Responses to activation and rest in patients with panic disorder and major depression

Effects of Aerobic Exercise on Anxiety Symptoms and Cortical Activity in Patients with Panic Disorder: A Pilot Study

BACKGROUND

The effects of the aerobic exercise on anxiety symptoms in patients with Panic Disorder (PD) remain unclear. Thus, the investigation of possible changes in EEG frontal asymmetry could contribute to understand the relationship among exercise, brain and anxiety.

OBJECTIVE

To investigate the acute effects of aerobic exercise on the symptoms of anxiety and the chronic effects of aerobic exercise on severity and symptoms related to PD, besides the changes in EEG frontal asymmetry.

METHODS

Ten PD patients were divided into two groups, Exercise Group (EG; n=5) and Control Group (CG; n=5), in a randomized allocation. At baseline and post-intervention, they submitted the psychological evaluation through Panic Disorder Severity Scale (PDSS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), EEG frontal asymmetry, and maximal oxygen consumption (VO2max). On the second visit, the patients of EG being submitted to the aerobic exercise (treadmill, 25 minutes, and 50-55% of heart rate reserve) and the CG remained seated for the same period of time. Both groups submitted a psychological evaluation with Subjective Units of Distress Scale (SUDS) at baseline, immediately after (Post-0), and after 10 minutes of the rest pause (Post-10). The patients performed 12 sessions of aerobic exercise with 48-72 hours of interval between sessions.

RESULTS

In EG, SUDS increased immediately after exercise practice and showed chronic decrease in BAI and BDI-II as well as increased in VO2max (Post-intervention).

CONCLUSION

Aerobic exercise can promote increase in anxiety acutely and regular aerobic exercise promotes reduction in anxiety levels.

Zumbido e ansiedade: uma revisão da literatura

O zumbido, som percebido pelo indivíduo sem que haja estímulo externo, resulta da interação dinâmica de centros do sistema nervoso central, incluindo vias auditivas e não auditivas. O resultado desta interação, especialmente sistema límbico e sistema nervoso autônomo, seria responsável pelo desencadeamento de associações emocionais negativas e reações de incômodo em pacientes com zumbido. A ansiedade, condição fisiológica inerente ao ser humano, quando exacerbada gera um transtorno de humor, comprometendo o pensamento, o comportamento e a atividade psicológica. Se um estímulo interno ou externo for interpretado como perigoso ou ameaçador, desencadeará uma reação emocional caracterizada como estado de ansiedade. Este artigo tem como objetivo realizar uma revisão da literatura sobre a relação do zumbido e da ansiedade. Em se tratando do zumbido, a forma como o som é percebido pode ser alterado pela ansiedade, aguçando assim a sensibilidade para detectar sons que parecem uma ameaça em potencial, pois para muitos o zumbido é sinônimo de enfermidade grave. A etiologia do desenvolvimento da depressão e ansiedade pode estar relacionada ao zumbido. Muitos adquirem esse sintoma por problemas físicos e, consequentemente, desenvolvem a depressão e a ansiedade. Outros com graus diferentes de angústias adquirem o zumbido devido ao comprometimento emocional. Dessa forma, existe um vínculo entre o zumbido e problemas emocionais, mas nem sempre é fácil identificar o precursor. Estudos demonstram que pacientes acometidos pelo zumbido apresentam maior tendência ao suicídio, depressão e ansiedade. Além disso, referem o efeito aditivo da ansiedade e da depressão na qualidade de vida e no zumbido dos indivíduos.

Anxiety sensitivity as a mediator of the relationship between moderate-intensity exercise and coping-oriented marijuana use motives

The present study examined the working hypothesis that moderate-intensity exercise is associated with coping-oriented marijuana use motives through its association with the fear of somatic arousal (ie, anxiety sensitivity). Using data from 146 young adult current marijuana users, we found evidence consistent with this hypothesis. Specifically, moderate-intensity exercise was associated with coping-oriented use motives, even after controlling for frequency of current marijuana use and other co-occurring marijuana use motives. This relationship became nonsignificant after entering anxiety sensitivity as an additional predictor variable, denoting a putative mediational role for this cognitive factor. These findings extend previous work and offer support for the potential utility of moderate-intensity aerobic exercise for the treatment of marijuana use problems.

Exercise for depression

BACKGROUND

Depression is a common and important cause of morbidity and mortality worldwide. Depression is commonly treated with antidepressants and/or psychotherapy, but some people may prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression.

OBJECTIVES

To determine the effectiveness of exercise in the treatment of depression.

SEARCH STRATEGY

We searched Medline, Embase, Sports Discus, PsycINFO, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews for eligible studies in March 2007. In addition, we hand-searched several relevant journals, contacted experts in the field, searched bibliographies of retrieved articles, and performed citation searches of identified studies. We also searched www.controlled-trials.com in May 2008.

SELECTION CRITERIA

Randomised controlled trials in which exercise was compared to standard treatment, no treatment or a placebo treatment in adults (aged 18 and over) with depression, as defined by trial authors. We excluded trials of post-natal depression.

DATA COLLECTION AND ANALYSIS

We calculated effect sizes for each trial using Cohen's method and a standardised mean difference (SMD) for the overall pooled effect, using a random effects model. Where trials used a number of different tools to assess depression, we included the main outcome measure only in the meta-analysis.

MAIN RESULTS

Twenty-eight trials fulfilled our inclusion criteria, of which 25 provided data for meta-analyses. Randomisation was adequately concealed in a minority of studies, most did not use intention to treat analyses and most used self-reported symptoms as outcome measures. For the 23 trials (907 participants) comparing exercise with no treatment or a control intervention, the pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect. However, when we included only the three trials with adequate allocation concealment and intention to treat analysis and blinded outcome assessment, the pooled SMD was -0.42 (95% CI -0.88, 0.03) i.e. moderate, non-significant effect. The effect of exercise was not significantly different from that of cognitive therapy. There was insufficient data to determine risks and costs.

AUTHORS' CONCLUSIONS

Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant. Further, more methodologically robust trials should be performed to obtain more accurate estimates of effect sizes, and to determine risks and costs. Further systematic reviews could be performed to investigate the effect of exercise in people with dysthymia who do not fulfil diagnostic criteria for depression.

Panic disorder and locomotor activity

Background

Panic disorder is one of the anxiety disorders, and anxiety is associated with some locomotor activity changes such as "restlessness". However, there have been few studies on locomotor activity in panic disorder using actigraphy, although many studies on other psychiatric disorders have been reported using actigraphy. Therefore, the aim of the present study was to investigate the relationship between panic disorder and locomotor activity pattern using a wrist-worn activity monitor. In addition, an ecological momentary assessment technique was used to record panic attacks in natural settings.

Methods

Sixteen patients with panic disorder were asked to wear a watch-type computer as an electronic diary for recording panic attacks for two weeks. In addition, locomotor activity was measured and recorded continuously in an accelerometer equipped in the watch-type computer. Locomotor activity data were analyzed using double cosinor analysis to calculate mesor and the amplitude and acrophase of each of the circadian rhythm and 12-hour harmonic component. Correlations between panic disorder symptoms and locomotor activity were investigated.

Results

There were significant positive correlations between the frequency of panic attacks and mesor calculated from double cosinor analysis of locomotor activity (r = 0.55) and between HAM-A scores and mesor calculated from double cosinor analysis of locomotor activity (r = 0.62).

Conclusion

Panic disorder patients with more panic attacks and more anxiety have greater objectively assessed locomotor activity, which may reflect the "restlessness" of anxiety disorders.

Exercise for depression

BACKGROUND

Depression is a common and important cause of morbidity and mortality worldwide. Depression is commonly treated with antidepressants and/or psychotherapy, but some people may prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression.

OBJECTIVES

To determine the effectiveness of exercise in the treatment of depression.

SEARCH STRATEGY

We searched Medline, Embase, Sports Discus, PsycLIT, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews for eligible studies. In addition, we hand-searched several relevant journals, contacted experts in the field, searched bibliographies of retrieved articles, and performed citation searches of identified studies. We also searched www.controlled-trials.com.

SELECTION CRITERIA

Randomised controlled trials in which exercise was compared to standard treatment, no treatment or a placebo treatment in adults (aged 18 and over) with depression, as defined by trial authors. We excluded trials of post-natal depression.

DATA COLLECTION AND ANALYSIS

We calculated effect sizes for each trial using Cohen's method and a standardised mean difference (SMD) for the overall pooled effect, using a random effects model. Where trials used a number of different tools to assess depression, we included the main outcome measure only in the meta-analysis.

MAIN RESULTS

Twenty-eight trials fulfilled our inclusion criteria, of which 25 provided data for meta-analyses. Randomisation was adequately concealed in a minority of studies, most did not use intention to treat analyses and most used self-reported symptoms as outcome measures. For the 23 trials (907 participants) comparing exercise with no treatment or a control intervention, the pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect. However, when we included only the three trials with adequate allocation concealment and intention to treat analysis and blinded outcome assessment, the pooled SMD was -0.42 (95% CI -0.88, 0.03) i.e. moderate, non-significant effect. The effect of exercise was not significantly different from that of cognitive therapy. There was insufficient data to determine risks and costs.

AUTHORS' CONCLUSIONS

Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant. Further, more methodologically robust trials should be performed to obtain more accurate estimates of effect sizes, and to determine risks and costs. Further systematic reviews could be performed to investigate the effect of exercise in people with dysthymia who do not fulfil diagnostic criteria for depression.

Transtornos de ansiedade e exercício físico

OBJETIVO: A maioria dos estudos sobre os efeitos ansiolíticos do exercício físico, até meados da década de 90, foram realizados avaliando-se estados de ansiedade, com indivíduos jovens, universitários ou atletas, que podem ser considerados pré-condicionados, limitando a validade das conclusões para populações com ansiedade patológica. Na atualidade, o número de estudos envolvendo pacientes com transtorno de ansiedade aumentou. O presente estudo tem por objetivo a revisão de artigos que discutem a influência do exercício físico nos transtornos de ansiedade. MÉTODO: Foi realizada uma pesquisa no Medline, no período de 1966-1995 e 1996-2006, utilizando-se os descritores: anxiety, panic, phobic disorders, exercise, physical fitness, além de referências cruzadas dos artigos selecionados e análise adicional de referências na literatura específica do tema. RESULTADOS: Os achados demonstraram desenhos heterogêneos assim como limitações metodológicas. As publicações mais recentes são promissoras e acenam para a utilização de exercícios físicos aeróbios como auxiliares das terapêuticas tradicionais no tratamento dos transtornos de ansiedade. CONCLUSÃO: Verificou-se que os exercícios aeróbios cuja intensidade não ultrapasse o limiar de lactato podem ser os mais apropriados, mas ainda não esclarecem as implicações dos exercícios anaeróbios, sugerindo cautela na prescrição de exercícios para indivíduos com ansiedade patológica, principalmente em relação aos exercícios anaeróbios.

Emotional vulnerability as a function of physical activity among individuals with panic disorder

This investigation evaluated the association between physical inactivity and emotional vulnerability in panic disorder. Participants were 39 adults (69% females) with a primary diagnosis of panic disorder (with or without agoraphobia), recruited through the community. Consistent with prediction, current physical inactivity was significantly associated with greater levels of anxiety sensitivity and severity of panic disorder. Results are discussed in relation to the importance of better understanding the role of physical inactivity in panic disorder.

Reduced attention and increased impulsivity in mice lacking NPY Y2 receptors: Relation to anxiolytic-like phenotype

Neuropeptide (NPY) Y2 receptors play an important role in some anxiety-related and stress-related behaviours in mice. Changes in the level of anxiety can affect some cognitive functions such as memory, attention and inhibitory response control. We investigated the effects of NPY Y2 receptor deletion (Y2(-/-)) in mice on visual attention and response control using the five-choice serial reaction time (5-CSRT) task in which accuracy of detection of a brief visual stimulus across five spatial locations may serve as a valid behavioural index of attentional functioning. Anticipatory and perseverative responses provide a measure of inhibitory response control. During training, the Y2(-/-) mice had lower accuracy (% correct), and made more anticipatory responses. At stimulus durations of 2 and 4s the Y2(-/-) were as accurate as the Y2(+/+) mice but still more impulsive than Y(+/+). At stimulus durations of 0.25 and 0.5s both groups performed worse but the Y2(-/-) mice made significantly fewer correct responses than the Y2(+/+) controls. The anxiolytic drug diazepam at 2mg/kg IP greatly increased the anticipatory responding of Y2(-/-) mice compared to Y2(+/+). The anxiogenic inverse benzodiazepine agonist, FG 7142, at 10mg/kg IP reduced the anticipatory responding of Y2(-/-) but not Y2(+/+) mice. These data suggest that NPY Y2 receptors make an important contribution to mechanisms controlling attentional functioning and "impulsivity". They also show that "impulsivity" of NPY Y2(-/-) mice may depend on their level of anxiety. These findings may help in understanding the pathophysiology of stress disorders and depression.

Neural anomalies during visual search in schizophrenia patients and unaffected siblings of schizophrenia patients

Schizophrenia patients and their unaffected first-degree relatives exhibit performance deficits on attention tasks, perhaps indicating genetic influence over attentional abnormalities in schizophrenia. To identify anomalous brain function associated with attention in individuals who likely have unexpressed genetic liability for schizophrenia, we studied electrophysiological characteristics of unaffected siblings of schizophrenia patients during a visual serial search task. We gathered behavioral and electrophysiological data from 19 schizophrenia patients, 18 unaffected biological siblings of schizophrenia patients, and 19 nonpsychiatric control participants during performance of the Span of Apprehension (Span) task and a control task. Schizophrenia patients had lower Span task accuracy than the other two groups. Schizophrenia and sibling groups exhibited diminished late positive potentials (P300) over parietal brain regions during Span trials. Compared to control task stimuli, attentional demands of Span stimuli elicited augmented early negative potentials (N1, P2) over posterior brain regions. The degree of augmentation was reduced in schizophrenia patients but not in siblings compared to control subjects. Unaffected siblings of schizophrenia patients appear to modulate early attentional functions of posterior brain regions more effectively than schizophrenia patients but show later electrophysiological anomalies suggestive of abnormal updating of task-relevant information. While the latter may reflect neural mechanisms predisposing performance deficits on attentional tasks, the former may reflect compensatory processes present in unaffected relatives of schizophrenia patients.

Reduced attention in mice overproducing corticotropin-releasing hormone

Data from several studies suggest that unrestrained secretion of corticotropin-releasing hormone in the CNS produces several signs and symptoms of depression. Recent evidence indicates that blockade of the CRH receptor 1 reduced depression scores in depressed patients. One of the symptoms that occur is depression is impairment in attentional processes. Whether these impairments are due to alterations in the CRH system are so far unknown. In order to investigate whether overproduction of CRH alters attentional process, transgenic mice overproducing CRH were tested on an operant five choice serial reaction time task, a task which taxes sustained and divided attention. Mutants showed impaired autoshaping. During initial discrimination learning, transgenics performed below wildtype level, but with extended training with long stimulus durations, transgenic animals reached similar accuracy levels as wildtype mice. When animals were tested at shortest stimulus duration (0.5s), a mild but significant impairment in accurate responding emerged in transgenics. This was accompanied by longer correct response latencies, while incorrect latencies did not differ between groups, suggesting attentional impairment in CRH transgenics. Because these animals have been reported to also show increased anxiety-related behaviour, animals were treated with the anxiolytic benzodiazepine diazepam. Diazepam failed to affect accuracy, but transgenic mice showed a stronger behavioural disinhibition. This suggests that the attentional impairment seen in CRH overexpressors is independent of alterations in anxiety-like behaviour. These findings may have implications for understanding the pathophysiology of psychiatric disorders such as depression, where it has been suggested that an overactivity of the CRH system accounts for a variety of symptoms, including hyper-arousal and attentional impairment.

The relationship between exercise motives and psychological well-being

The aim of the present study was to use the self-determination model of exercise motives to examine the relationship between extrinsic and intrinsic motives for exercise and a number of measures of psychological well-being. Undergraduate students purporting to exercise regularly (N = 227; 102 men, 125 women) were split into 2 groups: those exercising for less than 6 months and those exercising for 6 months or more. The respondents were asked to complete measures of exercise motivation, self-esteem, psychological well-being, and stress. Among individuals exercising for less than 6 months, a number of extrinsic motivations for exercise were significantly related to poorer psychological well-being. Among individuals exercising for 6 months or more, a number of intrinsic motivations were significantly related to better psychological well-being. The present findings suggest that researchers can use self-determination theory to understand the relationship between exercise motivation and psychological well-being.

The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials

OBJECTIVE

To determine the effectiveness of exercise as an intervention in the management of depression.

DESIGN

Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals.

MAIN OUTCOME MEASURES

Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy.

RESULTS

All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size -1.1 (95% confidence interval -1.5 to -0.6); weighted mean difference in Beck depression inventory -7.3 (-10.0 to -4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1)).

CONCLUSIONS

The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up.

Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory

Until recently, claims for the psychological benefits of physical exercise have tended to precede supportive evidence. Acutely, emotional effects of exercise remain confusing, both positive and negative effects being reported. Results of cross-sectional and longitudinal studies are more consistent in indicating that aerobic exercise training has antidepressant and anxiolytic effects and protects against harmful consequences of stress. Details of each of these effects remain unclear. Antidepressant and anxiolytic effects have been demonstrated most clearly in subclinical disorder, and clinical applications remain to be exploited. Cross-sectional studies link exercise habits to protection from harmful effects of stress on physical and mental health, but causality is not clear. Nevertheless, the pattern of evidence suggests the theory that exercise training recruits a process which confers enduring resilience to stress. This view allows the effects of exercise to be understood in terms of existing psychobiological knowledge, and it can thereby provide the theoretical base that is needed to guide future research in this area. Clinically, exercise training continues to offer clinical psychologists a vehicle for nonspecific therapeutic social and psychological processes. It also offers a specific psychological treatment that may be particularly effective for patients for whom more conventional psychological interventions are less acceptable.

Physical activity and mental health: current concepts

Physical activity may play an important role in the management of mild-to-moderate mental health diseases, especially depression and anxiety. Although people with depression tend to be less physically active than non-depressed individuals, increased aerobic exercise or strength training has been shown to reduce depressive symptoms significantly. However, habitual physical activity has not been shown to prevent the onset of depression. Anxiety symptoms and panic disorder also improve with regular exercise, and beneficial effects appear to equal meditation or relaxation. In general, acute anxiety responds better to exercise than chronic anxiety. Studies of older adults and adolescents with depression or anxiety have been limited, but physical activity appears beneficial to these populations as well. Excessive physical activity may lead to overtraining and generate psychological symptoms that mimic depression. Several differing psychological and physiological mechanisms have been proposed to explain the effect of physical activity on mental health disorders. Well controlled studies are needed to clarify the mental health benefits of exercise among various populations and to address directly processes underlying the benefits of exercise on mental health.