Hypothalamic-pituitary-adrenal axis and suicide

The Effect of Probiotic Intervention in Ameliorating the Altered Central Nervous System Functions in Neurological Disorders: A Review

There has been a significant rise in the occurrence of various neurological ailments worldwide. The need to investigate newer and safer intervention therapies with prophylactic and/or therapeutic effects is well understood. Probiotics have recently been shown to hold promise as an intervention option that warrants future work. Probiotic strains have shown beneficial treatment outcomes as evidenced in various animal and human studies. Although numerous articles have highlighted the role of gut microbiota and its cross-talk with human brain in modulating Central Nervous System (CNS) physiology and neurochemistry, the present review solely focuses on the ability of externally administered probiotic strains (that may or may not be part of the already existing gut microflora of an average human) in ameliorating the altered CNS functions in patients. The review aims at giving a comprehensive analysis of the studies performed on animals and humans and discusses the findings in different neurological and psychiatric disorders (Anxiety, Major Depressive disorder, bipolar disorder, schizophrenia, autism spectrum disorder, cognitive impairmentsetc). The article also highlights different mechanisms through which the probiotic bacteria operate in improving neurologic manifestations or decreasing the incidence of neurological disorders. These underlying mechanisms include both direct as well as indirect pathways involving neural, hormonal and immunological pathways. The potential of probiotics as an important dietary modification as well as a useful intervention therapy with preventive and therapeutic value for the target population holds strong. However, future evaluation into formulation designing, selecting the best probiotic strain(s) for each specific disease and safety and tolerability aspects in patients needs to be considered.

Factors of Hamilton Depression Rating Scale (17 items) at 2 weeks correlated with poor outcome at 1 year in patients with ischemic stroke

There was fewer paper about the relation between the Hamilton Depression Rating Scale (17 Items, HDRS-17) factors and stroke outcomes. Our aim was to investigate the influence of total score and factors of HDRS-17 on outcome of ischemic stroke at 1 year. A total of 1,953 patients with acute ischemic stroke were enrolled into a multicentered and prospective cohort study. The HDRS-17 was used to assess symptoms at 2 weeks after ischemic stroke. The Modified Ranking Scale (mRS) scores of 3-6 points and 0-2 points were regarded as poor outcome and benign outcome, respectively. At 1 year, 1,753 (89.8 %) patients had mRS score data. After adjusting for the confounders, patients with a total HDRS-17 score of ≥ 8 had a worse outcome at 1 year (OR = 1.62, 95 % CI 1.18-2.23). Symptoms of suicide (OR = 1.89, 95 % CI 1.27-2.83), decreased or loss of interest of work (OR = 1.89, 95 % CI 1.38-2.58), retardation (OR = 1.74, 95 % CI 1.27-2.38), psychic anxiety (OR = 1.72, 95 % CI 1.26-2.34), and agitation (OR = 1.61, 95 % CI 1.08-2.40) increased the risks for poor outcome by >60 %, respectively. Depressed mood, somatic anxiety, somatic symptoms-gastrointestinal, and early insomnia also increased the risk for poor outcome by nearly 50 %, respectively. A total HDRS-17 score of ≥ 8, and suicide, decreased or loss of interest of work, anxiety, agitation, retardation, depressed mood, somatic anxiety, somatic symptoms-gastrointestinal, and early insomnia of the HDRS-17 factors at 2 weeks after ischemic stroke increase the risk for poor outcome at 1 year.

The role of corticotropin-releasing factor in the pathophysiology of affective and anxiety disorders: laboratory and clinical studies

The unique distribution of corticotropin-releasing factor (CRF) and its receptors within the central nervous system, its pre-eminent role in mediating the endocrine, behavioural, autonomic and immunological effects of stress and its potent effects after direct administration into the CNS all support the hypothesis that alterations in CRF neuronal systems contribute to the pathophysiology of depression and certain anxiety disorders. This report summarizes a series of preclinical and clinical investigations which have sought to test the hypothesis that CRF-containing neurons show alterations in depression and anxiety, and that drugs used to treat these disorders alter CRF neuronal circuits. Direct injection of CRF into the locus ceruleus or nearby parabrachial nucleus evokes an anxiogenic response. Stress increases CRF concentrations in the locus ceruleus, whereas alprazolam, a benzodiazepine anxiolytic, decreases the concentration of the peptide in the same area. Clinical studies reveal that drug-free depressed patients show: (1) hyperactivity of the hypothalamo-pituitary-adrenal axis; (2) increased CRF concentrations in the cerebrospinal fluid; (3) a blunted release of ACTH in response to CRF; (4) a reduced density of CRF receptors in the frontal cortex; (5) pituitary and adrenal gland hypertrophy. These findings are all concordant with hypersecretion of CRF from hypothalamic and extrahypothalamic CRF neurons in depression.

Dihydropyridopyrazinones and dihydropteridinones as corticotropin-releasing factor-1 receptor antagonists: structure-activity relationships and computational modeling

The CRF antagonist pharmacophore is a heterocyclic ring bearing a critical hydrogen-bond acceptor nitrogen and an orthogonal aromatic ring. CRFR1 antagonists have shown a 40-fold and 200-fold loss in potency against the CRFR1 H199V and M276I mutant receptors, suggesting key interactions with these residues. We have derived a two component computational model that correlates CRFR1 binding affinity within the reported series to antagoinst/H199 complexation energy and M276 hydrophobic contacts.

The role of tumor necrosis factor-alpha in stress-induced worsening of cerebral ischemia in rats

Whereas stress is known to be one of the risk factors of stroke, few experimental studies have examined the possible mechanisms by which stress may affect stroke outcome. Most of the knowledge on the effects of stress on cerebrovascular disease in humans is restricted to catecholamines and glucocorticoids effects on blood pressure and/or development of atherosclerosis. By using an experimental paradigm consisting of the exposure of Fischer rats to repeated immobilization sessions (1 h daily during seven consecutive days) prior to permanent middle cerebral artery occlusion (MCAO), we have found that stress worsens behavioral outcome and increases infarct size after MCAO. These changes occur concomitantly to an increase in inducible nitric oxide synthase (iNOS) expression and to the accumulation of lipid peroxidation markers in brain tissue. The possible regulatory role of TNFalpha was studied by looking at the mechanisms of release of this cytokine as well as to the expression of its receptors (TNFR1 and 2). The results of the present study suggest an increase in TNFalpha expression and release after stress, as well as an increase in the expression of TNFR1. Pharmacological blockade of TNFalpha with anti-TNFalpha led to a decrease in the infarct size as well as in the oxidative/nitrosative biochemical parameters seen after ischemia. In summary, our results indicate that TNFalpha accounts, at least partly, for the worsening of MCAO consequences in brain of rats exposed to stress. Furthermore, the data presented here provide evidence that stress can increase brain ischemic damage and support a possible protective effect of treatment of stressful situations before and during the development of the brain ischemia.

Ist die autonome kardiale Regulation bei Patienten mit Depression und Koronarer Herzkrankheit gestört?

Zusammenfassung. Hintergrund und Zielsetzung: Beeinträchtigung der Herzratenvariabilität ist ein Indikator für eine erhöhte kardiovaskuläre Mortalität. Geprüft werden sollte, ob depressive Symptome die Herzratenvariabilität beeinflussen können. Methode: Die Herzratenvariabilität wurde bei 22 ambulanten nicht behandelten Patienten (16 w, 6 m) und bei 11 gesunden Kontrollpersonen (8 w, 3 m) gemessen. Darüber hinaus wurden 41 Patienten mit koronarangiographisch gesicherter KHK (5 w, 36 m) untersucht. Ergebnisse: Die Herzratenvariabilität war bei herzgesunden Patienten mit Depression um 50% vermindert im Vergleich zu Kontrollpersonen (p < 0,05) während das Vorhandensein depressiver Symptome bei Patienten mit KHK keinen signifikanten Einfluss auf die Herzratenvariabilität hatte. Schlussfolgerungen: Störung der autonomen kardialen Regulation konnte für herzgesunde Patienten mit Depression nachgewiesen werden.

Impact of the selective serotonin reuptake inhibitor citalopram on insulin sensitivity, leptin and basal cortisol secretion in depressed and non-depressed euglycemic women of reproductive age

INTRODUCTION

Major depression in women of reproductive age may be accompanied by multiple endocrine and metabolic disturbances, which, in turn, may affect reproductive functioning. Enhanced cortisol synthesis, impaired leptin production and diminished insulin sensitivity have been reported in some depressed populations. We sought to determine whether an 8-week administration of citalopram would have an effect on these endocrine factors in a group of euglycemic depressed and non-depressed women of reproductive age.

MATERIALS AND METHODS

Fourteen depressed and 18 non-depressed women (diagnosed by structured clinical interview) aged between 18 and 45 years completed an 8-week study. All depressed women were treated with citalopram and non-depressed subjects randomized to citalopram or no treatment in an open label cohort study. An oral glucose tolerance test with insulin levels was performed at baseline and at the end of the 8-week trial. Weight, blood pressure, fasting serum cortisol, fasting serum leptin and Beck Depression Inventory were assessed at baseline, 2, 4 and 8 weeks.

RESULTS

Citalopram significantly improved depressive symptoms and Beck Depression Inventory scores in the depressed cohort. Cortisol production was higher in depressed women but did not diminish with citalopram therapy over 8 weeks. Indices of insulin sensitivity and leptin production were similar between depressed and non-depressed women and did not change despite citalopram therapy.

CONCLUSION

. Insulin sensitivity in moderately depressed women of reproductive age does not differ from that in a similar group of non-depressed women. Insulin sensitivity, cortisol secretion and leptin production do not change significantly in depressed women following an 8-week course of citalopram despite substantial improvement in depression scores.

Brain-immune interactions and disease susceptibility

Many studies have established the routes by which the immune and central nervous (CNS) systems communicate. This network of connections permits the CNS to regulate the immune system through both neuroendocrine and neuronal pathways. In turn, the immune system signals the CNS through neuronal and humoral routes, via immune mediators and cytokines. This regulatory system between the immune system and CNS plays an important role in susceptibility and resistance to autoimmune, inflammatory, infectious and allergic diseases. This review focuses on the regulation of the immune system via the neuroendocrine system, and underlines the link between neuroendocrine dysregulation and development of major depressive disorders, autoimmune diseases and osteoporosis.

The role of corticotropin-releasing factor-like peptides in cannabis, nicotine, and alcohol dependence

The corticotropin-releasing factor (CRF)-like peptides, which include the mammalian peptides CRF, urocortin 1, urocortin 2, and urocortin 3, play an important role in orchestrating behavioral and physiological responses that may increase an organism's chance of survival when confronted with internal or external stressors. There is, however, evidence that a chronic overactivity of brain CRF systems under basal conditions may play a role in the etiology and maintenance of psychiatric disorders such as depression and anxiety disorders. In addition, there is evidence of a role for CRF-like peptides in acute and protracted drug abstinence syndromes and relapse to drug-taking behavior. This review focuses on the role of CRF-like peptides in the negative affective state associated with acute and protracted withdrawal from three widely abused drugs, cannabis, nicotine, and alcohol. In addition, we discuss the high comorbidity between stress-associated psychiatric disorders and drug dependence. A better understanding of the brain stress systems that may underlie psychiatric disorders, acute and protracted drug withdrawal, and relapse to drug-taking behavior may help in the development of new and improved pharmacotherapies for these widespread psychiatric disorders.

Neurobiological mechanisms in addictive and psychiatric disorders

The studies reviewed indicate that brain stress system play an important role in the acquisition and maintenance of drugs of abuse that target the brain's reward centers. In doing so, they may destabilize these areas, making the perception of pleasure more elusive and difficult to attain. Withdrawal from drugs of abuse leads to the activation of brain CRF systems that may produce the anxiogenic response associated with drug withdrawal. More research, however, is needed to investigate the role of brain stress systems and neuropeptides in other drug withdrawal symptoms such as anhedonia. A better understanding of the brain systems underlying drug withdrawal may help in the development of improved pharmacotherapies that can alleviate drug withdrawal symptoms. The second part of the article indicated that there is a very high comorbidity between depression and drug dependence. The reviewed studies suggest that depressed patients initiate drug-taking behavior to self-medicate the symptoms associated with their psychiatric disorder. Chronic use of drugs of abuse, however, may exacerbate the symptoms of pre-existing mental disorders and subsequently increase drug-taking behavior. Conversely, professional treatment of pre-existing psychiatric disorders may decrease the use of illicit substances.

Synthesis, Structure−Activity Relationships, and in Vivo Properties of 3,4-Dihydro-1H-pyrido[2,3-b]pyrazin-2-ones as Corticotropin-Releasing Factor-1 Receptor Antagonists

Corticotropin releasing factor (CRF) is the primary regulator of the hypothalamus-pituitary-adrenal (HPA) axis, coordinating the endocrine, behavioral, and autonomic responses to stress. It has been postulated that small molecules that can antagonize the binding of CRF1 to its receptor may serve as a treatment for anxiety-related and/or affective disorders. Members within a series of 3,4-dihydro-1H-pyrido[2,3-b]pyrazin-2-ones, exemplified by compound 2 (IC50 = 0.70 nM), were found to be very potent antagonists of CRF1. Compound 8w showed high CRF1 receptor binding affinity and was examined further in vivo. The compound was efficacious in a defensive withdrawal model of anxiety in rats and had a long half-life and reasonable oral bioavailability in dog pharmacokinetic studies.

Behavioral, neuroendocrine and neurochemical effects of the imidazoline I2 receptor selective ligand BU224 in naive rats and rats exposed to the stress of the forced swim test

RATIONALE

There is evidence for alterations in imidazoline(2) (I(2)) receptor density in depressed patients. Selective I(2) receptor ligands modulate central monoamine levels and activate the hypothalamo-pituitary-adrenal (HPA) axis and may have potential as antidepressants.

OBJECTIVES

To study the behavioral effects of the selective I(2) receptor ligand BU224 in the rat forced swim test (FST) and its effects on the HPA axis and central monoaminergic responses.

METHODS

Rats received saline or BU224 (10 mg/kg IP) 24, 18 and 1 h prior to 15 min exposure to the FST. Saline- and BU224-treated non-stressed groups were included. Time spent immobile, struggling and swimming calmly was measured. Plasma adrenocorticotrophic hormone (ACTH) and corticosterone levels 90 min post-BU224 were measured in addition to tissue levels of monoamines and metabolites in the frontal cortex, hippocampus and hypothalamus.

RESULTS

Administration of BU224 significantly reduced immobility and increased mild swimming without affecting struggling. Exposure to the FST significantly increased plasma ACTH and corticosterone levels. BU224 administration also increased ACTH and potentiated the ACTH response to FST with no effect on corticosterone. BU224 administration significantly increased frontal cortex 5-hydroxytryptamine (5-HT) levels and decreased 5-HT turnover in the frontal cortex and hypothalamus of rats exposed to FST. In non-stressed rats, BU224 decreased 5-HT turnover in the hippocampus and hypothalamus and decreased norepinephrine turnover in the frontal cortex.

CONCLUSIONS

The selective I(2) receptor ligand BU224 reduces immobility of rats in the FST, indicative of antidepressant-like activity. This effect is accompanied by alterations in HPA axis and central monoaminergic activity.

The pharmacology of CP-154,526, a non-peptide antagonist of the CRH1 receptor: a review

Since CRH has been shown to mediate stress-induced physiological and behavioral changes, it has been hypothesized that CRH receptor antagonists may have therapeutic potential in disorders that involve excessive CRH activity. CP-154,526 and its close analog antalarmin are potent, brain-penetrable, selective nonpeptide CRH1 receptor antagonists that were discovered in an effort to develop compounds with efficacy in CNS disorders precipitated by stress. Since its discovery many investigators have used CP-154,526 as a tool to study the pharmacology of CRH and its receptors and to evaluate its therapeutic potential in a variety of CNS and peripheral disorders. Systemically-administered CP-154,526 has been demonstrated to antagonize CRH- and stress-induced neuroendocrine, neurochemical, electrophysiological, and behavioral effects. These findings support the hypothesis that CRH1 receptor antagonists may have therapeutic utility in a number of neuropsychiatric disorders. CP-154,526, as well as other CRH1 receptor antagonists that have since been discovered, have also shown activity in several preclinical models of anxiety, depression, and substance abuse, while having little effect on locomotor activity and motor function. Although these effects are on occasion inconsistent among different laboratories, clinical evaluation of CRH1 antagonists appears justified on the basis of these and clinical data implicating the involvement of CRH in several CNS disorders. The effects of CRH1 antagonists on cognition, neurodegeneration, inflammation, and the gastrointestinal system have not been as extensively characterized and additional studies will be necessary to evaluate their therapeutic potential in these areas.

Depression in patients with heart failure: physiologic effects, incidence, and relation to mortality

Heart failure affects 4.8 million people in the United States. Patients depressed after myocardial infarction have increased morbidity and mortality. Only a few studies have investigated the effects of depression in patients with heart failure. The incidence of depression in heart failure ranges from 13% to 77.5%. Men with heart failure are more likely to become depressed than the general population. Depression incidence is higher in hospitalized patients with heart failure than in stabilized outpatients. In patients with heart failure, depression is associated with mortality. Physiologic changes, which occur in depressed patients, have been implicated as possibly contributing to the increased mortality. Nurses have a major role in the management of patients with heart failure and can be pivotal in the detection and treatment of depression in these patients. Reduction in depression is likely to decrease morality in patients with heart failure.

Insulin resistance: a metabolic link between depressive disorder and atherosclerotic vascular diseases

The association of depression with insulin resistance (IR) and athersclerotic vascular diseases has been well documented. This review examines the relevance of IR as a link between depressive disorder and atherosclerotic vascular diseases. Relevant articles collected from Medline database over the period of 1966-2001 were reviewed. Studies have shown that IR is a state-dependent abnormality in depression and depression increases the risk of vascular morbidity and mortality. Given that IR is a central component of cardiovascular risk factors, depression-related IR might play a role in the development and progression of coronary and cerebral atherosclerosis in chronic-resistant depression. Further, IR may contribute to the pathophysiology of depressive disorder. In conclusion IR could account for the linkage between depression and atherosclerotic vascular diseases. More studies are needed to examine the importance of improving insulin sensitivity in the treatment of chronic-resistant depression and prevention of depression-related vascular morbidity and mortality.

Neuropeptides involved in the pathophysiology of schizophrenia and major depression

The present review summarizes the findings on the role of neuropeptides in the pathophysiology of schizophrenia and major depression. Several neuropeptides as vasopressin and endorphins in particular, beta-endorphin and gamma-type endorphins, cholecystokinin (CCK), neurotensin, somatostatin and Neuropeptide Y have been implicated in schizophrenia. During the last decade, however, few attempts to explore the significance of most of these and other neuropeptides in the pathophysiology of the disease or their therapeutic potential are found in the literature. An exception is neurotensin, which exerts neuroleptic-like effects in animal studies, while CSF, brain and blood studies are inconclusive. Things are different in major depression. Here much attention is paid to the endocrine abnormalities found in this disorder in particular the increased activity of the hypothalamic-pituitary-adrenal (HPA) axis. Neuropeptides as corticotropin-releasing hormone (CRH), vasopressin and corticosteroids are implicated in the symptomatology of this disorder. As a consequence much work is going on investigating the influence of CRH and corticosteroid antagonists or inhibitors of the synthesis of corticosteroids as potential therapeutic agents. This review emphasizes the role of vasopressin in the increased activity of the HPA axis in major depression and suggests exploration of the influence of the now available non-peptidergic vasopressin orally active V1 antagonists.

New directions in the development of antidepressants: the interface of neurobiology and psychiatry

There have been considerable advances in neurobiology in recent years that are providing new directions for the development of novel classes of antidepressants. For example, the finding that corticotropin-releasing factor (CRF) is hypersecreted in depressed patients and mediates certain symptoms of depression has led to the development of specific antagonists of the CRF(1) receptor. These are expected to prove highly effective for the treatment of mood and anxiety disorders. Another related avenue of research is based on evidence that cortisol is integral to the pathophysiology of major depression with psychotic features. One alternative for treating this subtype of affective disorder is, therefore, to block the action of glucocorticoids using a receptor antagonist such as mifepristone. These are just two of the many new directions that will likely lead to the development of antidepressants in the near future.

Effects of psychological and social factors on organic disease: a critical assessment of research on coronary heart disease

An extensive research literature in the behavioral sciences and medicine suggests that psychological and social factors may play a direct role in organic coronary artery disease (CAD) pathology. However, many in the medical and scientific community regard this evidence with skepticism. This chapter critically examines research on the impact of psychological and psychosocial factors on the development and outcome of coronary heart disease, with particular emphasis on studies employing verifiable outcomes of CAD morbidity or mortality. Five key variables identified as possible psychosocial risk factors for CAD are addressed: acute and chronic stress, hostility, depression, social support, and socioeconomic status. Evidence regarding the efficacy of psychosocial interventions is also presented. It is suggested that, taken as a whole, evidence for a psychological and social impact on CAD morbidity and mortality is convincing. However, continued progress in this area requires multidisciplinary research integrating expertise in cardiology and the behavioral sciences, and more effective efforts to communicate research findings to a biomedical audience.

Depressive disorder, dysthymia, and risk of stroke: thirteen-year follow-up from the Baltimore epidemiologic catchment area study

BACKGROUND AND PURPOSE

This study examined depressive disorder as a risk factor for incident stroke in a prospective, population-based design.

METHODS

The Baltimore Epidemiologic Catchment Area Study is a prospective 13-year follow-up of a probability sample of household residents from Baltimore, Md. Depressive disorder was measured with the diagnostic interview schedule, and stroke was assessed by questions from the health interview survey or by documentation on a death certificate.

RESULTS

During the 13-year follow-up of 1703 individuals, 66 strokes were reported and 29 strokes were identified by death certificate search. Individuals with a history of depressive disorder were 2.6 times more likely to report stroke than those without this disorder after controlling for heart disease, hypertension, diabetes, and current and previous use of tobacco. Medications used in the treatment of depressive disorder at baseline did not alter this finding. A history of dysthymia demonstrated a similar relationship to stroke, although the estimate was not statistically significant.

CONCLUSIONS

Depressive disorder is a risk factor for stroke that appears to be independent of traditional cardiovascular risk factors. Further research on mechanisms for the association and the impact of treatment for depressive disorder on subsequent stroke is needed.

The Hypothalamic-Pituitary-Adrenal Axis in Major Depressive Disorder: A Brief Primer for Primary Care Physicians

BACKGROUND: One of the most enduring and replicated findings in biological psychiatry is activation of the hypothalamic-pituitary-adrenal (HPA) axis in a subset of patients with major depressive disorder. This review will discuss some of these findings and their pertinence to the assessment and treatment of depressed patients. METHOD: MEDLINE, PsychINFO, and Current Contents databases were searched for pertinent articles on the HPA axis in patients with depression. In addition, hand searches were conducted of references from these sources and abstracts from meetings and books on this topic. Articles that would provide an overview of major or interesting studies in the field were selected for inclusion. RESULTS: The data support that HPA axis activation is common in depressed patients. Frequently reported findings include elevated cortisol and corticotropin-releasing hormone (CRH), nonsuppression on the dexamethasone suppression test, a blunted adrenocorticotropic hormone (ACTH) response to CRH, and hippocampal volume reduction. Evidence of HPA axis activation appears to have prognostic value and is associated with increased risk of depression relapse and even suicide. CONCLUSION: Future research in this area will focus on a better understanding of the etiology and long-term consequences of HPA axis activation in depressed patients. In addition, medications that act on the HPA axis are currently in development and may be part of the psychiatrist's and primary care physician's pharmacopoeia in the near future.

Effects of sertraline on regional neuropeptide concentrations in olfactory bulbectomized rats

Corticotropin-releasing factor (CRF) and thyrotropin-releasing hormone (TRH) are two neuropeptides that exhibit increased cerebrospinal fluid (CSF) concentrations during major depressive episodes while somatostatin (somatotropin-release inhibiting factor, SRIF) is decreased. Clinical and basic research findings indicate that clinically effective antidepressant therapies often normalize the indicators of CRF and TRH hypersecretion as well as SRIF hyposecretion. The olfactory bulbectomized (OBX) rat is used to screen potential antidepressant drugs for clinical efficacy. This model requires chronic administration of the antidepressant drug to normalize OBX-induced behaviors such as increased locomotion in a novel environment. This report describes the regional brain concentration changes in CRF, TRH and SRIF produced by OBX and demonstrates the ability of the selective serotonin re-uptake inhibitor and antidepressant drug, sertraline (10 mg/kg), to normalize certain of these alterations in regional neuropeptide concentrations as well as normalizing OBX-induced increases in locomotor activity. OBX-induced increases in CRF concentrations in the hypothalamus and bed nucleus of the stria terminalis were specifically and significantly decreased by sertraline. OBX-induced increases in TRH concentrations in the hypothalamus were reversed by sertraline. The concentration of SRIF was significantly reduced by OBX in the anterior caudate and the piriform cortex, but sertraline reversed these changes only in the anterior caudate.

Corticotropin-releasing hormone and animal models of anxiety: gene-environment interactions

The study of the neural substrates underlying stress and anxiety has in recent years been enriched by a burgeoning pool of genetic information gathered from rodent studies. Two general approaches have been used to characterize the interaction of genetic and environmental factors in stress regulation: the evaluation of stress-related behavioral and endocrine responses in animals with targeted deletion or overexpression of specific genes and the evaluation of changes in central nervous system gene expression in response to environmental perturbations. We review recent studies that have used molecular biology and genetic engineering techniques such as in situ hybridization, transgenic animal, and antisense oligonucleotide gene-targeting methodologies to characterize the function of corticotropin-releasing hormone (CRH) system genes in stress. The effects of genetic manipulations of each element of the CRH system (CRH, its two receptors, and its binding protein) on stress-related responses are summarized. In addition, the effects of stress (acute, repeated, or developmental) on CRH system gene expression are described. The results from these studies indicate that experimentally engineered or stress-induced dysregulation of gene expression within the CRH system is associated with aberrant responses to environmental contingencies. These results are discussed in the context of how CRH system dysfunction might contribute to stress-related psychopathology and are presented in conjunction with clinical findings of CRH system dysregulation in psychiatric illness. Finally, future research strategies (i.e., high-throughput gene screening and novel gene-targeting methodologies) that may be used to gain a fuller understanding of how CRH system gene expression affects stress-related functioning are discussed.

Assessment and treatment of depression in the cancer patient

The prevalence, diagnosis, and treatment of depression in the cancer patient are reviewed. Although frequently encountered in the cancer patient population, depression often remains undiagnosed and untreated. This carries grave consequences in that depressed cancer patients experience a poorer quality of life, are less compliant with medical care, have longer hospital stays, and have higher mortality rates. Diagnostic assessment of depression in the cancer patient raises difficulties both upon phenomenological and etiological grounds. In particular, the presence of neurovegetative symptoms which may be secondary to either cancer or depression may cloud the diagnostic picture. Due to the serious consequences of unrecognized depression, a more sensitive inclusive approach to diagnosis is recommended in the clinical setting. Finally, the limited data regarding treatment of depression in patients with cancer is reviewed. This includes a discussion of both psychosocial and pharmacological interventions which are shown to alleviate depression, improve quality of life measures, improve immune function, and lengthen survival time.

Antidepressant-like effects of CP-154,526, a selective CRF1 receptor antagonist

The effects of CP-154,526 (butyl-ethyl-[2,5-dimethyl-7-(2,4,6 -trimethyl-phenyl)-7H-pyrrolo[2,3-d]pyrimidin-4-yl]-amine), a selective corticotropin releasing factor (CRF1) receptor antagonist, were examined in the learned helplessness procedure, a putative model of depression with documented sensitivity to diverse classes of antidepressant drugs. Rats were exposed to a series of inescapable foot shocks on three consecutive days and tested in a shock-escape procedure on the fourth day. Animals exposed to 'helplessness' training performed poorly in the shock-escape test compared with control animals not receiving inescapable shocks. CP-154,526 (10-32 mg/kg, intraperitoneally) dose-dependently reversed the escape deficit when administered 60 min prior to the test session, but had no effect on the performance of control rats not receiving prior exposure to inescapable stress. In comparison, the tricyclic antidepressant imipramine (17.8 mg/kg) reversed the escape deficit after repeated, but not acute, administration. These data support evidence implicating stress systems in the pathophysiology of depression, and suggest potential efficacy of small-molecule CRF receptor antagonists in the treatment of affective disorders.

Adrenal weight and morphology in victims of completed suicide

Several lines of evidence have implicated hypothalamic-pituitary-adrenal (HPA) axis dysfunction in major depression and suicidal behavior. In the present study, the weight and morphology of postmortem adrenal glands were compared between suicide victims and sudden death, nonpsychiatric controls. The mean adrenal weight of the combined left and right glands was significantly higher in the suicide group; this difference was accounted for specifically by increases in left adrenal weight of suicides compared with the control group. There was a positive correlation between adrenal weight and total cortical thickness in both left and right glands, providing direct evidence that increased adrenal weight in suicide victims is due to cortical hypertrophy. The finding of left-right adrenal weight asymmetry in suicides is consistent with the hypothesis of abnormal lateralized input from higher control centers of the HPA axis.

Hormone levels and personality traits in abusive and suicidal male alcoholics

This study presents personality and biochemical correlates to abusive and suicidal behavior in 49 male alcoholics. Our hypothesis was that neuroendocrine and personality characteristics reflect a postulated regulatory mechanism that determines the direction of aggression either outward (abusive) or inward (suicidal). Eleven patients (22%) had physically abused someone on one occasion and 15 (31%) constituted a more violent subgroup with repeated instances of abuse. Thirteen (27%) had attempted suicide at least once. There was a significant positive correlation between the number of abusive and suicidal events (r = 0.33). The violent subgroup with repeated episodes of physical abuse had elevated levels of serum testosterone and low levels of cortisol when compared with the rest of the sample. Aggressive, antisocial, and impulsive personality traits were common. Suicidal alcoholics did not differ from the rest regarding hormone levels, but exhibited high impulsivity and muscular tension on the personality test. It is suggested that the high impulsivity without aggressive traits makes them exhibit autoagressive rather than abusive behavior. Both the abusive and suicidal alcoholics partly had a history typical of the type 2 alcoholic. We propose that these two categories constitute subgroups of the type 2 alcoholic determined by a combination of genetic predisposition to alcoholism, certain personality traits, and, with regard to the violent group, also hormone disturbances. We find it highly justified to identify and treat these subgroups because of their harmful acting-out behavior.

Interactions of anxiolytic and antidepressant drugs with hormones of the hypothalamic-pituitary-adrenal axis

Changes in hormones of the hypothalamic-pituitary-adrenal (HPA) axis in patients suffering from anxiety and depressive disorders are reviewed, and the changes that occur when animals are exposed to test situations used preclinically to model anxiety or depression. The effects of exogenous administration of HPA hormones both clinically and in animal tests is discussed and the effects of clinically used anxiolytics and antidepressants on hormones of the HPA axis. The final section discusses stress-induced changes in the CNS.

Acute effects of alprazolam and adinazolam on the concentrations of corticotropin-releasing factor in the rat brain

Corticotropin-releasing factor (CRF) is the major physiological regulator of the hypothalamic-pituitary-adrenal (HPA) axis. However, considerable evidence indicates that CRF may be responsible for integrating not only the endocrine, but the autonomic and behavioral responses of an organism to stress as well. In addition, clinical studies indicate that CRF of both hypothalamic and extrahypothalamic origin may be hypersecreted in major depression as well as other psychiatric disorders. These findings, taken together, led to the hypothesis that the efficacy of antidepressant and/or anxiolytic drugs may be related to their actions on CRF-containing neural pathways in the central nervous system (CNS). Therefore, alterations of CRF concentrations in 18 rat brain regions were studied after acute administration of a tricyclic antidepressant (imipramine) or one of two triazolobenzodiazepines (alprazolam or adinazolam) that possess anxiolytic properties typical of benzodiazepines, as well as purported antidepressant activity unique to these compounds. Treatment with alprazolam or adinazolam increased hypothalamic CRF concentrations, which was associated with lower plasma ACTH concentrations. In contrast, the concentration of CRF was markedly reduced in the locus coeruleus, amygdala, and several cortical regions by either triazalobenzodiazepine. Acute treatment with imipramine was without effect on CRF concentrations in any brain region studied. Of particular interest is the finding that the two triazolobenzodiazepines exert effects on CRF concentrations in the locus coeruleus and hypothalamus that are opposite to CRF changes seen after stress.

The neurobiology of aging and the neurobiology of depression: is there a relationship?

The relationship between the biology of aging and the biology of affective disorders remains obscure, largely for two reasons. First, and most important, is the equivocal nature of the data that indicates that increasing age predisposes an individual to episodes of major depression. Second, is the lack of tools to assess neurotransmitter turnover and availability in humans. Indirect measures such as neuroendocrine function tests, platelet, plasma and CSF studies contain too many confounding factors, to allow for adequate testing of neurochemical hypotheses. Development of novel approaches based on dynamic brain imaging methods may ameliorate these shortcomings.

Corticotropin-releasing factor immunoreactivity in post-mortem brain from depressed suicides

Corticotropin-releasing factor immunoreactivity (CRF-I) was measured in cortical brain tissue obtained at post-mortem from 12 suicide victims with clear evidence of depressive illness and 12 age-matched and sex-matched control subjects dying by natural causes. There were no significant differences in mean CRF-I concentrations in frontal, temporal, motor and parietal cortex between the total suicide group, or the eight drug-free suicides and their matched controls. These findings suggest that cortical CRF-I concentrations are unaltered in depressive illness and are discussed in relation to recent reports of elevated CRF-I con centrations in the cerebrospinal fluid of depressed patients.