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Cattaneo A, Begni V, Zonca V, Riva MA. Early life adversities, psychopathologies and novel pharmacological strategies. Pharmacol Ther 2024; 260:108686. [PMID: 38969307 DOI: 10.1016/j.pharmthera.2024.108686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/05/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
Exposure to adversities during early life stages (early life adversities - ELA), ranging from pregnancy to adolescence, represents a major risk factor for the vulnerability to mental disorders. Hence, it is important to understand the molecular and functional underpinning of such relationship, in order to develop strategies aimed at reducing the psychopathologic burden associated with ELA, which may eventually lead to a significant improvement in clinical practice. In this review, we will initially recapitulate clinical and preclinical evidence supporting the link between ELA and psychopathology and we will primarily discuss the main biological mechanisms that have been described as potential mediators of the effects of ELA on the psychopathologic risk, including the role for genetic factors as well as sex differences. The knowledge emerging from these studies may be instrumental for the development of novel therapeutic strategies aimed not only at correcting the deficits that emerge from ELA exposure, but also in preventing the manifestation of a full-blown psychopathologic condition. With this respect, we will specifically focus on adolescence as a key time frame for disease onset as well as for early therapeutic intervention. We believe that incorporating clinical and preclinical research data in the context of early life adversities can be instrumental to elucidate the mechanisms contributing to the risk for psychopathology or that may promote resilience. This will ultimately allow the identification of 'at risk' individuals who may benefit from specific forms of interventions that, by interfering with disease trajectories, could result in more benign clinical outcomes.
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Affiliation(s)
- Annamaria Cattaneo
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy; Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Veronica Begni
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy
| | - Valentina Zonca
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy; Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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2
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Pantell MS, Silveira PP, de Mendonça Filho EJ, Wing H, Brown EM, Keeton VF, Pokhvisneva I, O'Donnell KJ, Neuhaus J, Hessler D, Meaney MJ, Adler NE, Gottlieb LM. Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children. Pediatr Res 2024; 95:1553-1563. [PMID: 38233512 PMCID: PMC11126389 DOI: 10.1038/s41390-023-02992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/17/2023] [Accepted: 11/11/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Prior work has found relationships between childhood social adversity and biomarkers of stress, but knowledge gaps remain. To help address these gaps, we explored associations between social adversity and biomarkers of inflammation (interleukin-1β [IL-1β], IL-6, IL-8, tumor necrosis factor-alpha [TNF-α], and salivary cytokine hierarchical "clusters" based on the three interleukins), neuroendocrine function (cortisol, cortisone, dehydroepiandrosterone, testosterone, and progesterone), neuromodulation (N-arachidonoylethanolamine, stearoylethanolamine, oleoylethanolamide, and palmitoylethanolamide), and epigenetic aging (Pediatric-Buccal-Epigenetic clock). METHODS We collected biomarker samples of children ages 0-17 recruited from an acute care pediatrics clinic and examined their associations with caregiver-endorsed education, income, social risk factors, and cumulative adversity. We calculated regression-adjusted means for each biomarker and compared associations with social factors using Wald tests. We used logistic regression to predict being in the highest cytokine cluster based on social predictors. RESULTS Our final sample included 537 children but varied based on each biomarker. Cumulative social adversity was significantly associated with having higher levels of all inflammatory markers and with cortisol, displaying a U-shaped distribution. There were no significant relationships between cumulative social adversity and cortisone, neuromodulation biomarkers or epigenetic aging. CONCLUSION Our findings support prior work suggesting that social stress exposures contribute to increased inflammation in children. IMPACT Our study is one of the largest studies examining associations between childhood social adversity and biomarkers of inflammation, neuroendocrine function, neuromodulation, and epigenetic aging. It is one of the largest studies to link childhood social adversity to biomarkers of inflammation, and the first of which we are aware to link cumulative social adversity to cytokine clusters. It is also one of the largest studies to examine associations between steroids and epigenetic aging among children, and one of the only studies of which we are aware to examine associations between social adversity and endocannabinoids among children. CLINICAL TRIAL REGISTRATION NCT02746393.
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Affiliation(s)
- Matthew S Pantell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA.
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA.
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA.
| | - Patricia P Silveira
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Euclides José de Mendonça Filho
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Holly Wing
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | | | - Victoria F Keeton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 490 Illinois St, Box 2930, 94143, San Francisco, CA, USA
| | - Irina Pokhvisneva
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
| | - Kieran J O'Donnell
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Yale Child Study Center & Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Danielle Hessler
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Michael J Meaney
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
| | - Laura M Gottlieb
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
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Johnston JN, Greenwald MS, Henter ID, Kraus C, Mkrtchian A, Clark NG, Park LT, Gold P, Zarate CA, Kadriu B. Inflammation, stress and depression: An exploration of ketamine's therapeutic profile. Drug Discov Today 2023; 28:103518. [PMID: 36758932 PMCID: PMC10050119 DOI: 10.1016/j.drudis.2023.103518] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/13/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
Well-established animal models of depression have described a proximal relationship between stress and central nervous system (CNS) inflammation - a relationship mirrored in the peripheral inflammatory biomarkers of individuals with depression. Evidence also suggests that stress-induced proinflammatory states can contribute to the neurobiology of treatment-resistant depression. Interestingly, ketamine, a rapid-acting antidepressant, can partially exert its therapeutic effects via anti-inflammatory actions on the hypothalamic-pituitary adrenal (HPA) axis, the kynurenine pathway or by cytokine suppression. Further investigations into the relationship between ketamine, inflammation and stress could provide insight into ketamine's unique therapeutic mechanisms and stimulate efforts to develop rapid-acting, anti-inflammatory-based antidepressants.
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Affiliation(s)
- Jenessa N Johnston
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Maximillian S Greenwald
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Christoph Kraus
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Anahit Mkrtchian
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Neil G Clark
- US School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Lawrence T Park
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Philip Gold
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Bashkim Kadriu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Bottaccioli AG, Bottaccioli F. Come gli stati psichici si traducono in molecole biologiche e come questo cambia la medicina e la psicologia. PSICOTERAPIA E SCIENZE UMANE 2023. [DOI: 10.3280/pu2023-001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Nell'aprile del 2022 abbiamo pubblicato, su invito di una rivista internazionale di biologia molecolare, un'ampia review che riporta le principali evidenze scientifiche sul tema delle relazioni tra vita psichica e biologia, traendone alcune conclusioni di carattere generale sulla psicologia e la medicina (Bottaccioli, Bologna & Bottaccioli, 2022). Il presente articolo riprende alcuni dei passaggi fondamentali presentati in quella review e si collega a un precedente articolo pubblicato sul n. 4/2014 di Psicoterapia e Scienze Umane (Bottaccioli, 2014b), di cui rappresenta un aggiornamento. Dalla pubblicazione di quell'articolo le evidenze sperimentali e cliniche sull'influenza della psiche sui sistemi biologici si sono moltiplicate. Al tempo stesso, conosciamo meglio le vie e i meccanismi con cui gli stati psichici si traducono in biologia.
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Simon MS, Weidinger E, Leitner B, Kisla Y, Niedeggen J, Thaler P, Zaudig M, Vorderholzer U, Schwarz M, Müller N. Tryptophan metabolites predict response after cognitive behavioral therapy for depression: a single-arm trial. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Simonetti A, Bernardi E, Janiri D, Mazza M, Montanari S, Catinari A, Terenzi B, Tosato M, Galluzzo V, Ciciarello F, Landi F, Sani G. Suicide Risk in Post-COVID-19 Syndrome. J Pers Med 2022; 12:jpm12122019. [PMID: 36556240 PMCID: PMC9785632 DOI: 10.3390/jpm12122019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Post-acute sequelae of COVID-19 include several neuropsychiatric disorders. Little is known about the relationship between post-COVID-19 syndrome and suicidality. The aim of the study was to investigate the risk of suicide in subjects with persistent post-COVID-19 syndrome. One-thousand five-hundred eighty-eight subjects were assessed in the Post-Acute Care Service at the Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS of Rome. Assessment included: (a) sociodemographic characteristics; (b) symptoms during and after COVID-19; (c) psychopathological evaluation. Participants were divided in those with (SUI) or without (NON SUI) suicide risk according to the Mini International Neuropsychiatric Interview. Additionally, subjects with SUI were split into those with high (HIGH SUI) and low (LOW SUI) suicide risk. Between-group comparisons were made with t-tests for continuous variables and χ2 tests for categorical variables. SUI showed greater percentages of physical complaints during and after COVID-19, greater percentages of psychiatric history and presence of psychiatric history in relatives, greater percentages of subjects previously undergoing psychopharmacotherapy, and greater levels of anxiety, mixed depressive symptoms, general psychopathology than NON SUI. HIGH SUI showed greater number of symptoms during and after COVID-19 and higher levels of mixed depressive symptoms than LOW SUI. Percentages of subjects undergoing psychotherapy was higher in LOW SUI than HIGH SUI. Greater levels of physical complaints and psychopathology during post-COVID-syndrome might enhance the risk of committing suicide. Treatment of physical complaints and psychotherapy might reduce suicide risk.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Evelina Bernardi
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Delfina Janiri
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | - Marianna Mazza
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Montanari
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonello Catinari
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Beatrice Terenzi
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Matteo Tosato
- Department of Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vincenzo Galluzzo
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Ciciarello
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Lo YJ, Mishra VK, Lo HY, Dubey NK, Lo WC. Clinical Spectrum and Trajectory of Innovative Therapeutic Interventions for Insomnia: A Perspective. Aging Dis 2022:AD.2022.1203. [PMID: 37163444 PMCID: PMC10389812 DOI: 10.14336/ad.2022.1203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/03/2022] [Indexed: 05/12/2023] Open
Abstract
Increasing incidences of insomnia in adults, as well as the aging population, have been reported for their negative impact on the quality of life. Insomnia episodes may be associated with neurocognitive, musculoskeletal, cardiovascular, gastrointestinal, renal, hepatic, and metabolic disorders. Epidemiological evidence also revealed the association of insomnia with oncologic and asthmatic complications, which has been indicated as bidirectional. Two therapeutic approaches including cognitive behavioral therapy (CBT) and drugs-based therapies are being practiced for a long time. However, the adverse events associated with drugs limit their wide and long-term application. Further, Traditional Chinese medicine, acupressure, and pulsed magnetic field therapy may also provide therapeutic relief. Notably, the recently introduced cryotherapy has been demonstrated as a potential candidate for insomnia which could reduce pain, by suppressing oxidative stress and inflammation. It seems that the synergistic therapeutic approach of cryotherapy and the above-mentioned approaches might offer promising prospects to further improve efficacy and safety. Considering these facts, this perspective presents a comprehensive summary of recent advances in pathological aetiologies of insomnia including COVID-19, and its therapeutic management with a greater emphasis on cryotherapy.
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Affiliation(s)
| | | | | | - Navneet Kumar Dubey
- Victory Biotechnology Co., Ltd., Taipei 114757, Taiwan
- ShiNeo Technology Co., Ltd., New Taipei City 24262, Taiwan
| | - Wen-Cheng Lo
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
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Panjwani AA, Aguiar S, Gascon B, Brooks DG, Li M. Biomarker opportunities in the treatment of cancer-related depression. Trends Mol Med 2022; 28:1050-1069. [PMID: 36371336 DOI: 10.1016/j.molmed.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
Depression comorbid with cancer is common and associated with a host of negative health outcomes. The inflammatory basis of depression is a growing area of research in cancer, focused on how stressors transduce into inflammation and contribute to the emergence of depression. In this review, we synthesize inflammatory biomarker associations with both depression and the currently available pharmacotherapies and psychotherapies in cancer, underscoring the need for expanding research on anti-inflammatory agents with antidepressant effects. Modulation of inflammatory neuroimmune pathways can slow tumor progression and reduce metastases. Biomarkers associated with depression in cancer may help with diagnosis and treatment monitoring, as well as inform research on novel drug targets to potentially improve cancer survival.
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Affiliation(s)
- Aliza A Panjwani
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Stefan Aguiar
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Bryan Gascon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David G Brooks
- Princess Margaret Research Institute, Toronto, ON, Canada; Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Princess Margaret Research Institute, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Azad AH, Khan SA, Ali I, Shafi H, Khan NA, Umar SA. Experience of psychologists in the delivery of cognitive behaviour therapy in a non-western culture for treatment of substance abuse: a qualitative study. Int J Ment Health Syst 2022; 16:55. [PMID: 36443829 PMCID: PMC9703777 DOI: 10.1186/s13033-022-00566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Psychotherapy is the preferred form of treatment for psychological disorders worldwide. Cognitive behaviour therapy (CBT) is one of the most widely used psychotherapies due to its proven efficacy for psychological disorders, including substance abuse. However, CBT was developed in the West according to the culture of developed countries. Therefore, it requires cross-cultural adaptation for non-Western countries. Pakistan is one of the developing non-Western countries where substance use disorders are increasing at an alarming rate. Despite the proven efficacy of CBT for substance use disorders, there is a dearth of its utilization in Pakistan. Therefore, in the present study, in-depth qualitative interviews were conducted with CBT practitioners in Pakistan to understand barriers and challenges in this regard. The study was a part of a broader project aimed at cultural adaptation of CBT for people with substance use disorders (SUDs) in Pakistan. METHODS In-depth qualitative interviews were conducted with CBT practitioners (N = 8) working in rehabilitation centres and hospitals in Islamabad, Pakistan. Thematic content analysis was conducted to develop core themes from the data. RESULTS CBT for SUDs requires some adjustments according to Pakistani culture for successful utilization. The challenges in providing CBT for SUDs revolved around three main themes, i.e., the mental health system, societal practices, and therapeutic issues, and 10 subthemes. CONCLUSION In order to utilize the benefits of CBT for SUDs in Pakistan, cultural adaptation is necessary as an initial step. However, its delivery requires stringent modifications in the health care system to address these challenges.
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Affiliation(s)
- Abrar Hussain Azad
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan
| | - Shahzad Ali Khan
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan
| | - Ijaz Ali
- Community Medicine, Mohi-Ud-Din Islamic Medical College, Mirpur, Azad Kashmir Pakistan
| | - Hina Shafi
- Community Medicine, Mohi-Ud-Din Islamic Medical College, Mirpur, Azad Kashmir Pakistan
| | - Nisar Ahmed Khan
- Community Medicine, Abbottabad International Medical College, Abbottabad, Pakistan
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Serrat M, Ferrés S, Auer W, Almirall M, Lluch E, D’Amico F, Maes M, Lorente S, Navarrete J, Montero-Marín J, Neblett R, Nijs J, Borràs X, Luciano JV, Feliu-Soler A. Effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent therapy in online and outdoor format in individuals with fibromyalgia: Study protocol of a randomized, controlled trial (On&Out study). Front Physiol 2022; 13:1046613. [DOI: 10.3389/fphys.2022.1046613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: The On&Out study is aimed at assessing the effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent intervention conducted in two different settings: online (FIBRO-On) or outdoors (FIBRO-Out). Both interventions have proved to be efficacious in the short-term but there is no study assessing their comparative effectiveness nor their long-term effects. For the first time, this study will also evaluate the cost-utility (6-month time-horizon) and the effects on immune-inflammatory biomarkers and Brain-Derived Neurotrophic Factor (BDNF) levels of both interventions. The objectives of this 6-month, randomized, controlled trial (RCT) are 1) to examine the effectiveness and cost-utility of adding FIBRO-On or FIBRO-Out to Treatment-As-Usual (TAU) for individuals with fibromyalgia (FM); 2) to identify pre–post differences in blood biomarker levels in the three study arms and 3) to analyze the role of process variables as mediators of 6-month follow-up clinical outcomes.Methods and analysis: Participants will be 225 individuals with FM recruited at Vall d’Hebron University Hospital (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs. TAU + FIBRO-On vs. TAU + FIBRO-Out. A comprehensive assessment to collect functional impairment, pain, fatigue, depressive and anxiety symptoms, perceived stress, central sensitization, physical function, sleep quality, perceived cognitive dysfunction, kinesiophobia, pain catastrophizing, psychological inflexibility in pain and pain knowledge will be conducted pre-intervention, at 6 weeks, post-intervention (12 weeks), and at 6-month follow-up. Changes in immune-inflammatory biomarkers [i.e., IL-6, CXCL8, IL-17A, IL-4, IL-10, and high-sensitivity C-reactive protein (hs-CRP)] and Brain-Derived Neurotrophic Factor will be evaluated in 40 participants in each treatment arm (total n = 120) at pre- and post-treatment. Quality of life and direct and indirect costs will be evaluated at baseline and at 6-month follow-up. Linear mixed-effects regression models using restricted maximum likelihood, mediational models and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed.Ethics and dissemination: This study has been approved by the Ethics Committee of the Vall d’Hebron Institute of Research. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities. Trial registration number NCT05377567 (clinicaltrials.gov).
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Dogaru IA, Puiu MG, Manea M, Dionisie V. Current Perspectives on Pharmacological and Non-Pharmacological Interventions for the Inflammatory Mechanism of Unipolar Depression. Brain Sci 2022; 12:brainsci12101403. [PMID: 36291336 PMCID: PMC9599138 DOI: 10.3390/brainsci12101403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 11/25/2022] Open
Abstract
Since depression remains a major public health issue there is a constant need for new and more efficient therapeutic strategies based on the mechanisms involved in the aetiology of depression. Thus, the pathogenic link between depression and inflammation is considered to play a potential key role in the development of such therapies. This review summarizes the results of various pharmacological (non-steroidal anti-inflammatory drugs, aspirin, cyclooxygenase inhibitors, cytokine inhibitors, corticosteroids, statins, minocycline, N-acetyl cysteine, omega-3 fatty acids and probiotics) and non-pharmacological interventions (electroconvulsive therapy, physical exercise and psychological therapy) and outlines their efficacy and discusses potential challenges. Both conventional and non-conventional anti-inflammatory drugs showed promising results according to the specific group of patients. The pre-existing pro-inflammatory status was, in most cases, a predictor for clinical efficacy and, in some cases, a correlation between clinical improvement and changes in various biomarkers was found. Some of the non-pharmacological interventions (physical exercise and electroconvulsive therapy) have also showed beneficial effects for depressive patients with elevated inflammatory markers. Treatments with anti-inflammatory action may improve clinical outcomes in depression, at least for some categories of patients, thus opening the way for a future personalised approach to patients with unipolar depression regarding the inflammation-related mechanism.
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Affiliation(s)
- Ioana-Alexandra Dogaru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maria Gabriela Puiu
- Department of Psychiatry and Psychology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence:
| | - Mirela Manea
- Department of Psychiatry and Psychology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Vlad Dionisie
- Department of Psychiatry and Psychology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Matits L, Gumpp AM, Kolassa IT, Behnke A, Mack M. Störungsspezifische und transdiagnostische Veränderung der Inflammationsaktivität bei psychischen Störungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Empirische Befunde deuten vermehrt auf eine erhöhte Entzündungsaktivität im Zusammenhang mit psychischen Störungen hin. Inwieweit sich inflammatorische Veränderungen über Störungen hinweg unterscheiden bzw. ob Inflammation ein transdiagnostisches Korrelat psychischer Störungen darstellt, ist bisher jedoch noch nicht eindeutig beantwortet. Fragestellung: Liegen spezifische inflammatorische Marker (z. B. Zytokine) über psychische Störungen hinweg verändert vor und/oder gibt es störungsspezifische Zytokinveränderungen bei Major Depression (MDD), Bipolarer Störung, Schizophrenie und Angststörungen inkl. Posttraumatischer Belastungsstörung (PTBS). Methode: Basierend auf einer Literaturrecherche werden aktuelle metaanalytische Befunde, die Studien bei Patient_innen mit MDD, Bipolarer Störung, Schizophrenie oder Angststörungen inkl. PTBS im Vergleich zu gesunden Kontrollen betrachten, zusammengetragen und vergleichend dargestellt. Ergebnisse: Aktuelle Evidenz verweist relativ konsistent auf Veränderungen des Immunsystems, wobei v. a. das Zytokin Interleukin (IL–) 6 und das C-reaktive Protein (CRP) störungsübergreifend leicht erhöht sind. Schlussfolgerungen: Perspektivisch könnten Patient_innen mit chronisch inflammatorischen Erkrankungen und psychischen Störungen von psychotherapiebegleitenden antiinflammatorischen Maßnahmen wie bspw. körperlicher Aktivität, antiinflammatorischer Ernährung und Entspannungsverfahren profitieren.
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Affiliation(s)
- Lynn Matits
- Sektion Sport- und Rehabilitationsmedizin, Innere Medizin, Universitätsklinikum Ulm, Deutschland
- Klinische & Biologische Psychologie, Institut für Psychologie und Pädagogik, Universität Ulm, Deutschland
| | - Anja Maria Gumpp
- Klinische & Biologische Psychologie, Institut für Psychologie und Pädagogik, Universität Ulm, Deutschland
| | - Iris-Tatjana Kolassa
- Klinische & Biologische Psychologie, Institut für Psychologie und Pädagogik, Universität Ulm, Deutschland
| | - Alexander Behnke
- Klinische & Biologische Psychologie, Institut für Psychologie und Pädagogik, Universität Ulm, Deutschland
| | - Matthias Mack
- Klinische & Biologische Psychologie, Institut für Psychologie und Pädagogik, Universität Ulm, Deutschland
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13
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Moragrega I, Ríos JL. Medicinal Plants in the Treatment of Depression. II: Evidence from Clinical Trials. PLANTA MEDICA 2022; 88:1092-1110. [PMID: 34157753 DOI: 10.1055/a-1517-6882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Depression is a syndrome characterized by deep sadness and the inhibition of psychic functions, sometimes accompanied by neurovegetative disorders, with symptoms of anxiety almost always present. The disease produces alterations in a variety of neural networks and neurotransmission systems, along with a dysfunction of the hypothalamic-pituitary-adrenal axis, which leads to concomitant alterations in the immunological response. Generally, there is a parallel increase in proinflammatory mediators as well as oxidative and nitrosative damage caused by a reduction of antioxidant defenses. In a previous review, we compiled and examined studies of medicinal plants that had been evaluated in preclinical assays, including existing data on 155 species studied and reported as antidepressants or as sources of active principles for treating this condition. This review will thus limit its focus to the 95 clinical trials found in PubMed among the 670 articles on antidepressant-like medicinal plants. To this end, we have reviewed the publications cited in the Cochrane Database of Systematic Reviews, PubMed, and the Science Citation Index from 2000 to 2020. Our review emphasizes those species that have demonstrated the greatest pharmacological potential when studied for their antidepressant properties in humans through clinical trials. Saffron, turmeric, St. John's wort, ginkgo, kava, and golden root are the most relevant plants that have provided important evidence for the treatment of depression in clinical trials.
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Affiliation(s)
- Inés Moragrega
- Departament de Psicobiologia, Facultat de Psicologia, Universitat de València, Valencia, Spain
| | - José Luis Ríos
- Departament de Farmacologia, Facultat de Farmàcia, Universitat de València, Valencia, Spain
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14
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O'Shields J, Patel D, Mowbray OP. Childhood maltreatment and inflammation: Leveraging structural equation modeling to test the social signal transduction theory of depression. J Affect Disord 2022; 311:173-180. [PMID: 35594973 DOI: 10.1016/j.jad.2022.05.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 05/03/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The experience of childhood maltreatment has long been understood to increase the risk for experiencing depressive symptoms and is often associated with an overall worse course of illness when these symptoms are elevated to a major depressive episode. Despite this, current treatments for depression continue to require a need for a greater understanding of the underlying mechanisms. METHOD We utilized structural equation modeling to test the effects of childhood maltreatment on inflammation and depressive symptoms. Inflammation was conceptualized as a latent variable, estimated by CRP, fibrinogen, IL-6, sICAM-1, sE-selectin, and TNF- α; whereas depressive symptoms were estimated using the subscales for the Center for Epidemiological Studies-Depression scale and childhood maltreatment was estimated using the subscales for the Childhood Trauma Questionnaire. RESULTS Multivariate results identified that childhood maltreatment had a significant positive relationship with inflammation as well as depressive symptoms, and inflammation had a significant positive relationship with depressive symptoms. Notably, childhood maltreatment also had a significant positive relationship with perceived stress over the last month and this perceived stress had a positive relationship with depressive symptoms; however perceived stress had no relationship with inflammation. LIMITATIONS Data from the present study is cross-sectional, requiring replication with longitudinal data. Some measures such as childhood maltreatment were measured by self-report and should be replicated with verified reports. CONCLUSIONS These results provide support for the Social Signal Transduction Theory of Depression, emphasizing the importance of the immune system and inflammation as a relevant mediator between early social treats and adulthood depressive symptoms.
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Affiliation(s)
- Jay O'Shields
- University of Georgia, School of Social Work, United States of America.
| | - Dipali Patel
- University of Georgia, School of Social Work, United States of America
| | - Orion P Mowbray
- University of Georgia, School of Social Work, United States of America
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15
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Fernández-Serrano AB, Moya-Faz FJ, Giner Alegría CA, Fernández Rodríguez JC. Negative correlation between IL-1β, IL-12 and TNF-γ, and cortisol levels in patients with panic disorder. Brain Behav 2022; 12:e2624. [PMID: 35588458 PMCID: PMC9226804 DOI: 10.1002/brb3.2624] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/26/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Chronic exposure to stress is a major risk factor in anxiety disorders (ADs) and can be accompanied by an altered microbiome-gut-brain axis and a compromised immune system. In recent years, the study of inflammatory processes in AD has gained special attention. Continued stress causes the reactivity of the hypothalamic-pituitary-adrenal (HPA) axis, the alteration of the intestinal microbiota and the consequent release of pro-inflammatory cytokines, affecting the sensitivity to stress and the similar behavior of anxiety. METHOD The aim of the present study was to evaluate the interrelationships between measures of proinflammatory cytokines and cortisol in patients with panic disorder (PD). RESULTS The main results of the correlation analysis revealed that the levels of pro-inflammatory cytokines interleukin (IL)-1β, IL-12, and tumor necrosis factor gamma were negatively correlated with cortisol scores (area under the curve with respect to the ground). CONCLUSIONS These results suggest that the inflammatory response is associated with the reactivity of the HPA axis in patients with PD and may influence the maintenance of anxiety behavior.
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Affiliation(s)
| | - Francisco José Moya-Faz
- Chair of Psychogeriatrics, Department of Health Sciences, Universidad Católica de Murcia UCAM, Murcia, Spain
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16
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Shonkoff JP, Boyce WT, Bush NR, Gunnar MR, Hensch TK, Levitt P, Meaney MJ, Nelson CA, Slopen N, Williams DR, Silveira PP. Translating the Biology of Adversity and Resilience Into New Measures for Pediatric Practice. Pediatrics 2022; 149:187008. [PMID: 35535547 DOI: 10.1542/peds.2021-054493] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
As the science of adversity and resilience advances, and public awareness of the health consequences of stress grows, primary care providers are being increasingly asked to address the effects of adverse experiences on child wellbeing. Given limited tools for assessing these effects early in life, the authors explore how enhanced capacity to measure stress activation directly in young children could transform the role and scope of pediatric practice. When employed within a trusted relationship between caregivers and clinicians, selective use of biological measures of stress responses would help address the documented limitations of rating scales of adverse childhood experiences as a primary indicator of individual risk and strengthen the ability to focus on variation in intervention needs, assess their effectiveness, and guide ongoing management. The authors provide an overview of the potential benefits and risks of such expanded measurement capacity, as well as an introduction to candidate indicators that might be employed in an office setting. The ultimate value of such measures for both pediatricians and parents will require vigilant attention to the ethical responsibilities of assuring their correct interpretation and minimizing the harm of inappropriate labeling, especially for children and families experiencing the hardships and threats of racism, poverty, and other structural inequities. Whereas much work remains to be done to advance measurement development and ensure its equitable use, the potential of validated markers of stress activation and resilience to strengthen the impact of primary health care on the lives of young children facing significant adversity demands increased attention.
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Affiliation(s)
- Jack P Shonkoff
- Center on the Developing Child.,Harvard Graduate School of Education.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - W Thomas Boyce
- University of California, San Francisco, San Francisco, California
| | - Nicole R Bush
- Departments of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences.,Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, San Francisco, California
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | - Takao K Hensch
- Center on the Developing Child.,Conte Center for Basic Mental Health Research.,Center for Brain Science, Harvard University, Cambridge, Massachusetts.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Pat Levitt
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael J Meaney
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore, Republic of Singapore
| | - Charles A Nelson
- Center on the Developing Child.,Harvard Graduate School of Education.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Natalie Slopen
- Center on the Developing Child.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - David R Williams
- Center on the Developing Child.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Patricia Pelufo Silveira
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
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17
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Fernández-Serrano AB, Moya-Faz FJ, Giner Alegría CA, Fernández Rodríguez JC, Soriano Guilabert JF, del Toro Mellado M. Effects of hydrogen water and psychological treatment in a sample of women with panic disorder: a randomized and controlled clinical trial. Health Psychol Res 2022; 10:35468. [DOI: 10.52965/001c.35468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022] Open
Abstract
Research suggests that inflammation is an important mediator in the pathophysiology of anxiety disorders. In addition, women are more likely to develop an anxiety and depression disorder, in comorbidity with a wide spectrum of diseases related to the immune system. In recent years, hydrogen-rich water has emerged as a promising therapeutic strategy to prevent and intervene in stress-related disorders, due to its antioxidant and anti-inflammatory properties. The present study aims to analyze the effects of psychological treatment and a hydrogen-rich drink on the severity of anxiety and depression, pro-inflammatory cytokine levels, the cortisol awakening response, and general health state in a sample of women with panic disorder. This is a completely randomized, placebo-controlled study. The treatment group simultaneously received psychological treatment and 1.5 L of hydrogenated water for three months, compared to the control group that received psychological treatment and placebo. The results show that the treatment group was not significantly better than the control group. But there was a further reduction in measured pro-inflammatory cytokine scores, improving body pain and physical health. When between-group treatment effects were removed, psychological treatment significantly decreased measured variables, including cytokines and cortisol. The results support the presence of a maladaptive inflammatory process in women with panic disorder.
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18
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Bottaccioli AG, Bologna M, Bottaccioli F. Psychic Life-Biological Molecule Bidirectional Relationship: Pathways, Mechanisms, and Consequences for Medical and Psychological Sciences—A Narrative Review. Int J Mol Sci 2022; 23:ijms23073932. [PMID: 35409300 PMCID: PMC8999976 DOI: 10.3390/ijms23073932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Today, it is possible to investigate the biological paths and mechanisms that link mental life to biological life. Emotions, feelings, desires, and cognitions influence biological systems. In recent decades, psychoneuroendocrinoimmunology research has highlighted the routes linking the psyche–brain–immune systems. Recently, epigenetics research has shown the molecular mechanisms by which stress and mental states modulate the information contained in the genome. This research shapes a new paradigm considering the human being as a whole, integrating biology and psychology. This will allow us to progress towards personalized precision medicine, deeply changing medical and psychological sciences and clinical practice. In this paper, we recognize leading research on both bidirectional relations between the psyche–brain–immunity and molecular consequences of psychological and mental states.
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Affiliation(s)
- Anna Giulia Bottaccioli
- Department of Psychology, University “Vita e Salute”, San Raffaele, 20132 Milan, Italy
- Italian Society of Psycho-Neuro-Endocrine-Immunology (SIPNEI), 00195 Rome, Italy; (M.B.); (F.B.)
- Correspondence:
| | - Mauro Bologna
- Italian Society of Psycho-Neuro-Endocrine-Immunology (SIPNEI), 00195 Rome, Italy; (M.B.); (F.B.)
- Department of Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Francesco Bottaccioli
- Italian Society of Psycho-Neuro-Endocrine-Immunology (SIPNEI), 00195 Rome, Italy; (M.B.); (F.B.)
- Department of Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Ma H, Xu J, Li R, McIntyre RS, Teopiz KM, Cao B, Yang F. The Impact of Cognitive Behavioral Therapy on Peripheral Interleukin-6 Levels in Depression: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:844176. [PMID: 35633813 PMCID: PMC9136073 DOI: 10.3389/fpsyt.2022.844176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED There is interest in the role of peripheral interleukin-6 (IL-6) in depression and the effect of treatment (e. g., pharmacologic, psychosocial, neurostimulation). However, the relationship between cognitive behavioral therapy (CBT), IL-6 and depression has not yet been established. We conducted a meta-analysis to explore the association between CBT and change of peripheral IL-6 levels in depressive symptoms or major depressive disorder (MDD). A systematic search of online databases (i.e., PubMed, Web of Science, Google Scholar, PsycINFO, and Cochrane Library) was completed from inception to May 2021. In total, 10 eligible papers with 940 participants reporting peripheral IL-6 levels before and after CBT were included in the analysis. The main result indicates that peripheral levels of IL-6 were significantly lower after CBT intervention in individuals with depression, with a small effect (SMD = 0.38, 95% CI: 0.07, 0.69, p = 0.02). The results of subgroup analyses demonstrate that (1) there was a significant decrease in IL-6 for studies that were equal to or <8 weeks in duration vs. more than 8 weeks in duration, and (2) IL-6 was significantly reduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis (i.e., DSM-IV, DSM-IV-TR, or DSM-V) of MDD, but not for the subgroup without DSM diagnosis. Publication year was identified as a potential contributor to heterogeneity of the results from our analysis. Taken together, our findings support the notion that CBT influences peripheral IL-6 in individuals with depression and represents a point of commonality with other antidepressant treatment modalities (e.g., antidepressants). SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/osf.io/tr9yh, identifier: 10.17605/osf.io/tr9yh.
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Affiliation(s)
- Haijing Ma
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Jiatong Xu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Ruonan Li
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Kayla M Teopiz
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China.,National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, China
| | - Fahui Yang
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China.,National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, China
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20
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Aschbacher K, Cole S, Hagan M, Rivera L, Baccarella A, Wolkowitz OM, Lieberman AF, Bush NR. An immunogenomic phenotype predicting behavioral treatment response: Toward precision psychiatry for mothers and children with trauma exposure. Brain Behav Immun 2022; 99:350-362. [PMID: 34298096 DOI: 10.1016/j.bbi.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022] Open
Abstract
Inflammatory pathways predict antidepressant treatment non-response among individuals with major depression; yet, this phenomenon may have broader transdiagnostic and transtherapeutic relevance. Among trauma-exposed mothers (Mage = 32 years) and their young children (Mage = 4 years), we tested whether genomic and proteomic biomarkers of pro-inflammatory imbalance prospectively predicted treatment response (PTSD and depression) to an empirically-supported behavioral treatment. Forty-three mother-child dyads without chronic disease completed Child Parent Psychotherapy (CPP) for roughly 9 months. Maternal blood was drawn pre-treatment, CD14 + monocytes isolated, gene expression derived from RNA sequencing (n = 34; Illumina HiSeq 4000;TruSeqcDNA library), and serum assayed (n = 43) for C-Reactive Protein (CRP) and interleukin-1ß (IL-1ß). Symptoms of PTSD and depression decreased significantly from pre- to post-treatment for both mothers and children (all p's < 0.01). Nonetheless, a higher pre-treatment maternal pro-inflammatory imbalance of M1-like versus M2-like macrophage-associated RNA expression (M1/M2) (ß = 0.476, p = .004) and IL-1ß (ß=0.333, p = .029), but not CRP, predicted lesser improvements in maternal PTSD symptoms, unadjusted and adjusting for maternal age, BMI, ethnicity, antidepressant use, income, education, and US birth. Only higher pre-treatment M1/M2 predicted a clinically-relevant threshold of PTSD non-response among mothers (OR = 3.364, p = .015; ROC-AUC = 0.78). Additionally, higher M1/M2 predicted lesser decline in maternal depressive symptoms (ß = 0.556, p = .001), though not independent of PTSD symptoms. For child outcomes, higher maternal IL-1ß significantly predicted poorer PTSD and depression symptom trajectories (ß's = 0.318-0.429, p's < 0.01), while M1/M2 and CRP were marginally associated with poorer PTSD symptom improvement (ß's = 0.295-0.333, p's < 0.056). Pre-treatment pro-inflammatory imbalance prospectively predicts poorer transdiagnostic symptom response to an empirically-supported behavioral treatment for trauma-exposed women and their young children.
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Affiliation(s)
- Kirstin Aschbacher
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, United States; Division of Cardiology, Department of Medicine, University of California San Francisco, United States; The Institute for Integrative Health, United States.
| | - Steve Cole
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, United States
| | - Melissa Hagan
- Department of Psychology, College of Science & Engineering, San Francisco State University, United States
| | - Luisa Rivera
- Department of Anthropology, Emory University, United States
| | | | - Owen M Wolkowitz
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, United States
| | - Alicia F Lieberman
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, United States
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, United States; Center for Health and Community, University of California San Francisco, United States; Department of Pediatrics, Division of Developmental Medicine, University of California San Francisco, United States.
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21
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Toenders YJ, Laskaris L, Davey CG, Berk M, Milaneschi Y, Lamers F, Penninx BWJH, Schmaal L. Inflammation and depression in young people: a systematic review and proposed inflammatory pathways. Mol Psychiatry 2022; 27:315-327. [PMID: 34635789 DOI: 10.1038/s41380-021-01306-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
Depression onset peaks during adolescence and young adulthood. Current treatments are only moderately effective, driving the search for novel pathophysiological mechanisms underlying youth depression. Inflammatory dysregulation has been shown in adults with depression, however, less is known about inflammation in youth depression. This systematic review identified 109 studies examining the association between inflammation and youth depression and showed subtle evidence for inflammatory dysregulation in youth depression. Longitudinal studies support the bidirectional association between inflammation and depression in youth. We hypothesise multiple inflammatory pathways contributing to depression. More research is needed on anti-inflammatory treatments, potentially tailored to individual symptom profiles.
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Affiliation(s)
- Yara J Toenders
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Liliana Laskaris
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam UMC, Department of Amsterdam Public Health Research Institute and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Department of Amsterdam Public Health Research Institute and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Department of Amsterdam Public Health Research Institute and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
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22
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Toft H, Bramness JG, Lien L. Levels of Peripheral Circulating IL-6 and IL-10 Decrease Over Time Despite High Depression Burden in PTSD Patients. Neuropsychiatr Dis Treat 2022; 18:737-747. [PMID: 35414745 PMCID: PMC8995001 DOI: 10.2147/ndt.s357797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with combined depression symptoms and post-traumatic stress disorder (PTSD) often exhibit high levels of circulating inflammatory biomarkers as either a cause or consequence of their disease. We aimed to investigate how cytokines and depression symptoms develop with one-year follow-up and compare them with non-PTSD patients. METHODS The study had a longitudinal design with one-year follow-up measurements in an inpatient treatment setting at a psychiatric center in Norway. PTSD diagnoses were set using the Mini International Neuropsychiatric Interview (MINI). The first three measurements were at baseline (T0), halfway (T1) and at discharge (T2) from a 12-week main stay, followed by a final measurement one year after discharge (T3). Serum blood samples were collected on all four occasions. The Beck Depression Inventory-II (BDI-II) was administered at T0, T2 and T3. RESULTS Levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) in PTSD patients were higher than in patients without PTSD at T0 (p = 0.005 and 0.042). The PTSD patients had a higher average level of IL-10 across all four measurements (B = 1.62, Standard Error (SE) = 0.78, p = 0.037). The IL-10 levels in PTSD patients declined from T0 to T3 (p = 0.039). The PTSD patients were more depressed than non-PTSD patients at T3 (p = 0.019). CONCLUSIONS The levels of IL-10 and IL-6 in PTSD patients more closely resembled the levels in non-PTSD patients at one-year follow-up, despite level of depression being unchanged in the PTSD patients. This calls into question the close relationship between level of circulating cytokines and depressive symptoms, at least in PTSD patients. Further research is needed to investigate what appears to be a complex relationship between immune markers and depression in patients with PTSD.
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Affiliation(s)
- Helge Toft
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Cao B, Li R, Ding L, Xu J, Ma H, Liu J, Xue J. Does cognitive behaviour therapy affect peripheral inflammation of depression? A protocol for the systematic review and meta-analysis. BMJ Open 2021; 11:e048162. [PMID: 34857553 PMCID: PMC8640668 DOI: 10.1136/bmjopen-2020-048162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cognitive-behavioural therapy (CBT) is becoming the most commonly implemented and standard treatment for depression. Up to date, only a few numbers of studies have investigated the potential relationship between CBT and the change of inflammatory biomarkers in individuals of depression. And the results are inconsistent among studies. The current study aims to provide a comprehensive, systematic review of the association between CBT and changes of peripheral inflammation of individuals with depression, and clarify the alterations of inflammatory cytokines pre-CBT and post-CBT treatment by meta-analysis, anti-inflammatory. METHODS AND ANALYSIS This study will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of predetermined terms will be conducted with electronic databases of CENTRAL, MEDLINE, EMBASE and PsycINFO from inception to July 2021. Database searches will be supplemented by expert contact, reference and citation checking, and grey literature. Primary outcomes of interest will be validated measures for levels of inflammatory cytokines pre-CBT and post- CBT treatment in individuals with depression. Hedges' g will be used to represent the effect size. SYSTEMATIC REVIEW REGISTRATION The protocol of current meta-analysis has been registered at the Open Science Framework (https://doi.org/10.17605/osf.io/tr9yh). ETHICS AND DISSEMINATION Formal ethical approval is not required by the National Ethical Review Board in China as primary data will not be collected. The results alterations of peripheral inflammatory cytokines pre-CBT and post-CBT treatment in individuals with depression will be disseminated through a peer-reviewed publication and inform the most up-to-date evidence of the roles of CBT treatment for depression.
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Affiliation(s)
- Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Ruonan Li
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Ling Ding
- Department of Pharmacy, JiangJin Central Hosptial of Chongqing, Chongqing, China
| | - Jiatong Xu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Haijing Ma
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Jie Liu
- Department of Pharmacy, JiangJin Central Hosptial of Chongqing, Chongqing, China
| | - Jian Xue
- Department of Health Management, Zunyi Medical and Pharmaceutical College, Zunyi, Guizhou, China
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Inflammation, depressive symptoms, and emotion perception in adolescence. J Affect Disord 2021; 295:717-723. [PMID: 34517245 PMCID: PMC8551069 DOI: 10.1016/j.jad.2021.08.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 07/06/2021] [Accepted: 08/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Individuals with depression often demonstrate an altered peripheral inflammatory profile, as well as emotion perception difficulties. However, correlations of inflammation with overall depression severity are inconsistent and inflammation may only contribute to specific symptoms. Moreover, measurement of the association between inflammation and emotion perception is sparse in adolescence, despite representing a formative window of emotional development and high-risk period for depression onset. METHODS Serum interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β were measured in 34 adolescents aged 12-17 with DSM-IV depressive disorders (DEP) and 29 healthy controls (HC). Participants were evaluated using the Children's Depression Rating Scale-Revised (CDRS-R) and symptom subscales were extracted based on factor analysis. Participants also completed a performance-based measure of emotion perception, the Facial Emotion Perception Test (FEPT), which assesses the accuracy of categorizing angry, fearful, sad, happy, and neutral facial emotions. RESULTS IL-6 and TNF-α correlated with reported depressed mood and somatic symptoms, respectively, but not total CDRS-R score, anhedonia or observed mood, across both DEP and HC. DEP demonstrated lower accuracy for identifying angry facial expressions. Higher IL-6 was inversely related to accuracy and discrimination of angry and neutral faces across all participants. IL-1β was associated with reduced discrimination of fearful faces. CONCLUSIONS Inflammatory markers were sensitive to affective and somatic symptoms of depression and processing of emotional threat in adolescents. In particular, IL-6 was elevated in depressed adolescents and therefore may represent a specific target for modulating depressive symptoms and emotion processing.
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Rengasamy M, Marsland A, McClain L, Kovats T, Walko T, Pan L, Price RB. Linking childhood trauma and cytokine levels in depressed adolescents. Psychoneuroendocrinology 2021; 133:105398. [PMID: 34479104 PMCID: PMC8530984 DOI: 10.1016/j.psyneuen.2021.105398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/28/2021] [Accepted: 08/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Evidence supports raised circulating levels of inflammatory mediators, such as interleukin-6 (IL-6) and tumor necrosis factor (TNFα), among clinically depressed adults, although preliminary findings in adolescents are mixed. Independently, meta-analyses identify correlations between childhood trauma and elevated cytokine levels in adulthood. Here, we examine the possible role of individual differences in exposure to childhood trauma in contributing to variability in cytokine levels in depressed adolescents. METHODS 52 depressed adolescents and 20 healthy adolescents completed measures of childhood trauma and provided blood for the assessment of plasma IL-6 and TNFα. Cross-sectional associations of childhood trauma and cytokine measures were assessed in both depressed and healthy adolescents, along with exploratory analysis of childhood trauma subtypes. Longitudinal relationships between childhood trauma and cytokine measures were also studied in an exploratory fashion within a subset of depressed participants (n = 36). RESULTS Higher childhood trauma (particularly emotional abuse) was positively associated with TNFα in depressed adolescents. Childhood trauma was not linked to longitudinal changes in cytokine levels. DISCUSSION In depressed adolescents, childhood trauma may relate to higher levels of the proinflammatory cytokine TNFα and contribute to heterogeneity in cytokine elevation among depressed adolescents. Such findings may ultimately help guide more effective individualized treatments for adolescents with depression.
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Affiliation(s)
- Manivel Rengasamy
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Lora McClain
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Tessa Kovats
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Thomas Walko
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Lisa Pan
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Rebecca B Price
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, USA
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Effects of maternal psychological stress during pregnancy on offspring brain development: Considering the role of inflammation and potential for preventive intervention. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:461-470. [PMID: 34718150 PMCID: PMC9043032 DOI: 10.1016/j.bpsc.2021.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
Heightened psychological stress during pregnancy has repeatedly been associated with increased risk for offspring development of behavior problems and psychiatric disorders. This review covers a rapidly growing body of research with the potential to advance a mechanistic understanding of these associations grounded in knowledge about maternal-placental-fetal stress biology and fetal brain development. Specifically, we highlight research employing magnetic resonance imaging to examine the infant brain soon after birth in relation to maternal psychological stress during pregnancy to increase capacity to identify specific alterations in brain structure and function and to differentiate between effects of pre- versus postnatal exposures. We then focus on heightened maternal inflammation during pregnancy as a mechanism through which maternal stress influences the developing fetal brain based on extensive preclinical literature and emerging research in humans. We place these findings in the context of recent work identifying psychotherapeutic interventions found to be effective for reducing psychological stress among pregnant individuals, which also show promise for reducing inflammation. We argue that a focus on inflammation, among other mechanistic pathways, has the potential to lead to a productive and necessary integration of research focused on the effects of maternal psychological stress on offspring brain development and prevention and intervention studies aimed at reducing maternal psychological stress during pregnancy. In addition to increasing capacity for common measurements and understanding potential mechanisms of action relevant to maternal mental health and fetal neurodevelopment, this focus can inform and broaden thinking about prevention and intervention strategies.
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Kautz MM. Applications of psychoneuroimmunology models of toxic stress in prevention and intervention efforts across early development. Brain Behav Immun Health 2021; 16:100322. [PMID: 34589810 PMCID: PMC8474171 DOI: 10.1016/j.bbih.2021.100322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/02/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
Although evidence supporting psychoneuroimmunology (PNI) models of toxic stress have emerged over the past decade, the PNI field has struggled to integrate these important findings into real-world practical applications. There is great potential for these models to reduce the societal burden of childhood adversity by facilitating early detection and prevention with those children and adolescents at greatest risk for stress-related physical and psychological disorders. But further research is needed to validate and scale developmentally appropriate interventions with specific immune and endocrine mechanism-based targets that are developmentally sensitive. The allostatic load and additive PNI models of toxic stress exposure in youth are summarized. These models highlight the importance of integrating a standardized screening of environmental and interpersonal risk factors with stable and scalable cognitive and biological markers of risk. PNI models of toxic stress illustrate the need for intervention delivery as early as possible to prevent negative health outcomes in youth and comprehensive screening efforts would facilitate the deployment of community and family level interventions. This review discusses practical applications of toxic stress models that are currently under investigation, clarifies key obstacles, such as research gaps and scalability, and provides potential solutions, including cross-disciplinary partnerships.
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Affiliation(s)
- Marin M Kautz
- Department of Psychology, Temple University Psychology, 1701 N. 13th St., Weiss Hall, Philadelphia, PA, 19122, United States
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Moragrega I, Ríos JL. Medicinal Plants in the Treatment of Depression: Evidence from Preclinical Studies. PLANTA MEDICA 2021; 87:656-685. [PMID: 33434941 DOI: 10.1055/a-1338-1011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Medicinal plants and their extracts are natural remedies with enormous potential for treating various diseases, including depression and anxiety. In the case of depression, hundreds of plants have traditionally been used in folk medicine for generations. Different plant extracts and natural products have been analyzed as potential antidepressant agents with validated models to test for antidepressant-like effects in animals, although other complementary studies have also been employed. Most of these studies focus on the possible mediators implicated in these potential effects, with dopamine, serotonin, and noradrenaline being the principal neurotransmitters implicated, both through interference with receptors and with their metabolism by monoamino oxidases, as well as through neuro-endocrine and neuroprotective effects. There are approximately 650 reports of antidepressant-like medicinal plants in PubMed; 155 of them have been compiled in this review, with a relevant group yielding positive results. Saffron and turmeric are the most relevant species studied in both preclinical and clinical studies; St. John's wort or kava have also been tested extensively. To the best of our knowledge, no review to date has provided a comprehensive understanding of the biomolecular mechanisms of action of these herbs or of whether their potential effects could have real benefits. The purpose of this narrative review is to provide an update regarding medicinal plants from the year 2000 to the present to examine the therapeutic potential of these antidepressant-like plants in order to contribute to the development of new therapeutic methods to alleviate the tremendous burden that depression causes worldwide.
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Affiliation(s)
- Inés Moragrega
- Departament de Psicobiologia, Facultat de Psicologia, Universitat de València
| | - José Luis Ríos
- Departament de Farmacologia, Facultat de Farmàcia, Universitat de València
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Walker JL, Slavish DC, Dolan M, Dietch JR, Wardle-Pinkston S, Messman B, Ruggero CJ, Kohut M, Borwick J, Kelly K, Taylor DJ. Age-dependent associations among insomnia, depression, and inflammation in nurses. Psychol Health 2021; 36:967-984. [PMID: 32795158 PMCID: PMC7882004 DOI: 10.1080/08870446.2020.1805450] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/29/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Insomnia and depression have been inconsistently associated with inflammation. Age may be one important moderator of these associations. This study examined associations between insomnia and depression with inflammatory biomarkers in nurses and how these associations varied by age. Design: Participants were 392 nurses ages 18-65 (Mage = 39.54 years ± 11.15, 92% female) recruited from two hospitals. Main outcome measures: Participants completed surveys to assess insomnia and depression symptoms. Serum samples were obtained and analysed for inflammatory biomarkers interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-1 beta (IL-1β), and tumour necrosis factor alpha (TNF-α). Results: Neither insomnia nor depression symptoms were associated with inflammatory biomarkers. Older age was associated with higher IL-1β, and age moderated the effects of depression symptoms on CRP and TNF-α: Greater depression symptoms were associated with higher CRP (b = .14, p = .017) and TNF-α (b = .008, p = .165) among older nurses only. Conclusion: Results suggest older nurses with higher depression symptoms may be at increased risk for elevated inflammation. Interventions should consider the role of age-related processes in modifying health and well-being. Given relatively low levels of depression in the current sample, future studies should replicate results in clinical and non-nurse samples.
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Affiliation(s)
- Jamie L Walker
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Jessica R Dietch
- War Related Illness and Injury Study Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA
| | | | - Brett Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Marian Kohut
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Joshua Borwick
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Kappelmann N, Czamara D, Rost N, Moser S, Schmoll V, Trastulla L, Stochl J, Lucae S, Binder EB, Khandaker GM, Arloth J. Polygenic risk for immuno-metabolic markers and specific depressive symptoms: A multi-sample network analysis study. Brain Behav Immun 2021; 95:256-268. [PMID: 33794315 DOI: 10.1016/j.bbi.2021.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND About every fourth patient with major depressive disorder (MDD) shows evidence of systemic inflammation. Previous studies have shown inflammation-depression associations of multiple serum inflammatory markers and multiple specific depressive symptoms. It remains unclear, however, if these associations extend to genetic/lifetime predisposition to higher inflammatory marker levels and what role metabolic factors such as Body Mass Index (BMI) play. It is also unclear whether inflammation-symptom associations reflect direct or indirect associations, which can be disentangled using network analysis. METHODS This study examined associations of polygenic risk scores (PRSs) for immuno-metabolic markers (C-reactive protein [CRP], interleukin [IL]-6, IL-10, tumour necrosis factor [TNF]-α, BMI) with seven depressive symptoms in one general population sample, the UK Biobank study (n = 110,010), and two patient samples, the Munich Antidepressant Response Signature (MARS, n = 1058) and Sequenced Treatment Alternatives to Relieve Depression (STAR*D, n = 1143) studies. Network analysis was applied jointly for these samples using fused graphical least absolute shrinkage and selection operator (FGL) estimation as primary analysis and, individually, using unregularized model search estimation. Stability of results was assessed using bootstrapping and three consistency criteria were defined to appraise robustness and replicability of results across estimation methods, network bootstrapping, and samples. RESULTS Network analysis results displayed to-be-expected PRS-PRS and symptom-symptom associations (termed edges), respectively, that were mostly positive. Using FGL estimation, results further suggested 28, 29, and six PRS-symptom edges in MARS, STAR*D, and UK Biobank samples, respectively. Unregularized model search estimation suggested three PRS-symptom edges in the UK Biobank sample. Applying our consistency criteria to these associations indicated that only the association of higher CRP PRS with greater changes in appetite fulfilled all three criteria. Four additional associations fulfilled at least two consistency criteria; specifically, higher CRP PRS was associated with greater fatigue and reduced anhedonia, higher TNF-α PRS was associated with greater fatigue, and higher BMI PRS with greater changes in appetite and anhedonia. Associations of the BMI PRS with anhedonia, however, showed an inconsistent valence across estimation methods. CONCLUSIONS Genetic predisposition to higher systemic inflammatory markers are primarily associated with somatic/neurovegetative symptoms of depression such as changes in appetite and fatigue, consistent with previous studies based on circulating levels of inflammatory markers. We extend these findings by providing evidence that associations are direct (using network analysis) and extend to genetic predisposition to immuno-metabolic markers (using PRSs). Our findings can inform selection of patients with inflammation-related symptoms into clinical trials of immune-modulating drugs for MDD.
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Affiliation(s)
- Nils Kappelmann
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Nicolas Rost
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Sylvain Moser
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Vanessa Schmoll
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Lucia Trastulla
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Department of Kinanthropology, Charles University, Prague, Czech Republic
| | | | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Janine Arloth
- Department of Translational Research in Psychiatry, Max-Planck-Institute of Psychiatry, Munich, Germany; Institute of Computational Biology, Helmholtz Zentrum Munich, Neuherberg, Germany
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Dolsen EA, Harvey AG. IL-6, sTNF-R2, and CRP in the context of sleep, circadian preference, and health in adolescents with eveningness chronotype: Cross-sectional and longitudinal treatment effects. Psychoneuroendocrinology 2021; 129:105241. [PMID: 33932814 DOI: 10.1016/j.psyneuen.2021.105241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/17/2021] [Accepted: 04/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Inflammation-related processes have emerged as a biological pathway related to adolescent development. This study examined cross-sectional and longitudinal associations of baseline inflammatory markers with sleep, circadian preference, and health at baseline and following treatment. METHODS Participants included 165 adolescents (58.2% female, mean age 14.7 years, 42.4% taking medication) "at-risk" in at least one domain (emotional, cognitive, behavioral, social, and physical health) who received a sleep-based intervention. Self-reported eveningness as well as total sleep time (TST) and bedtime from sleep diary were assessed at baseline and following treatment. Baseline soluble tumor necrosis factor receptor-2 (sTNF-R2) and interleukin (IL)-6 were assayed from oral mucosal transudate. Baseline C-reactive protein (CRP) was assayed from saliva. RESULTS At baseline, shorter TST was associated with more emotional risk among adolescents with higher CRP (b = -0.014, p = 0.007). Greater eveningness was related to more behavioral risk in the context of lower IL-6 (b = -0.142, p = 0.005). Following treatment, lower baseline IL-6 was associated with reduced behavioral risk (Χ2 = 8.06, p = 0.045) and lower baseline CRP was related to reduced physical health risk (Χ2 = 9.34, p = 0.025). Baseline inflammatory markers were not significantly associated with sleep, circadian, or other health domain change following treatment. CONCLUSIONS There was cross-sectional evidence that sleep and circadian dysfunction differentially relate to emotional and behavioral health risk for high and low levels of inflammatory markers. Longitudinal analyses indicated that lower levels of baseline inflammatory markers may be related to better treatment response to a sleep-based intervention.
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Affiliation(s)
- Emily A Dolsen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA.
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The ratio of morning cortisol to CRP prospectively predicts first-onset depression in at-risk adolescents. Soc Sci Med 2021; 281:114098. [PMID: 34126291 DOI: 10.1016/j.socscimed.2021.114098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/25/2021] [Accepted: 05/31/2021] [Indexed: 12/22/2022]
Abstract
RATIONALE Early-onset adolescent depression is related to poor prognosis and a range of psychiatric and medical comorbidities later in life, making the identification of a priori risk factors for depression highly important. Increasingly, dysregulated levels of immune and neuroendocrine markers, such as C-reactive protein (CRP) and cortisol, have been demonstrated as both precursors to and consequences of depression. However, longitudinal research with adolescent populations is limited and demonstrates mixed immuno-endocrine-depression links. OBJECTIVE This study explored the putative bidirectional relationship between salivary measures of cortisol (Cort) and CRP, including the novel Cort:CRP ratio and depression. METHODS Participants from the randomized control trial 'Sleep and Education: learning New Skills Early' (SENSE) Study were 122 adolescents at risk for depression (73 females) aged 12-16 years (M = 12.71 years, SD = 1.01 years) assessed at baseline (T1), post-intervention (T2), and a two-year follow-up (T3). RESULTS Logistic regression results demonstrated that adolescents with higher T1 Cort:CRPmorn ratio levels were two-fold more likely to develop a first-onset depressive disorder from T2 to T3 as compared to adolescents with lower Cort:CRPmorn ratio levels, β = 0.73, t (36) = 2.15, p = .04, OR = 2.08. This effect was not moderated by treatment condition (β = -1.38, t (13) = -1.33, p = .20) and did not change when controlling for known risk factors for depression, including sex, age, body-mass index, socio-economic status, T1 anxiety disorder, nor T1 sleep disturbance, anxiety, or depressive symptoms (β = 0.91, t (31) = 2.14, p = .04). CONCLUSION Results highlight potential immuno-endocrine dysregulation as an underlying risk factor for adolescent first-onset depression, and may inform the development of targeted, preventative biobehavioral treatment strategies for youth depression.
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Pathways to well-being: Untangling the causal relationships among biopsychosocial variables. Soc Sci Med 2021; 272:112846. [DOI: 10.1016/j.socscimed.2020.112846] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 12/30/2019] [Accepted: 02/08/2020] [Indexed: 02/07/2023]
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Salzmann S, Euteneuer F, Laferton JAC, Shedden-Mora MC, Schedlowski M, Moosdorf R, Rief W. IL-8 and CRP moderate the effects of preoperative psychological interventions on postoperative long-term outcomes 6 months after CABG surgery - The randomized controlled PSY-HEART trial. Brain Behav Immun 2021; 91:202-211. [PMID: 33002633 DOI: 10.1016/j.bbi.2020.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Inflammation has been related to several somatic and psychological disorders and may moderate effects of psychological interventions. In the PSY-HEART trial patients benefitted from preoperative psychological interventions before undergoing coronary artery bypass graft surgery (CABG) and, if necessary, concomitant valvular surgery, compared to standard medical care. In this study we examined whether patients' baseline inflammatory status moderated the intervention effects. MATERIAL AND METHODS In a prospective three-arm randomized clinical trial with 6-months follow-up, 124 patients scheduled for CABG surgery alone or concomitant with valvular surgery were randomized to (i) standard medical care only (SMC) or two preoperative psychological interventions: (ii) CBT-based optimizing expectations (EXPECT) and an (iii) an active control group focusing on emotional support (SUPPORT). Available baseline CRP- (n = 79), IL-6- (n = 78), IL-8- (n = 78) and TNF-alpha-(n = 80) parameters were considered as potential moderators (CRP as a categorical and continuous moderator). Linear mixed model analyses were calculated to test whether baseline inflammatory levels moderated intervention effects on disability, mental and physical quality of life at 6 months after surgery. RESULTS IL-8 moderated intervention effects on patients' disability and categorical CRP moderated intervention effects on mental quality of life. Follow-up tests indicated that EXPECT (and in part SUPPORT) led to lower postoperative disability and higher mental quality of life compared to SMC in patients with low baseline inflammatory markers. EXPECT indicated higher mental quality of life compared to SUPPORT in the high CRP subgroup. Patients in the SMC group had higher mental quality of life in the high CRP subgroup compared to the low CRP subgroup. CONCLUSION Especially for patients with a lower inflammatory baseline status preoperative psychological interventions might be helpful to optimize long-term CABG surgery outcomes.
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Affiliation(s)
- Stefan Salzmann
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany; Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany; Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Meike C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Clinic Essen, Essen, Germany; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institute, 17177 Stockholm, Sweden
| | - Rainer Moosdorf
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
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35
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Belliveau C, Nagy C, Escobar S, Mechawar N, Turecki G, Rej S, Torres-Platas SG. Effects of Mindfulness-Based Cognitive Therapy on Peripheral Markers of Stress and Inflammation in Older-Adults With Depression and Anxiety: A Parallel Analysis of a Randomized Controlled Trial. Front Psychiatry 2021; 12:804269. [PMID: 35002817 PMCID: PMC8739479 DOI: 10.3389/fpsyt.2021.804269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Depression and anxiety are prevalent in older-adults and often difficult to treat: up to 55% of patients are unresponsive to pharmacotherapy. Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment, however, its biological mechanisms remain unknown in older-adults. Methods: We examined if, in older-adults, decreased depression and anxiety symptoms after MBCT are associated with changes in the expression levels of C-reactive protein, Interleukin-1β, Monocyte chemoattractant protein-1 and mineralocorticoid receptor compared to treatment as usual (TAU). Older-adults (age ≥60) with depression and anxiety were randomized to MBCT or treatment as usual. Gene expression levels from blood samples were measured using quantitative polymerase chain reaction (n = 37) at baseline and after 8-weeks of MBCT or TAU. Results: As previously published, we found a significant reduction in symptoms of depression F (1, 35) = 10.68, p = 0.002, partial η2 = 0.23 and anxiety F (1, 35) = 9.36, p = 0.004, partial η2 = 0.21 in geriatric participants following MBCT compared to TAU. However, the expression levels of measured genes were not significantly different between groups and were not associated with changes in depression and anxiety symptoms. Conclusion: Our results suggest that the symptom reduction following MBCT in older-adults may not be accompanied by changes in the stress-response and inflammatory pathways. Future research should address other potential biological alterations associated to MBCT that may be responsible for the reduction of symptoms.
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Affiliation(s)
- Claudia Belliveau
- McGill Group for Suicide Studies (MGSS), Douglas Mental Health University Institute, Montreal, QC, Canada.,Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Corina Nagy
- McGill Group for Suicide Studies (MGSS), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sophia Escobar
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Naguib Mechawar
- McGill Group for Suicide Studies (MGSS), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies (MGSS), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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36
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Strawbridge R, Marwood L, King S, Young AH, Pariante CM, Colasanti A, Cleare AJ. Inflammatory Proteins and Clinical Response to Psychological Therapy in Patients with Depression: An Exploratory Study. J Clin Med 2020; 9:jcm9123918. [PMID: 33276697 PMCID: PMC7761611 DOI: 10.3390/jcm9123918] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
In people with depression, immune dysfunctions have been linked with treatment non-response, but examinations of psychological therapy outcomes, particularly longitudinal biomarker studies, are rare. This study investigated relationships between inflammation, depressive subtypes and clinical outcomes to psychological therapy. Adults with depression (n = 96) were assessed before and after a course of naturalistically-delivered psychological therapy. In total, 32 serum inflammatory proteins were examined alongside therapy outcomes and depressive subtypes (somatic/cognitive symptom subtype, and bipolar/unipolar depression). Overall, 49% of participants responded to treatment. High levels of tumour necrosis factor (TNFα), interleukin-6 (IL-6) and soluble intracellular adhesion molecule-1 (sICAM1), and low interferon-γ (IFNγ), preceded a poorer response to therapy. After therapy, non-responders had elevated c-reactive protein (CRP), thymus and activation-regulated chemokine (TARC) and macrophage chemoattractant protein-4 (MCP4), and attenuated IFNy. Non-somatic depressive symptoms were universally not associated with proteins, while somatic-depressive symptom severity was positively correlated with several pro-inflammatory markers. In the somatic subgroup only, IL-6 and serum amyloid alpha (SAA) decreased between pre- and post-therapy timepoints. Regardless of treatment response, IL-7, IL-8, IL-15 and IL-17 increased over time. These results suggest that inflammation is associated with somatic symptoms of depression and non-response to psychological therapy. Future work may enhance the prospective prediction of treatment-response by examining larger samples of individuals undertaking standardised treatment programmes.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
- Correspondence:
| | - Lindsey Marwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
| | - Sinead King
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Carmine M. Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Alessandro Colasanti
- Department of Neuroscience, Brighton and Sussex Medical School, Sussex University, Brighton BN1 9PX, UK;
| | - Anthony J. Cleare
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London SE5 8AZ, UK; (L.M.); (S.K.); (A.H.Y.); (C.M.P.); (A.J.C.)
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
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Alessi MG, Bennett JM. Mental health is the health of the whole body: How psychoneuroimmunology & health psychology can inform & improve treatment. J Eval Clin Pract 2020; 26:1539-1547. [PMID: 32171052 DOI: 10.1111/jep.13386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/12/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Converging and accumulating evidence for the cross-communication among the nervous, immune, and endocrine systems, a field of study known as psychoneuroimmunology, implicates immunological dysfunction as a shared and common mechanism of both mental and physical illness. For example, psychiatric disorders like schizophrenia, bipolar disorder, major depression, and anxiety disorders have higher prevalence rates across a spectrum of autoimmune conditions compared to the general population. Additionally, subclinical immunological abnormalities are observed in a variety of psychiatric conditions, with chronic inflammation most extensively studied in the pathophysiology of depression. These observations blur the historical distinctions between mental and physical illness, yet clinical practice remains fragmented and primarily focused on differentially treating individual symptoms. PROPOSED THESIS Therapeutically targeting inflammation offers translational opportunities for integrating mental and physical healthcare, a key niche of the interdisciplinary field of health psychology. CONCLUSION Utilizing a psychoneuroimmunological lens, health psychologists and clinicians can reconceptualize healthcare through integrative treatment approaches and advocacy for comprehensive policy-level reform at both the individual-level of care as well as community-wide prevention approaches.
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Affiliation(s)
- Maria G Alessi
- Health Psychology PhD Program, UNC Charlotte, Charlotte, North Carolina, USA
| | - Jeanette M Bennett
- Health Psychology PhD Program, UNC Charlotte, Charlotte, North Carolina, USA.,Department of Psychological Science, UNC Charlotte, Charlotte, North Carolina, USA
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38
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Blues in the Brain and Beyond: Molecular Bases of Major Depressive Disorder and Relative Pharmacological and Non-Pharmacological Treatments. Genes (Basel) 2020; 11:genes11091089. [PMID: 32961910 PMCID: PMC7564223 DOI: 10.3390/genes11091089] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Despite the extensive research conducted in recent decades, the molecular mechanisms underlying major depressive disorder (MDD) and relative evidence-based treatments remain unclear. Various hypotheses have been successively proposed, involving different biological systems. This narrative review aims to critically illustrate the main pathogenic hypotheses of MDD, ranging from the historical ones based on the monoaminergic and neurotrophic theories, through the subsequent neurodevelopmental, glutamatergic, GABAergic, inflammatory/immune and endocrine explanations, until the most recent evidence postulating a role for fatty acids and the gut microbiota. Moreover, the molecular effects of established both pharmacological and non-pharmacological approaches for MDD are also reviewed. Overall, the existing literature indicates that the molecular mechanisms described in the context of these different hypotheses, rather than representing alternative ones to each other, are likely to contribute together, often with reciprocal interactions, to the development of MDD and to the effectiveness of treatments, and points at the need for further research efforts in this field.
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39
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Salwen-Deremer JK, Siegel CA, Smith MT. Cognitive Behavioral Therapy for Insomnia: A Promising Treatment for Insomnia, Pain, and Depression in Patients With IBD. CROHN'S & COLITIS 360 2020; 2:otaa052. [PMID: 36776493 PMCID: PMC9802437 DOI: 10.1093/crocol/otaa052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Indexed: 12/18/2022] Open
Abstract
Over 75% of people with active inflammatory bowel diseases (IBDs) report sleep disturbances, which heighten risk for IBD relapse and flares. Despite mounting evidence for sleep disturbances in IBD, discussion of treatment is severely limited. The most common sleep disturbance, insomnia, occurs in over 50% of adults with chronic health conditions. Herein we describe the gold standard treatment for insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I). Although yet to be studied in IBD, CBT-I reduces a number of IBD-related comorbidities, including chronic pain, depression, and systemic inflammation. We describe treatment with CBT-I, the impact of CBT-I on these comorbidities, and recommendations for providers.
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Affiliation(s)
- Jessica K Salwen-Deremer
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA,Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA,Address correspondence to: Jessica K. Salwen-Deremer, PhD, One Medical Center Drive, Lebanon, NH 03756 ()
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Michael T Smith
- Department of Psychiatry, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Nursing, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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40
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Abstract
In major depression, remission rate in response to monoaminergic antidepressant is around 50%. The lack of strong synergies between classical antidepressants and psychotherapy may be due to the molecular effects of classical antidepressants. They modulate synapses but they do not substantially influence synaptogenesis. They also increase brain-derived neurotrophic factor (BDNF). However, for activity-dependent plasticity, BDNF release has to work in concert with activation of synaptogenesis. There has been considerable excitement about ketamine's antidepressant effect. Ketamine leads to fast changes in synaptic function and plasticity that go well beyond effects of classical antidepressants. As a result, ketamine may turn out to have the capacity to considerably enhance the effects of psychotherapy. Such enhancing effects may become an important clinical indication for ketamine since its purely pharmacological effect is transient. This editorial outlines some mechanistic hypotheses, how Behavioral Activation, Trauma-Focused Psychotherapies and Humanistic Psychotherapy may specifically prolong ketamine's antidepressant effects.
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41
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Horn SR, Fisher PA, Pfeifer JH, Allen NB, Berkman ET. Levers and barriers to success in the use of translational neuroscience for the prevention and treatment of mental health and promotion of well-being across the lifespan. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:38-48. [PMID: 31868386 DOI: 10.1037/abn0000465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Neuroscientific tools and approaches such as neuroimaging, measures of neuroendocrine and psychoneuroimmune activity, and peripheral physiology are increasingly used in clinical science and health psychology research. We define translational neuroscience (TN) as a systematic, theory-driven approach that aims to develop and leverage basic and clinical neuroscientific knowledge to aid the development and optimization of clinical and public health interventions. There is considerable potential across basic and clinical science fields for this approach to provide insights into mental and physical health pathology that had previously been inaccessible. For example, TN might hold the potential to enhance diagnostic specificity, better recognize increased vulnerability in at-risk populations, and augment intervention efficacy. Despite this potential, there has been limited consideration of the advantages and limitations of such an approach. In this article, we articulate extant challenges in defining TN and propose a unifying conceptualization. We illustrate how TN can inform the application of neuroscientific tools to realistically guide clinical research and inform intervention design. We outline specific leverage points of the TN approach and barriers to progress. Ten principles of TN are presented to guide and shape the emerging field. We close by articulating ongoing issues facing TN research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Santoft F, Hedman-Lagerlöf E, Salomonsson S, Lindsäter E, Ljótsson B, Kecklund G, Lekander M, Andreasson A. Inflammatory cytokines in patients with common mental disorders treated with cognitive behavior therapy. Brain Behav Immun Health 2020; 3:100045. [PMID: 34589836 PMCID: PMC8474381 DOI: 10.1016/j.bbih.2020.100045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 01/24/2023] Open
Abstract
Peripheral inflammation has been found associated with psychiatric disorders. However, results are inconclusive as to its role in common mental disorders (CMDs), i.e., depression, anxiety, insomnia and stress-related disorders. Further, some research suggests that cognitive behavior therapy (CBT) could reduce inflammatory markers in CMDs. In the present study, we measured pro-inflammatory cytokines (tumor necrosis factor alpha [TNF-α], interleukin-6 [IL-6] and IL-8) pre- and post-treatment in two clinical trials (N = 367) investigating CBT for patients with CMDs in primary care. We hypothesized that higher levels of these cytokines would be associated with more severe psychiatric symptoms (i.e., symptoms of depression, stress and anxiety). We also hypothesized that level of cytokines would decrease after CBT and that the reduced levels would correlate with a reduction in symptoms. Results showed that in men, higher levels of TNF-α were associated with more severe psychiatric symptoms. Further, age moderated the association between TNF-α, as well as IL-6, and stress, and exploratory stratified analyses revealed significant associations in subgroups. No other significant associations between cytokines and psychiatric symptoms were found. None of the cytokines were reduced following CBT, and the marked improvements in psychiatric symptoms after treatment were not associated with changes in cytokines. In conclusion, although inflammation might be of relevance in subgroups, it seems to be of limited importance for clinical improvements across mild to moderate CMDs. Immune dysregulation has been implicated in the etiology of common mental disorders. Pro-inflammatory cytokines were measured pre and post cognitive behavior therapy. Baseline associations between cytokines and symptoms were only found in subgroups. Cytokine levels (TNF-α, IL-6 and IL-8) were not reduced after treatment. Symptom improvement was not accompanied by reductions in cytokine levels.
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Affiliation(s)
- Fredrik Santoft
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Corresponding author. Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 77, Stockholm, Sweden.
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sigrid Salomonsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elin Lindsäter
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Göran Kecklund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Mats Lekander
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Anna Andreasson
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Psychology, Macquarie University, North Ryde, Australia
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43
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Pearlstein JG, Staudenmaier PJ, West AE, Geraghty S, Cosgrove VE. Immune response to stress induction as a predictor of cognitive-behavioral therapy outcomes in adolescent mood disorders: A pilot study. J Psychiatr Res 2020; 120:56-63. [PMID: 31634750 DOI: 10.1016/j.jpsychires.2019.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022]
Abstract
Cognitive-behavioral therapy (CBT) alleviates symptoms of depression in youth with bipolar disorder (BD) and major depressive disorder (MDD). Empirical research has linked inflammatory markers to depressive symptoms and acute psychosocial stress; however, a gap remains as to whether immune response to stress may serve as a putative mechanism of treatment. This preliminary pilot study determined the modest feasibility of assessing psychobiological response to stress as a predictor of CBT outcomes for youth with mood disorders. We evaluated whether participation in a 10-session group-CBT intervention for mood disorders altered inflammatory response to a laboratory psychosocial stress induction and if this alteration in immune stress responsivity was related to a decrease in depressive symptoms. Thirty-four youth (age M = 15.03, SD = 1.91) diagnosed with BD or MDD participated in a 10-session CBT group and pre- and post-group assessments; twenty-eight participants who completed the group had usable cytokine data. Pre- and post-group assessments included stress induction with the Trier Social Stress Test (TSST) during which inflammatory cytokines were measured at baseline (time 0) and after the TSST at 30, 60, and 90 min. Results suggest it is modestly feasible to measure immune response to stress alongside CBT treatment for adolescent mood disorders. Our findings were mixed; across seven cytokines, hierarchical linear models indicated two cytokines, IL6 and IL12, were sensitive to acute laboratory stress. We also found significant correlations between life stress, inflammation, and depression both pre- and post- CBT group. Inflammation pre-group, as measured by IL12 and IL1 β predicted depressive symptoms following treatment. Although we did not find significant within-subject reductions in inflammation, chronic stress predicted changes in IL β, signaling the central role of chronic stress. This study offers preliminary evidence that immune responsivity to stress induction could serve as a mechanism of treatment for mood disorders in youth, indicating a potential marker for more personalized model of healthcare.
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Affiliation(s)
| | | | - Amy E West
- University of Southern California, United States
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Li X, Sun N, Yang C, Liu Z, Li X, Zhang K. C-Reactive Protein Gene Variants in Depressive Symptoms & Antidepressants Efficacy. Psychiatry Investig 2019; 16:940-947. [PMID: 31711279 PMCID: PMC6933135 DOI: 10.30773/pi.2019.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/05/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Although the pathogenesis of depression remains unclear, C-reactive protein (CRP) levels are commonly elevated in depressed patients. Thus, CRP single-nucleotide polymorphisms (SNPs) that influence CRP levels may be associated with depression. In the present study, we explored whether CRP SNPs are related to depressive symptoms and antidepressants efficacy in Han Chinese patients. METHODS We analyzed data from 440 patients with first-episode depression. We obtained genome CRP SNPs, scores of the 17-item Hamilton Rating Scale for Depression 17 (HAMD17) and its four-factor at baseline and after 6 weeks. Quantitative trait analysis was performed using UNPHASED software and curative effects were analyzed using SPSS software. RESULTS Male patients with SNP rs1800947G exhibited lower insomnia scores and rs2794521CC exhibited lower scores of anxiety/ physical symptoms, total HAMD17 score. Female patients with rs2794521TT exhibited higher scores of insomnia and lower antidepressants efficacy. CONCLUSION CRP SNPs rs1800947 and rs2794521 may be associated with depressive symptoms in patients with depression in a sexspecific fashion. Furthermore, rs2794521 may be a predictor of the efficacy of antidepressants in female patients.
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Affiliation(s)
- Xinxin Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinrong Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
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45
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Portelli J, Wiers CE, Li X, Deschaine SL, McDiarmid GR, Bermpohl F, Leggio L. Peripheral proinflammatory markers are upregulated in abstinent alcohol-dependent patients but are not affected by cognitive bias modification: Preliminary findings. Drug Alcohol Depend 2019; 204:107553. [PMID: 31541874 PMCID: PMC6913873 DOI: 10.1016/j.drugalcdep.2019.107553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/28/2019] [Accepted: 07/07/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Inflammatory pathways are known to be negatively affected in patients with alcohol use disorder (AUD). Cognitive bias modification (CBM), an emerging behavioral treatment that involves the 're-training' of cognitive biases using computerized tasks, has been reported to reduce alcohol craving and relapse rates. The aim of this study was to compare peripheral concentrations of the proinflammatory biomarkers IL-18, IL-6, IL-1β, TNF-α and CRP in AUD patients versus controls and to identify whether CBM treatment affected these biomarkers in AUD patients. METHODS This 3-week double-blind randomized controlled study tested 36 male abstinent AUD patients receiving CBM or placebo-training, who were also compared to 18 male healthy controls. The approach avoidance task (AAT) was used to test the AUD patients before and after training. CBM training took place over 6 sessions, using a joystick-based approach-avoidance task. Blood samples were collected after the pre- and post-AAT test sessions for the AUD groups, and during an outpatient appointment with the controls. RESULTS AUD patients, versus controls, presented with significantly higher plasma levels of TNF- α (P < 0.0001) and CRP (P = 0.0031). No changes in the CBM versus placebo groups were noted in IL-18, TNF-α and CRP concentrations following pre-post change or within group pretest- posttest analysis. IL-6 and IL-1β levels fell under the lower detection limit, thus were not included in the final analyses. CONCLUSIONS This study confirms that the inflammatory system is altered in AUD. This was the first study that investigated whether CBM training affected proinflammatory markers in AUD patients.
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Affiliation(s)
- Jeanelle Portelli
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Corinde E. Wiers
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Sara L. Deschaine
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Gray R. McDiarmid
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Germany.,Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Germany
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, USA; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
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Steptoe A, Fancourt D. Protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:889-890. [PMID: 31631866 DOI: 10.1016/s2215-0366(19)30393-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK.
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
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47
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Yuan N, Chen Y, Xia Y, Dai J, Liu C. Inflammation-related biomarkers in major psychiatric disorders: a cross-disorder assessment of reproducibility and specificity in 43 meta-analyses. Transl Psychiatry 2019; 9:233. [PMID: 31534116 PMCID: PMC6751188 DOI: 10.1038/s41398-019-0570-y] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
Inflammation is a natural defence response of the immune system against environmental insult, stress and injury, but hyper- and hypo-inflammatory responses can trigger diseases. Accumulating evidence suggests that inflammation is involved in multiple psychiatric disorders. Using inflammation-related factors as biomarkers of psychiatric disorders requires the proof of reproducibility and specificity of the changes in different disorders, which remains to be established. We performed a cross-disorder study by systematically evaluating the meta-analysis results of inflammation-related factors in eight major psychiatric disorders, including schizophrenia (SCZ), bipolar disorder (BD), autism spectrum disorder (ASD), major depression disorder (MDD), post-trauma stress disorder (PTSD), sleeping disorder (SD), obsessive-compulsive disorder (OCD) and suicide. A total of 43 meta-analyses involving 704 publications on 44 inflammation-related factors were included in the study. We calculated the effect size and statistical power for every inflammation-related factor in each disorder. Our analyses showed that well-powered case-control studies provided more consistent results than underpowered studies when one factor was meta-analysed by different researchers. After removing underpowered studies, 30 of the 44 inflammation-related factors showed significant alterations in at least one disorder based on well-powered meta-analyses. Eleven of them changed in patients of more than two disorders when compared with the controls. A few inflammation-related factors showed unique changes in specific disorders (e.g., IL-4 increased in BD, decreased in suicide, but had no change in MDD, ASD, PTSD and SCZ). MDD had the largest number of changes while SD has the least. Clustering analysis showed that closely related disorders share similar patterns of inflammatory changes, as genome-wide genetic studies have found. According to the effect size obtained from the meta-analyses, 13 inflammation-related factors would need <50 cases and 50 controls to achieve 80% power to show significant differences (p < 0.0016) between patients and controls. Changes in different states of MDD, SCZ or BD were also observed in various comparisons. Studies comparing first-episode SCZ to controls may have more reproducible findings than those comparing pre- and post-treatment results. Longitudinal, system-wide studies of inflammation regulation that can differentiate trait- and state-specific changes will be needed to establish valuable biomarkers.
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Affiliation(s)
- Ning Yuan
- Department of Psychiatry, The Second Xiangya Hospital; Mental health Institute of the Second Xiangya Hospital; National Clinical Research Center on Mental Disorders; National Technology Institute on Mental Disorders, Central South University, Changsha, Hunan, China
- Department of Psychiatry, Hunan Provincial Brain Hospital; Clinical Research Center for Mental Behavioral Disorder in Hunan Province, Clinical Medical School of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yu Chen
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Yan Xia
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jiacheng Dai
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Chunyu Liu
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA.
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi, China.
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48
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It is time to investigate integrative approaches to enhance treatment outcomes for depression? Med Hypotheses 2019; 126:82-94. [DOI: 10.1016/j.mehy.2019.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/11/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
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49
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Liu CH, Zhang GZ, Li B, Li M, Woelfer M, Walter M, Wang L. Role of inflammation in depression relapse. J Neuroinflammation 2019; 16:90. [PMID: 30995920 PMCID: PMC6472093 DOI: 10.1186/s12974-019-1475-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/01/2019] [Indexed: 12/13/2022] Open
Abstract
Major depressive disorder (MDD) is a leading cause of disability worldwide. After the first episode, patients with remitted MDD have a 60% chance of experiencing a second episode. Consideration of therapy continuation should be viewed in terms of the balance between the adverse effects of medication and the need to prevent a possible relapse. Relapse during the early stages of MDD could be prevented more efficiently by conducting individual risk assessments and providing justification for continuing therapy. Our previous work established the neuroimaging markers of relapse by comparing patients with recurrent major depressive disorder (rMDD) in depressive and remitted states. However, it is not known which of these markers are trait markers that present before initial relapse and, consequently, predict disease course. Here, we first describe how inflammation can be translated to subtype-specific clinical features and suggest how this could be used to facilitate clinical diagnosis and treatment. Next, we address the central and peripheral functional state of the immune system in patients with MDD. In addition, we emphasize the important link between the number of depressive episodes and rMDD and use neuroimaging to propose a model for the latter. Last, we address how inflammation can affect brain circuits, providing a possible mechanism for rMDD. Our review suggests a link between inflammatory processes and brain region/circuits in rMDD.
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Affiliation(s)
- Chun-Hong Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, 100010, China
| | - Guang-Zhong Zhang
- Dermatological Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Bin Li
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Meng Li
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany
| | - Marie Woelfer
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany.,Department of Psychiatry and Psychotherapy, University of Tuebingen, Tubeingen, 72074, Germany.,Leibniz Institute for Neurobiology, Magdeburg, 39118, Germany
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06030, USA.
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Zabihiyeganeh M, Vafaee Afshar S, Amini Kadijani A, Jafari D, Bagherifard A, Janbozorgi M, Akbari A, Mirzaei A. The effect of cognitive behavioral therapy on the circulating proinflammatory cytokines of fibromyalgia patients: A pilot controlled clinical trial. Gen Hosp Psychiatry 2019; 57:23-28. [PMID: 30669022 DOI: 10.1016/j.genhosppsych.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES There is no consensus over the effect size of cognitive behavioral therapy (CBT) in the treatment of fibromyalgia (FM). This study aims to evaluate the effect of CBT on FM patients, through assessing circulating proinflammatory cytokines. METHODS A controlled, single-blind, parallel clinical trial was performed with 21 FM patients in each group. Sixteen FM patients in the intervention group (CBT) and 17 FM patients in the control group (waiting-list) completed the study. For the intervention group, traditional face-to-face CBT was performed for groups of 10 and 11 patients in 20 sessions. Fibromyalgia Impact Questionnaire (FIQ), widespread pain index (WPI), circulating IL-6, IL-8, and TNF-α level were evaluated before and after the intervention using enzyme-linked immunosorbent assay. Intention-to-treat analysis was performed as the primary analysis. RESULTS The average changes of factors examined were as follows: FIQ score -0.61 ± 5.5 in the waiting-list group and 10.2 ± 14.9 in the CBT group (p = 0.012); WPI -0.33 ± 1.1 in the waiting-list group and 2.4 ± 3.1 in the CBT group (p = 0.002); serum IL-6 level -0.05 ± 0.86 pg/ml in the waiting-list group and 1.5 ± 2.4 pg/ml in the CBT group (p = 0.002); serum IL-8 level - 0.55 ± 0.2.5 pg/ml in the waiting-list group and 5 ± 5.9 pg/ml in the CBT group (p = 0.002); serum TNF-α level 0.67 ± 1.8 pg/ml in the waiting-list group and 0.7 ± 1.6 pg/ml in the CBT group (p = 0.89). CONCLUSION Reductions in proinflammatory cytokines after CBT compared with a waiting-list control group confirm the potential value of these biomarkers as surrogate outcome measures in FM.
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Affiliation(s)
- Mozhdeh Zabihiyeganeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Vafaee Afshar
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Azade Amini Kadijani
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davod Jafari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Janbozorgi
- Department of Psychology, Research Institute of Hawzah and University, Ghom, Iran
| | - Abolfazl Akbari
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
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