC, Fonoff ET, Barbosa ER, Quaranta T, Machado RB, de Andrade DC, Teixeira MJ, Fuentes D. Correlation between impulsivity and executive function in patients with Parkinson disease experiencing depression and anxiety symptoms. J Geriatr Psychiatry Neurol 2015; 28:49-56. [PMID: 25009159 DOI: 10.1177/0891988714541870] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression and anxiety are comorbidities often associated with Parkinson disease (PD). Recent studies debate on how affective disorders can influence the cognition of patients with PD. This study sought to investigate how depression and anxiety affect specific executive functions and impulsivity traits in these patients. METHODS Twenty-eight patients with advanced PD and 28 closely matched healthy volunteers (HV) were assessed for depressive and anxiety symptoms, impulsivity, executive function and control attention and behavioral response. RESULTS Compared to the HV group, the PD group showed significantly higher perseverative responses and slowness to adapt to changes in environmental stimuli and longer reaction time for inter-stimulus interval change. Depression symptoms were significantly correlated to motor impulsivity score and total Barratt Impulsiveness Scale (BIS -11) score. Moreover, there was also significant correlation between anxiety symptoms and attentional impulsivity score and total BIS-11 score. Correlation analysis between impulsivity and control attention indicated a positive correlation in commission and a negative correlation in reaction time and detectability in the PD group. CONCLUSIONS The present results suggest that depression and anxiety were highly correlated to impulsivity but not to executive functions changes in these PD patients.
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Affiliation(s)
| | - Erich Talamoni Fonoff
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Thais Quaranta
- LINEU, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Manoel Jacobsen Teixeira
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Fuentes
- LINEU, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Morris G, Berk M, Galecki P, Walder K, Maes M. The Neuro-Immune Pathophysiology of Central and Peripheral Fatigue in Systemic Immune-Inflammatory and Neuro-Immune Diseases. Mol Neurobiol 2015; 53:1195-1219. [PMID: 25598355 DOI: 10.1007/s12035-015-9090-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 01/05/2015] [Indexed: 01/18/2023]
Abstract
Many patients with systemic immune-inflammatory and neuro-inflammatory disorders, including depression, rheumatoid arthritis, systemic lupus erythematosus, Sjögren's disease, cancer, cardiovascular disorder, Parkinson's disease, multiple sclerosis, stroke, and chronic fatigue syndrome/myalgic encephalomyelitis, endure pathological levels of fatigue. The aim of this narrative review is to delineate the wide array of pathways that may underpin the incapacitating fatigue occurring in systemic and neuro-inflammatory disorders. A wide array of immune, inflammatory, oxidative and nitrosative stress (O&NS), bioenergetic, and neurophysiological abnormalities are involved in the etiopathology of these disease states and may underpin the incapacitating fatigue that accompanies these disorders. This range of abnormalities comprises: increased levels of pro-inflammatory cytokines, e.g., interleukin-1 (IL-1), IL-6, tumor necrosis factor (TNF) α and interferon (IFN) α; O&NS-induced muscle fatigue; activation of the Toll-Like Receptor Cycle through pathogen-associated (PAMPs) and damage-associated (DAMPs) molecular patterns, including heat shock proteins; altered glutaminergic and dopaminergic neurotransmission; mitochondrial dysfunctions; and O&NS-induced defects in the sodium-potassium pump. Fatigue is also associated with altered activities in specific brain regions and muscle pathology, such as reductions in maximum voluntary muscle force, downregulation of the mitochondrial biogenesis master gene peroxisome proliferator-activated receptor gamma coactivator 1-alpha, a shift to glycolysis and buildup of toxic metabolites within myocytes. As such, both mental and physical fatigue, which frequently accompany immune-inflammatory and neuro-inflammatory disorders, are the consequence of interactions between multiple systemic and central pathways.
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Affiliation(s)
- Gerwyn Morris
- Tir Na Nog, Bryn Road seaside 87, Llanelli, SA152LW, Wales, UK
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, P.O. Box 291, Geelong, 3220, Australia.,Orygen Youth Health Research Centre and the Centre of Youth Mental Health, Poplar Road 35, Parkville, 3052, Australia.,The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Royal Parade 30, Parkville, 3052, Australia.,Department of Psychiatry, University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia
| | - Piotr Galecki
- Department of Adult Psychiatry, Medical University of Lodz, Lodz, Poland
| | - Ken Walder
- Metabolic Research Unit, Deakin University, Geelong, Australia
| | - Michael Maes
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, P.O. Box 291, Geelong, 3220, Australia. .,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil. .,Impact Strategic Research Center, Deakin University, Geelong, Australia.
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20
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Liberg B, Rahm C. The functional anatomy of psychomotor disturbances in major depressive disorder. Front Psychiatry 2015; 6:34. [PMID: 25806006 PMCID: PMC4354237 DOI: 10.3389/fpsyt.2015.00034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/19/2015] [Indexed: 12/16/2022] Open
Abstract
Psychomotor disturbances (PMD) are a classic feature of depressive disorder that provides rich clinical information. The aim our narrative review was to characterize the functional anatomy of PMD by summarizing findings from neuroimaging studies. We found evidence across several neuroimaging modalities that suggest involvement of fronto-striatal neurocircuitry, and monoaminergic pathways and metabolism. We suggest that PMD in major depressive disorder emerge from an alteration of limbic signals, which influence emotion, volition, higher-order cognitive functions, and movement.
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Affiliation(s)
- Benny Liberg
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden
| | - Christoffer Rahm
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Unit of Metabolism, Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden
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21
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Carvalho AF, Berk M, Hyphantis TN, McIntyre RS. The integrative management of treatment-resistant depression: a comprehensive review and perspectives. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:70-88. [PMID: 24458008 DOI: 10.1159/000357500] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/20/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Major depressive disorder is a prevalent and disabling illness. Notwithstanding numerous advances in the pharmacological treatment of depression, approximately 70% of patients do not remit after first-line antidepressant treatment. METHODS The MEDLINE/PubMed, EMBASE and ClinicalTrials.gov electronic databases were searched from inception to October 1, 2013, for randomized controlled trials (RCT), relevant open-label trials, meta-analyses and ongoing trials of pharmacological and psychotherapeutic approaches to treatment-resistant depression (TRD). RESULTS Switching to a different antidepressant is a useful option following nonresponse to a first-line agent. Although widely used in clinical practice, there is limited evidence to support antidepressant combination for TRD. Notwithstanding evidence for lithium or T3 augmentation to be successful in TRD, most studies were carried out when participants were treated with tricyclic antidepressants (TCA). Of the available strategies to augment the response to new-generation antidepressants, the use of some atypical antipsychotics is best supported by evidence. Several novel therapeutic options are currently discussed. Evidence suggests that cognitive therapy (CT) is an effective strategy for TRD. CONCLUSIONS The success of switching to a different antidepressant following a first-line agent is supported by evidence, but there is limited evidence for effective combination strategies. Lithium and T3 augmentation of TCA have the strongest evidence base for successful treatment of TRD. The use of augmentation of newer-generation antidepressants with atypical antipsychotics is supported by a growing evidence base. Current evidence supports CT as an effective strategy for TRD. There is a need for additional large-scale RCT of TRD. The development of new antidepressants targeting novel pathways opens a promising perspective for the management of TRD.
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Affiliation(s)
- Andre F Carvalho
- Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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22
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Sarris J, O’Neil A, Coulson CE, Schweitzer I, Berk M. Lifestyle medicine for depression. BMC Psychiatry 2014; 14:107. [PMID: 24721040 PMCID: PMC3998225 DOI: 10.1186/1471-244x-14-107] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 03/07/2014] [Indexed: 12/16/2022] Open
Abstract
The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. "Lifestyle Medicine" provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated, due to the complexity of human illness/wellbeing, the emerging evidence encourages a more integrative approach for depression, and an acknowledgment that lifestyle modification should be a routine part of treatment and preventative efforts.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Adrienne O’Neil
- School of Medicine, Deakin University, Geelong, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Isaac Schweitzer
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
| | - Michael Berk
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
- School of Medicine, Deakin University, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
- Orygen Youth Health Research Institute, Parkville, Australia
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Liberg B, Ekman CJ, Sellgren C, Johansson A, Landén M. Vertex-based morphometry in euthymic bipolar disorder implicates striatal regions involved in psychomotor function. Psychiatry Res 2014; 221:173-8. [PMID: 24508205 DOI: 10.1016/j.pscychresns.2014.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 01/10/2014] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
We hypothesized that psychomotor disturbances in patients with bipolar disorder are associated with morphometric changes in functionally specific regions of the basal ganglia and thalamus. We used structural magnetic resonance imaging and vertex-based morphometry to investigate whether psychomotor performance is associated with changes in volume and shape in euthymic subjects with bipolar disorder (n=27) compared with matched healthy controls (n=27). We saw no significant differences between age- and sex-matched groups in motor performance. We found a statistically significant group difference in the shape of the right putamen in the absence of psychomotor disturbances. There was an association between shape and motor performance in controls that was lacking in patients. We conclude that euthymic subjects with bipolar disorder without psychomotor disturbances show shape changes in regions of the right putamen that contribute to executive functions and motor function. It may be that other brain regions sustain the psychomotor functions that produce nearly identical motor performance in both groups.
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Affiliation(s)
- Benny Liberg
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
| | - Carl Johan Ekman
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Carl Sellgren
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Anette Johansson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Maes M, Anderson G, Kubera M, Berk M. Targeting classical IL-6 signalling or IL-6 trans-signalling in depression? Expert Opin Ther Targets 2014; 18:495-512. [PMID: 24548241 DOI: 10.1517/14728222.2014.888417] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Increased IL-6 and soluble IL-6 receptor (sIL-6R) levels in depressed patients was first shown over 20 years ago. The pro-inflammatory effects of IL-6 are predominantly mediated by IL-6 trans-signalling via the sIL-6R, whereas IL-6R membrane signalling has anti-inflammatory effects. AREAS COVERED We review data on IL-6 and sIL-6R in inflammation, depression, animal models of depression and the effects of different classes of antidepressants. The biological context for IL-6 trans-signalling as a pathogenic factor in depression involves its role in the acute phase response, disorders in zinc and the erythron, hypothalamic-pituitary-adrenal axis activation, induction of the tryptophan catabolite pathway, oxidative stress, bacterial translocation, transition towards sensitisation, autoimmune processes and neuroprogression and the multicausal aetiology of depression, considering that psychosocial stressors and comorbid immune-inflammatory diseases are associated with the onset of depression. EXPERT OPINION The homeostatic functions of IL-6 imply that ubiquitous IL-6 inhibitors, for example, tocilizumab, may not be the optimal treatment target in depression. A more promising target may be to increase soluble glycoprotein 130 (sgp130) inhibition of IL-6 trans-signalling, while allowing the maintenance of IL-6R membrane signalling. Future research should delineate the effects of treatments with sgp130Fc in combination with antidepressants in various animal models of chronic depression.
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Affiliation(s)
- Michael Maes
- Deakin University, Department of Psychiatry , Geelong , Australia
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25
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Fabbri C, Porcelli S, Serretti A. From pharmacogenetics to pharmacogenomics: the way toward the personalization of antidepressant treatment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:62-75. [PMID: 24881125 PMCID: PMC4079233 DOI: 10.1177/070674371405900202] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Major depressive disorder is the most common psychiatric disorder, worldwide, yet response and remission rates are still unsatisfactory. The identification of genetic predictors of antidepressant (AD) response could provide a promising opportunity to improve current AD efficacy through the personalization of treatment. The major steps and findings along this path are reviewed together with their clinical implications and limitations. METHOD We systematically reviewed the literature through MEDLINE and Embase database searches, using any word combination of "antidepressant," "gene," "polymorphism," "pharmacogenetics," "genome-wide association study," "GWAS," "response," and "adverse drug reactions." Experimental works and reviews published until March 2012 were collected and compared. RESULTS Numerous genes pertaining to several functional systems were associated with AD response. The more robust findings were found for the following genes: solute carrier family 6 (neurotransmitter transporter), member 4; serotonin receptor 1A and 2A; brain-derived neurotrophic factor; and catechol-O-methyltransferase. Genome-wide association studies (GWASs) provided many top markers, even if none of them reached genome-wide significance. CONCLUSIONS AD pharmacogenetics have not produced any knowledge applicable to routine clinical practice yet, as results were mainly inconsistent across studies. Despite this, the rising awareness about methodological deficits of past studies could allow for the identication of more suitable strategies, such as the integration of the GWAS approach with the candidate gene approach, and innovative methodologies, such as pathway analysis and study of depressive endophenotypes.
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Affiliation(s)
- Chiara Fabbri
- Researcher, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Porcelli
- Researcher, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Professor, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
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Liberg B, Klauser P, Harding IH, Adler M, Rahm C, Lundberg J, Masterman T, Wachtler C, Jonsson T, Kristoffersen-Wiberg M, Pantelis C, Wahlund B. Functional and structural alterations in the cingulate motor area relate to decreased fronto-striatal coupling in major depressive disorder with psychomotor disturbances. Front Psychiatry 2014; 5:176. [PMID: 25538633 PMCID: PMC4255491 DOI: 10.3389/fpsyt.2014.00176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/21/2014] [Indexed: 01/14/2023] Open
Abstract
Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest as lack of facial expressions and decreased speech production, reduced body posture and mobility, and slowed voluntary movement. The neural correlates of psychomotor disturbances in depression are poorly understood but it has been suggested that outputs from the cingulate motor area (CMA) to striatal motor regions, including the putamen, could be involved. We used functional and structural magnetic resonance imaging to conduct a region-of-interest analysis to test the hypotheses that neural activation patterns related to motor production and gray matter volumes in the CMA would be different between depressed subjects displaying psychomotor disturbances (n = 13) and matched healthy controls (n = 13). In addition, we conducted a psychophysiological interaction analysis to assess the functional coupling related to self-paced finger-tapping between the caudal CMA and the posterior putamen in patients compared to controls. We found a cluster of increased neural activation, adjacent to a cluster of decreased gray matter volume in the caudal CMA in patients compared to controls. The functional coupling between the left caudal CMA and the left putamen during finger-tapping task performance was additionally decreased in patients compared to controls. In addition, the strength of the functional coupling between the left caudal CMA and the left putamen was negatively correlated with the severity of psychomotor disturbances in the patient group. In conclusion, we found converging evidence for involvement of the caudal CMA and putamen in the generation of psychomotor disturbances in depression.
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Affiliation(s)
- Benny Liberg
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden ; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden
| | - Paul Klauser
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Monash Clinical and Imaging Neuroscience, School of Psychology and Psychiatry, Monash University , Clayton, VIC , Australia
| | - Ian H Harding
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; School of Psychological Sciences, Monash University , Melbourne, VIC , Australia
| | - Mats Adler
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Christoffer Rahm
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden
| | - Johan Lundberg
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Thomas Masterman
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Caroline Wachtler
- Primary Care Research Unit, Department of General Practice, The University of Melbourne , Melbourne, VIC , Australia ; Centre for Family Medicine (CeFAM), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Tomas Jonsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden ; Department of Medical Physics, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Maria Kristoffersen-Wiberg
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden ; Department of Radiology, Karolinska University Hospital , Stockholm , Sweden
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia
| | - Björn Wahlund
- Department of Energy and Engineering, Swedish University of Agricultural Sciences , Uppsala , Sweden
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Berk M, Sarris J, Coulson CE, Jacka FN. Lifestyle management of unipolar depression. Acta Psychiatr Scand Suppl 2013:38-54. [PMID: 23586875 DOI: 10.1111/acps.12124] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Psychological management of unipolar depression' [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24-37]. To provide clinically relevant recommendations for lifestyle modifications in depression, derived from a literature review. METHOD A search of pertinent literature was conducted up to August 2012 in the area of lifestyle factors and depression. A narrative review was then conducted. RESULTS There is evidence that level of physical activity plays a role in the risk of depression, and there is a large and validated evidence base for exercise as a therapeutic modality. Smoking and alcohol and substance misuse appear to be independent risk factors for depression, while the new epidemiological evidence supports the contention that diet is a risk factor for depression; good quality diets appear protective and poor diets increase risk. CONCLUSION Lifestyle modification, with a focus on exercise, diet, smoking and alcohol, may be of substantial value in reducing the burden of depression in individuals and the community.
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Affiliation(s)
| | | | - C. E. Coulson
- Department of Psychiatry; The University of Melbourne; Melbourne; Vic; Australia
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Nunes SOV, Vargas HO, Prado E, Barbosa DS, de Melo LP, Moylan S, Dodd S, Berk M. The shared role of oxidative stress and inflammation in major depressive disorder and nicotine dependence. Neurosci Biobehav Rev 2013; 37:1336-45. [DOI: 10.1016/j.neubiorev.2013.04.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 04/23/2013] [Accepted: 04/25/2013] [Indexed: 11/29/2022]
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Stafford L, Berk M, Jackson HJ. Tobacco smoking predicts depression and poorer quality of life in heart disease. BMC Cardiovasc Disord 2013; 13:35. [PMID: 23705944 PMCID: PMC3666905 DOI: 10.1186/1471-2261-13-35] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 05/03/2013] [Indexed: 12/02/2022] Open
Abstract
Background We report on the prospective association between smoking and depression and health-related quality of life (HRQOL) in patients with coronary artery disease (CAD). Methods Prospective study of 193 patients with assessment of depression occurring 3-, 6- and 9- months (T1, 2, and 3, respectively) following discharge from hospital for a cardiac event. HRQOL was assessed at T3. T1 depression was assessed by clinical interview; T2 and T3 depression was assessed by self-report. Smoking at time of cardiac event was assessed by self-report. Multivariate analyses controlled for known demographic, psychosocial and clinical correlates of depression. Results Smoking at the time of index cardiac event increased the likelihood of being diagnosed with Major Depressive Disorder (MDD) at T1 by 4.30 [95% CI, 1.12-16.46; p < .05]. The likelihood of receiving a diagnosis of minor depression, dysthymia or MDD as a combined group was increased by 8.03 [95% CI, 2.35-27.46; p < .01]. Smoking did not reliably predict depression at T2 or T3 and did not reliably predict persistent depression. Smoking increased the likelihood of being classified as depressed according to study criteria at least once during the study period by 5.19 [95% CI, 1.51-17.82; p < .01]. Smoking independently predicted worse mental HRQOL. Conclusions The findings support a role for smoking as an independent predictor of depression in CAD patients, particularly in the first 3 months post-cardiac event. The well-established imperative to encourage smoking cessation in these patients is augmented and the findings may add to the evidence for smoking cessation campaigns in the primary prevention of depression.
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Affiliation(s)
- Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia.
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Abstract
There is currently a crisis in drug discovery for neuropsychiatric disorders, with a profound, yet unexpected drought in new drug development across the spectrum. In this commentary, the sources of this dilemma and potential avenues to redress the issue are explored. These include a critical review of diagnostic issues and of selection of participants for clinical trials, and the mechanisms for identifying new drugs and new drug targets. Historically, the vast majority of agents have been discovered serendipitously or have been modifications of existing agents. Serendipitous discoveries, based on astute clinical observation or data mining, remain a valid option, as is illustrated by the suggestion in the paper by Wahlqvist and colleagues that treatment with sulfonylurea and metformin reduces the risk of affective disorder. However, the identification of agents targeting disorder-related biomarkers is currently proving particularly fruitful. There is considerable hope for genetics as a purist, pathophysiologically valid pathway to drug discovery; however, it is unclear whether the science is ready to meet this promise. Fruitful paradigms will require a break from the orthodoxy, and creativity and risk may well be the fingerprints of success.See related article http://www.biomedcentral.com/1741-7015/10/150.
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Affiliation(s)
- Michael Berk
- Deakin University, School of Medicine, Barwon Health, P,O, Box 291, Geelong, 3220, Australia.
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Yun WJ, Shin MH, Kweon SS, Ryu SY, Rhee JA. Association of smoking status, cumulative smoking, duration of smoking cessation, age of starting smoking, and depression in Korean adults. BMC Public Health 2012; 12:724. [PMID: 22938088 PMCID: PMC3495214 DOI: 10.1186/1471-2458-12-724] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many previous studies did not sufficiently control for several confounding factors that may affect the association between smoking and depression, such as socioeconomic status. We investigated the association between depression and smoking status, smoking exposure, duration of smoking cessation, and age of starting smoking while controlling for socioeconomic factors. METHODS This study was based on a community health survey performed in Jeollanam-do, South Korea, between September and November 2009. In total, 20,084 subjects (9,118 males and 10,966 females) were included in the analysis. Information on smoking characteristics, such as smoking status, pack-years of smoking, and age of starting smoking, was collected using a standardized questionnaire. Depression was defined using the Korean CES-D score. RESULTS The odds ratios (ORs) of depression were 1.35 (0.92-1.98) for former smokers and 1.77 (1.27-2.48) for current-smokers among males, and 2.67 (1.38-5.16) for former smokers and 3.72 (2.11-6.54) for current-smokers among females, after adjusting for other confounding factors. Compared to light smoking, heavy smoking was significantly associated with depression in males [OR = 3.97, 95% confidence interval (CI) = 1.42-11.14], but not in females (OR = 1.24, 95% CI = 0.73-2.09). No significant associations between depression and age of starting smoking and duration of smoking cessation were observed among former smokers. CONCLUSIONS Our data demonstrate that smoking is strongly associated with depression, particularly among females. These findings suggest that depression prevention may need to be combined with smoking prevention and that different strategies may be needed for males and females.
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Affiliation(s)
- Woo-Jun Yun
- Department of Preventive Medicine, Chonnam National University Medical School, Hak-1-dong, Dong-gu, Gwangju, 501-746, Republic of Korea
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Arent CO, Réus GZ, Abelaira HM, Ribeiro KF, Steckert AV, Mina F, Dal-Pizzol F, Quevedo J. Synergist effects of n-acetylcysteine and deferoxamine treatment on behavioral and oxidative parameters induced by chronic mild stress in rats. Neurochem Int 2012; 61:1072-80. [PMID: 22898295 DOI: 10.1016/j.neuint.2012.07.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/23/2012] [Accepted: 07/31/2012] [Indexed: 12/11/2022]
Abstract
A growing body of evidence has pointed to a relationship between oxidative stress and depression. Thus, the present study was aimed at evaluating the effects of the antioxidants n-acetylcysteine (NAC), deferoxamine (DFX) or their combination on sweet food consumption and oxidative stress parameters in rats submitted to 40days of exposure to chronic mild stress (CMS). Our results showed that in stressed rats treated with saline, there was a decrease in sweet food intake and treatment with NAC or NAC in combination with DFX reversed this effect. Treatment with NAC and DFX decreased the oxidative damage, which include superoxide and TBARS production in submitochondrial particles, and also thiobarbituric acid reactive substances (TBARS) levels and carbonyl proteins in the prefrontal cortex, amygdala and hippocampus. Treatment with NAC and DFX also increased the activity of the antioxidant enzymes, superoxide dismutase and catalase in the same brain areas. Even so, a combined treatment with NAC and DFX produced a stronger increase of antioxidant activities in the prefrontal cortex, amygdala and hippocampus. The results described here indicate that co-administration may induce a more pronounced antidepressant activity than each treatment alone. In conclusion, these results suggests that treatment with NAC or DFX alone or in combination on oxidative stress parameters could have positive effects against neuronal damage caused by oxidative stress in major depressive disorders.
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Affiliation(s)
- Camila O Arent
- Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
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Anderson RJ, Frye MA, Abulseoud OA, Lee KH, McGillivray JA, Berk M, Tye SJ. Deep brain stimulation for treatment-resistant depression: efficacy, safety and mechanisms of action. Neurosci Biobehav Rev 2012; 36:1920-33. [PMID: 22721950 DOI: 10.1016/j.neubiorev.2012.06.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 06/06/2012] [Accepted: 06/10/2012] [Indexed: 12/22/2022]
Abstract
Deep brain stimulation (DBS), a neuromodulation therapy that has been used successfully in the treatment of symptoms associated with movement disorders, has recently undergone clinical trials for individuals suffering from treatment-resistant depression (TRD). Although the small patient numbers and open label study design limit our ability to identify optimum targets and make definitive conclusions about treatment efficacy, a review of the published research demonstrates significant reductions in depressive symptomatology and high rates of remission in a severely treatment-resistant patient group. Despite these encouraging results, an incomplete understanding of the mechanisms of action underlying the therapeutic effects of DBS for TRD is highlighted, paralleling the incomplete understanding of the neuroanatomy of mood regulation and treatment resistance. Proposed mechanisms of action include short and long-term local effects of stimulation at the neuronal level, to modulation of neural network activity.
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Pasco JA, Jacka FN, Williams LJ, Evans-Cleverdon M, Brennan SL, Kotowicz MA, Nicholson GC, Ball MJ, Berk M. Dietary selenium and major depression: a nested case-control study. Complement Ther Med 2012; 20:119-23. [DOI: 10.1016/j.ctim.2011.12.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 06/21/2011] [Accepted: 12/30/2011] [Indexed: 10/14/2022] Open
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Maes M, Fišar Z, Medina M, Scapagnini G, Nowak G, Berk M. New drug targets in depression: inflammatory, cell-mediated immune, oxidative and nitrosative stress, mitochondrial, antioxidant, and neuroprogressive pathways. And new drug candidates--Nrf2 activators and GSK-3 inhibitors. Inflammopharmacology 2012; 20:127-50. [PMID: 22271002 DOI: 10.1007/s10787-011-0111-7] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 12/15/2011] [Indexed: 02/07/2023]
Abstract
This paper reviews new drug targets in the treatment of depression and new drug candidates to treat depression. Depression is characterized by aberrations in six intertwined pathways: (1) inflammatory pathways as indicated by increased levels of proinflammatory cytokines, e.g. interleukin-1 (IL-1), IL-6, and tumour necrosis factor α. (2) Activation of cell-mediated immune pathways as indicated by an increased production of interferon γ and neopterin. (3) Increased reactive oxygen and nitrogen species and damage by oxidative and nitrosative stress (O&NS), including lipid peroxidation, damage to DNA, proteins and mitochondria. (4) Lowered levels of key antioxidants, such as coenzyme Q10, zinc, vitamin E, glutathione, and glutathione peroxidase. (5) Damage to mitochondria and mitochondrial DNA and reduced activity of respiratory chain enzymes and adenosine triphosphate production. (6) Neuroprogression, which is the progressive process of neurodegeneration, apoptosis, and reduced neurogenesis and neuronal plasticity, phenomena that are probably caused by inflammation and O&NS. Antidepressants tend to normalize the above six pathways. Targeting these pathways has the potential to yield antidepressant effects, e.g. using cytokine antagonists, minocycline, Cox-2 inhibitors, statins, acetylsalicylic acid, ketamine, ω3 poly-unsaturated fatty acids, antioxidants, and neurotrophic factors. These six pathways offer new, pathophysiologically guided drug targets suggesting that novel therapies could be developed that target these six pathways simultaneously. Both nuclear factor (erythroid-derived 2)-like 2 (Nrf2) activators and glycogen synthase kinase-3 (GSK-3) inhibitors target the six above-mentioned pathways. GSK-3 inhibitors have antidepressant effects in animal models of depression. Nrf2 activators and GSK-3 inhibitors have the potential to be advanced to phase-2 clinical trials to examine whether they augment the efficacy of antidepressants or are useful as monotherapy.
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Affiliation(s)
- Michael Maes
- Maes Clinics@TRIA, 998 Rimklongsamsen Road, Bangkok 10310, Thailand.
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Pogarell O, Padberg F, Karch S, Segmiller F, Juckel G, Mulert C, Hegerl U, Tatsch K, Koch W. Dopaminergic mechanisms of target detection - P300 event related potential and striatal dopamine. Psychiatry Res 2011; 194:212-218. [PMID: 22104371 DOI: 10.1016/j.pscychresns.2011.02.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 12/30/2010] [Accepted: 02/06/2011] [Indexed: 11/26/2022]
Abstract
The P300 is a cortically generated event related potential (ERP) widely used in neurophysiological research since it is related to cognitive functions and central information processing. Intracerebral recordings and functional neuroimaging studies have demonstrated that this potential is generated by various brain regions including frontal, temporal and parietal cortices. Regarding the neurochemical background, clinical and genetic investigations suggest that dopaminergic neurons could be involved in the generation of the P300. However, there is no direct evidence in vivo that P300 amplitudes and latencies are related to dopaminergic parameters. The aim of this study was to further elucidate dopaminergic aspects of the P300 ERP by combining neurophysiological and nuclear medicine assessments in vivo. Patients with a major depressive episode underwent both P300 recordings and dynamic [¹²³I] IBZM SPECT for the evaluation of striatal dopamine D₂/D₃-receptor availability. There were statistically significant positive correlations of the striatal dopamine D₂/D₃-receptor status with P300 amplitudes and significant negative correlations with P300 latencies. Using this combined approach, the study presents direct evidence in vivo that the central dopaminergic system might play an important role in the generation of the P300 and that central dopaminergic activity could be involved in the modulation of P300 parameters. This association might be of relevance for the interpretation of P300 studies in psychiatric disorders.
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Affiliation(s)
- Oliver Pogarell
- Department of Psychiatry, Ludwig-Maximilian-University of Munich, Munich, Germany.
| | - Frank Padberg
- Department of Psychiatry, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Felix Segmiller
- Department of Psychiatry, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Georg Juckel
- Department of Psychiatry, University of Bochum, Bochum, Germany
| | - Christoph Mulert
- Department of Psychiatry, University of Hamburg, Hamburg, Germany
| | - Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Germany
| | - Klaus Tatsch
- Department of Nuclear Medicine, Ludwig-Maximilian-University of Munich, Munich, Germany; Department of Nuclear Medicine, Municipal Hospital of Karlsruhe Inc., Karlsruhe, Germany
| | - Walter Koch
- Department of Nuclear Medicine, Ludwig-Maximilian-University of Munich, Munich, Germany
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Nunes SOV, Vargas HO, Brum J, Prado E, Vargas MM, Castro MRPD, Dodd S, Berk M. A Comparison of Inflammatory Markers in Depressed and Nondepressed Smokers. Nicotine Tob Res 2011; 14:540-6. [DOI: 10.1093/ntr/ntr247] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Hirvonen J, Hietala J, Kajander J, Markkula J, Rasi-Hakala H, Salminen JK, Någren K, Aalto S, Karlsson H. Effects of antidepressant drug treatment and psychotherapy on striatal and thalamic dopamine D2/3 receptors in major depressive disorder studied with [11C]raclopride PET. J Psychopharmacol 2011; 25:1329-36. [PMID: 20829308 DOI: 10.1177/0269881110376691] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antidepressant drug treatment and psychotherapy are both effective in treating major depression, but there are no published studies comparing the effects of these two treatments on the dopaminergic neurotransmitter system in major depression. We conducted a randomized comparative study on the effects of fluoxetine medication and short-term psychodynamic psychotherapy on striatal and thalamic dopamine D(2/3) receptors in patients with major depression. Duration of the treatment was 4 months, and dopamine D(2/3) receptor binding was quantified before and after treatment as the binding potential (BP (ND)) using [(11)C]raclopride and 3D positron emission tomography. Both treatments were clinically effective in treating major depression, as shown by substantial decreases in symptom ratings. Yet, there were no effects on D(2/3) receptor availability in the ventral striatum or other subdivisions of the striatum. Fluoxetine but not psychotherapy increased [(11)C]raclopride BP (ND) in lateral thalamus (+7.74%, p = 0.002) but this increase was not correlated with clinical improvement. In conclusion, this preliminary study does not support the involvement of ventral dopaminergic neurotransmission in the antidepressant effects of fluoxetine or psychodynamic psychotherapy. The effects of fluoxetine on thalamic dopamine systems need to be further explored.
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Affiliation(s)
- Jussi Hirvonen
- Department of Psychiatry, University of Turku, Turku, Finland
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Rizvi SJ, Donovan M, Giacobbe P, Placenza F, Rotzinger S, Kennedy SH. Neurostimulation therapies for treatment resistant depression: a focus on vagus nerve stimulation and deep brain stimulation. Int Rev Psychiatry 2011; 23:424-36. [PMID: 22200132 DOI: 10.3109/09540261.2011.630993] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Antidepressant treatments, including pharmacotherapy and psychotherapy, do not result in remission for the majority of patients with major depressive disorder. The high prevalence of treatment resistant depression (TRD) poses a significant issue for patients as well as both societal and economic costs. Due to the limited efficacy of existing therapies in this sub-population, alternative somatic treatments are being explored. Both vagus nerve stimulation (VNS) and deep brain stimulation (DBS) are neurostimulation treatments for TRD. While VNS has Food Drug Administration approval as an adjunctive therapy for MDD, DBS is still in the experimental stages. This article will review the evidence supporting the clinical utility of these therapies.
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Affiliation(s)
- Sakina J Rizvi
- Department of Psychiatry, University Health Network, Toronto, Canada
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Porcelli S, Drago A, Fabbri C, Serretti A. Mechanisms of antidepressant action: an integrated dopaminergic perspective. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1532-43. [PMID: 21402119 DOI: 10.1016/j.pnpbp.2011.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/23/2011] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
Abstract
The molecular mechanisms that cause and maintain the major depressive disorder (MDD) are currently unknown. Consistently, antidepressant treatments are characterized by insufficient success rates. This causes high social costs and severe personal sufferings. In the present review we analyze some of the paradigms that are used to explain MDD, particularly from the perspective of the dopaminergic (DA) system. DA has been more classically associated with psychosis and substance abuse disorders, even though a role of DA in MDD has been proposed as well and some antidepressants with DA profile exist. In the present work, we review some of the molecular mechanisms that underpin MDD from the perspective of the dopaminergic system, in the hope of unifying some of the major theories of MDD - the monoaminergic, inflammatory, epigenetics, neurotrophin and anti-apoptotic theories. Several shared components of these theories are highlighted, partially accounted by the functions of the DA system (see supplementary video).
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Affiliation(s)
- S Porcelli
- Institute of Psychiatry, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy.
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Berk M, Johansson S, Wray NR, Williams L, Olsson C, Haavik J, Bjerkeset O. Glutamate cysteine ligase (GCL) and self reported depression: an association study from the HUNT. J Affect Disord 2011; 131:207-13. [PMID: 21277635 DOI: 10.1016/j.jad.2010.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/21/2010] [Accepted: 12/21/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is increasing evidence suggesting oxidative stress may play a role in the aetiology of depression. Glutathione is the brain's predominant free radical scavenger, and associated polymorphisms of the glutamate cysteine ligase (GCL) gene have been reported for related psychiatric disorders. The aim of the study was to investigate candidate polymorphisms of GCL validated in schizophrenia and their association with current state depression, as measured by the Hospital Anxiety and Depression Scale (HADS). METHODS Polymorphisms were genotyped on 983 cases and 967 controls selected from a population sample of adults participating in the Nord-Trøndelag Health Study. Cases were the top scoring individuals (98.5th percentile) on the HADS depression subscale while the controls were randomly selected from below this cut-off. The polymorphisms comprised three SNPs from GCLM, the gene encoding the GCL modifier and 9 SNPs plus a trinucleotide repeat (TNTR) from intron 1 and the 5'UTR of GCLC, the gene encoding the GCL catalytic subunit. Using the linkage disequilibrium between the GCLC markers we also tested whether SNPs could represent the variation of the TNTR. RESULTS The candidate polymorphisms showed no evidence for association with depression. The C allele of SNP rs9474592 is coupled with the 9 GAG repeats allele of the TNTR, r²=0.81. None of the other SNPs either individually or as two or three-SNP haplotypes was associated with the TNTR alleles. LIMITATIONS Depression was self-reported and measured at one time point. CONCLUSIONS This study provides no evidence to suggest that polymorphisms of GCL are associated with self-reported depression.
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Affiliation(s)
- Michael Berk
- School of Medicine, Deakin University, Geelong, Australia.
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Flensborg-Madsen T, von Scholten MB, Flachs EM, Mortensen EL, Prescott E, Tolstrup JS. Tobacco smoking as a risk factor for depression. A 26-year population-based follow-up study. J Psychiatr Res 2011; 45:143-9. [PMID: 20630542 DOI: 10.1016/j.jpsychires.2010.06.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 05/05/2010] [Accepted: 06/11/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND A key question regarding the documented association between smoking and depression is whether it reflects a causal influence of smoking on depression; however, only a limited number of longitudinal studies exist in the literature, all of which have relatively short time frames. The purpose was to prospectively assess the risk of depression according to daily tobacco consumption in a Danish longitudinal study. METHODS A prospective cohort study, the Copenhagen City Heart Study (n = 18,146), was analyzed with up to 26 years of follow-up. It contains three updated data sets on tobacco consumption and potential confounding factors. The study population was linked to Danish hospital registers to detect registrations with depression. Individuals with depression before baseline were excluded. RESULTS Women smoking more than 10 g of tobacco per day were at significantly increased risk of depression compared to women who did not smoke. The adjusted risk of depression among women smoking 11-20 g per day was 1.74 (CI:1.33-2.27) and 2.17 (CI:1.45-3.26) among women smoking more than 20 g per day. For men, there was an increased risk of depression for those smoking more than 20 g per day (HR = 1.90; CI:1.05-3.44). All tests for linear trend were significant (all p < 0.01). The estimates remained significant in sensitivity analyses aiming to eliminate reverse causation, and in analyses based on a reduced sample without individuals with chronic diseases or psychiatric disorders other than depression. CONCLUSION The study suggests that smoking is associated with increased risk of developing depression. This underlines the potentially harmful consequences of smoking for mental health and supports efforts to prevent and stop smoking.
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Affiliation(s)
- Trine Flensborg-Madsen
- Research Programme on Lifestyle and Health, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5, 1399 København K, Denmark.
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Pasco JA, Nicholson GC, Williams LJ, Jacka FN, Henry MJ, Kotowicz MA, Schneider HG, Leonard BE, Berk M. Association of high-sensitivity C-reactive protein with de novo major depression. Br J Psychiatry 2010; 197:372-7. [PMID: 21037214 DOI: 10.1192/bjp.bp.109.076430] [Citation(s) in RCA: 249] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although there is cross-sectional evidence that changes in the immune system contribute to the pathophysiology of depression, longitudinal data capable of elucidating cause and effect relationships are lacking. AIMS We aimed to determine whether subclinical systemic inflammation, as measured by serum high-sensitivity C-reactive protein (hsCRP) concentration, is associated with an increased risk of de novo major depressive disorder. METHOD Major depressive disorder was diagnosed using a clinical interview (SCID-I/NP). This is a retrospective cohort study; from a population-based sample of 1494 randomly selected women recruited at baseline during the period 1994-7, 822 were followed for a decade and provided measures of both exposure and outcome. Of these women, 644 (aged 20-84 years) had no prior history of depression at baseline and were eligible for analysis. RESULTS During 5827 person-years of follow-up, 48 cases of de novo major depressive disorder were identified. The hazard ratio (HR) for depression increased by 44% for each standard deviation increase in log-transformed hsCRP (ln-hsCRP) (HR = 1.44, 95% CI 1.04-1.99), after adjusting for weight, smoking and use of non-steroidal anti-inflammatory drugs. Further adjustment for other lifestyle factors, medications and comorbidity failed to explain the observed increased risk for depression. CONCLUSIONS Serum hsCRP is an independent risk marker for de novo major depressive disorder in women. This supports an aetiological role for inflammatory activity in the pathophysiology of depression.
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Affiliation(s)
- Julie A Pasco
- Epidemiology and Biostatistics Unit, Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, PO Box 281, Geelong 3220, Australia.
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Laks J, Engelhardt E. Peculiarities of geriatric psychiatry: a focus on aging and depression. CNS Neurosci Ther 2010; 16:374-9. [PMID: 20875046 DOI: 10.1111/j.1755-5949.2010.00196.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
There is a debate on whether Geriatric Psychiatry stands for itself as a discrete specialty or whether it is an extension of clinical Geriatrics, Neurology, and Psychiatry. This review aims to outline some recent data and possible approaches to define peculiarities of Geriatric Psychiatry, focusing on certain characteristics that define the aging brain. Geriatric depression is discussed taking into consideration some data from translational research. The brain aging process is not uniform. Frontal areas show marked impairment in inhibiting irrelevant information in working memory as they age, and the recruitment of these areas occur differently than in young subjects. Executive functions also change in normal elderly. Geriatric depression is a general definition of a multidimensional disorder with multiple risk factors. Dysexecutive syndrome is considered as a key to the neuropsychology of geriatric depression, correlated with functional impairment in late life. Late-onset depression has a higher load of comordibity, of cerebrovascular disease, and of some genetic factors that may be different from early onset depression. Also, there are at least four clusters of treatment outcomes that are common in geriatric depression, which mirror the neuropsychological and clinical profiles. Research and practice in Geriatric Psychiatry should focus on the interaction of various dimensions and risk factors rather than on attempting to find a single cause to the disorders. Some answers may be found in comorbidity issues, in white matter lesions, which are more common in the elderly, and in genetic factors that impact on the aging process.
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Affiliation(s)
- Jerson Laks
- Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Geschwind N, Peeters F, Jacobs N, Delespaul P, Derom C, Thiery E, van Os J, Wichers M. Meeting risk with resilience: high daily life reward experience preserves mental health. Acta Psychiatr Scand 2010; 122:129-38. [PMID: 20064128 DOI: 10.1111/j.1600-0447.2009.01525.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine prospectively whether high reward experience (the ability to generate positive affect boosts from pleasurable daily events) protects against affective symptoms and whether environmental or genetic risk factors moderate protective effects. METHOD At baseline, 498 female twins participated in an experience sampling study measuring reward experience in daily life. They also completed questionnaires on childhood adversity and recent stressful life events (SLE). Affective symptoms were measured at baseline and at four follow-ups using SCL-90 anxiety and depression subscales. Co-twin affective symptoms were used as indicators of genetic risk. RESULTS Baseline reward experience did not predict follow-up affective symptoms, regardless of level of genetic risk. However, high reward experience was associated with reduced future affective symptoms after previous exposure to childhood adversity or recent SLE. CONCLUSION High daily life reward experience increases resilience after environmental adversity; modification of reward experience may constitute a novel area of therapeutic intervention.
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Affiliation(s)
- N Geschwind
- Department of Neuropsychiatry and Psychology, EURON, Maastricht University, the Netherland.
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Goetz CG. New developments in depression, anxiety, compulsiveness, and hallucinations in Parkinson's disease. Mov Disord 2010; 25 Suppl 1:S104-9. [PMID: 20187250 DOI: 10.1002/mds.22636] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Increasing research efforts are focused on nonmotor aspects of Parkinson's disease (PD). Depression, anxiety, compulsivity (dopamine dysregulation symptoms), and hallucinations/psychosis are among these disorders, and all complicate the management of PD with negative influences on quality of life. There is a strong overlap between depression and apathy and likewise, depression and anxiety can coexist and require careful pharmacologic management. Dopamine dysregulation syndrome is linked to medication use and most clearly associated with dopamine agonists. In contrast, although hallucinations and psychosis do not occur unless patients with PD are treated with dopaminergic drugs, medication doses do not directly relate to this problem. Functional neuroimaging provides an excellent resource for investigating these behaviors as well as their anatomical and neurochemical bases. New treatments are being developed, but there have been very few large-scale randomized clinical trials to test the relative roles of new or available agents for abating these problematic behaviors.
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Affiliation(s)
- Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.
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Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev 2010; 31:225-35. [PMID: 20471738 DOI: 10.1016/j.cpr.2010.04.003] [Citation(s) in RCA: 365] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 03/11/2010] [Accepted: 04/09/2010] [Indexed: 01/04/2023]
Abstract
Sleep disturbance is increasingly recognized as an important, but understudied, mechanism in the complex and multi-factorial causation of the symptoms and functional disability associated with psychiatric disorders. This review proposes that it is biologically plausible for sleep disturbance to be mechanistically transdiagnostic. More specifically, we propose that sleep disturbance is aetiologically linked to various forms of psychopathology through: its reciprocal relationship with emotion regulation and its shared/interacting neurobiological substrates in (a) genetics--genes known to be important in the generation and regulation of circadian rhythms have been linked to a range of disorders and (b) dopaminergic and serotonergic function--we review evidence for the interplay between these systems and sleep/circadian biology. The clinical implications include potentially powerful and inexpensive interventions including interventions targeting light exposure, dark exposure, the regulation of social rhythms and the reduction of anxiety. We also consider the possibility of developing a 'transdiagnostic' treatment; one treatment that would reduce sleep disturbance across psychiatric disorders.
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Werneck ALDS, Rosso AL, Vincent MB. The use of an antagonist 5-HT2a/c for depression and motor function in Parkinson' disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 67:407-12. [PMID: 19623435 DOI: 10.1590/s0004-282x2009000300007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 04/02/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To test the ability of a 5HT2a/c (trazodone) antagonist, to improve depression and motor function in Parkinson' disease (PD). METHOD Twenty PD patients with and without depression were randomly assigned to receive trazodone (group 1) or not (group 2). They were evaluated through UPDRS and Hamilton Depression Rating Scale (HAM-D). RESULTS For the UPDRS the mean score of group 2 was 33.1 +/- 19.7 and 37.1 +/- 18.0 at the end. For the group 1, the corresponding scores were 31.4 +/- 11.3 and 25.9 +/- 13.7. The variations in the Mann-Whitney test were 0.734 at the initial moment and 0.208 at the final moment. The variation in the comparison of the initial moment with the final moment was 0.005 providing statistical significance. For the HAM-D, the mean score went up 4 points in group 2, contrary to a 5.5 points decrease in group 1. CONCLUSION Data analysis shows that this agent significantly improves depression, but the motor function improved only in the depressed patients. Because of the known anti-dopaminergic property of the 5-HT2c receptors, a possible approach for depression in PD could be the use of 5-HT2c antagonists, similarly to the use of atypical neuroleptics in case of psychotic symptoms.
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Montel SR, Bungener C. Coping and quality of life of patients with Parkinson disease who have undergone deep brain stimulation of the subthalamic nucleus. ACTA ACUST UNITED AC 2009; 72:105-10; discussion 110-1. [DOI: 10.1016/j.surneu.2008.05.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Accepted: 05/25/2008] [Indexed: 11/24/2022]
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A study using transcranial magnetic stimulation to investigate motor mechanisms in psychomotor retardation in depression. Int J Neuropsychopharmacol 2008; 11:935-46. [PMID: 18447965 DOI: 10.1017/s1461145708008821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The pathophysiological basis of psychomotor retardation in depression is unclear. In this study, transcranial magnetic stimulation (TMS) was used to examine the functioning of the motor cortical system in 19 depressed patients and 10 healthy control subjects. Motor-evoked potentials were measured in the biceps brachii muscle during a series of tests with the muscle at rest and during voluntary elbow flexion contractions. Maximal voluntary force, as well as force and electromyographic responses to TMS were also measured during fatiguing maximal contractions. Depressed psychomotor-retarded subjects were less able to produce output from the motor cortex than non-psychomotor-retarded, depressed subjects and healthy controls during maximal exertion and fatigue. This finding was independent of depression severity. In contrast, responses to TMS elicited during relaxation or weak contractions did not differ between healthy and psychomotor-retarded subjects. Our study suggests that although the motor pathway from the motor cortex to the muscle is unimpaired, psychomotor retardation in depression is characterized by a reduced ability to drive the motor cortex.
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