Mood Worsening on Days with High Pollen Counts is associated with a Summer Pattern of Seasonality

Associations between ambient pollen exposure and measures of cognitive performance

Background

Prior research suggests pollen allergies may be associated with cognitive function, although the effect sizes and specific cognitive outcomes varied across studies. With pollen seasons starting earlier and intensifying due to climate change, understanding the effects of pollen exposure on cognition is increasingly relevant. This study investigated the relationship between ambient pollen exposure and cognitive performance in Swiss adults.

Methods

Four cognitive assessments were used to measure the daily performance of 392 participants (299 with pollen allergies) over a 10-day period during pollen season. We used generalized additive mixed models to assess the exposure-response relationship between individualized pollen exposure and cognitive performance, as well as allergic symptom severity and cognitive performance, adjusting for individual characteristics and time-varying environmental and individual confounders (e.g., air pollution, weather, and coffee intake).

Results

We did not find any statistically significant relationships between pollen exposure or severity of allergic symptoms and overall score or reaction time on tests of response inhibition, attention, and visual-spatial memory. We observed a 1% increase [95% confidence interval (CI) = 0.13%, 2.0%] in average reaction time on a test of grammatical reasoning for allergic participants at an exposure of 300 pollen/m3 (12-hour average).

Conclusion

Overall, our study population did not exhibit changes in cognitive performance related to pollen exposure or perceived allergic symptoms. A marginal, but statistically significant effect on the response time of pollen-allergic individuals was observed for a test of verbal reasoning, however, this is likely to be a chance finding considering the number of exposures and outcomes evaluated.

Sunshine and Sadness: A Case Report on Summer Season Depression

Seasonal affective disorder (SAD) is typically associated with winter; however, its less common variant, summertime depression, presents with depressive episodes during the summer months. We report a case of a 46-year-old male patient with recurrent summertime depressive episodes characterized by low mood, fatigue, anhedonia, insomnia, and loss of appetite, each resolving with the onset of the winter season. Our patient's history of summertime depression aligned with the atypical SAD symptoms, including irritability and weight loss, commonly associated with non-seasonal depression. A diagnosis of major depressive disorder, moderate severity, with a seasonal pattern was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria, and the Seasonal Pattern Assessment Questionnaire. The patient was initiated on desvenlafaxine 50 mg once a day with a dose titrated to 100 mg once a day in two weeks, while his previous mood stabilizer oxcarbazepine 600 mg in two divided doses was continued. He achieved remission within four to six weeks with his Hamilton Rating Scale for Depression score decreasing from 18 to seven. Our case underscores the importance of recognizing seasonal patterns in affective disorders within tropical climates, like India, and highlights potential environmental and physiological mechanisms, such as heat stress and immune responses, contributing to summertime SAD.

Uncovering a Severe Patient Group With Pollen-Related Extrarespiratory Allergic Symptoms: A Year-Long Diary Survey in Japan

BACKGROUND

The most common symptoms of pollen allergy are rhinitis and conjunctivitis. However, in real-world clinical practice, we sometimes encounter patients with pollen allergy suffering from severe extrarespiratory symptoms including skin, gastrointestinal, or flu-like symptoms in relation to exposure to sensitized pollen.

OBJECTIVE

To elucidate the extrarespiratory symptoms in patients with pollen allergy.

METHODS

We performed a non-drug-focused prospective study of patients with pollen allergy (n = 384). During the 1-year observational period, they were asked to complete a weekly electronic diary consisting of visual analog scale (VAS) scores to assess all symptoms experienced in various organs over the past week. An association between seasonal pollen levels and seasonal increase in VAS scores was evaluated using a mixed-effects model for repeated measures. A k-means cluster analysis was performed to identify a group of patients experiencing stronger extrarespiratory symptoms.

RESULTS

In patients sensitized to grass or birch pollen, higher seasonal levels of these pollen grains were associated with higher VAS scores for headache, gastrointestinal symptoms, skin symptoms, and fatigue. A cluster analysis identified a group of severe pollen-allergic patients with higher extrarespiratory symptoms (n = 42). This group was characterized by a higher frequency of comorbid food allergy/atopic dermatitis, higher rate of IgE sensitization to pollens, and higher impaired activity and work productivity.

CONCLUSIONS

This 1-year survey identified a small but nonnegligible group of patients with pollen-related extrarespiratory symptoms. More attention should be paid to this patient group considering their impaired activity and work productivity.

Clinical characteristics and sociodemographic features of psychotic major depression

BACKGROUND

Psychotic major depression (PMD) is a subtype of depression with a poor prognosis. Previous studies have failed to find many differences between patients with PMD and those with non-psychotic major depression (NMD) or schizophrenia (SZ). We compared sociodemographic factors (including season of conception) and clinical characteristics between patients with PMD, NMD, and schizophrenia. Our aim was to provide data to help inform clinical diagnoses and future etiology research.

METHODS

This study used data of all patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases who had experienced an episode of PMD (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0-2/9, F33.0-2/9), and SZ (F20-20.9). Data on sex, main discharge diagnosis, date of birth, ethnicity, family history of psychiatric diseases, marital status, age at first onset, education, allergy history, and presence of trigger events were collected. Odds ratios (OR) were calculated using logistic regression analyses. Missing values were filled using the k-nearest neighbor method.

RESULTS

PMD patients were more likely to have a family history of psychiatric diseases in their first-, second-, and third-degree relatives ([OR] 1.701, 95% confidence interval [CI] 1.019-2.804) and to have obtained a higher level of education (OR 1.451, 95% CI 1.168-1.808) compared with depression patients without psychotic features. Compared to PMD patients, schizophrenia patients had lower education (OR 0.604, 95% CI 0.492-0.741), were more often divorced (OR 3.087, 95% CI 1.168-10.096), had a younger age of onset (OR 0.934, 95% CI 0.914-0.954), less likely to have a history of allergies (OR 0.604, 95% CI 0.492-0.741), and less likely to have experienced a trigger event 1 year before first onset (OR 0.420, 95% CI 0.267-0.661). Season of conception, ethnicity, and sex did not differ significantly between PMD and NMD or schizophrenia and PMD.

CONCLUSIONS

PMD patients have more similarities with NMD patients than SZ patients in terms of demographic and clinical characteristics. The differences found between PMD and SZ, and PMD and NMD correlated with specificity of the diseases. Furthermore, allergy history should be considered in future epidemiological studies of psychotic disorders.

Can we prevent seasonal affective disorder (SAD) with melatonergic agents?

Seasonal affective disorder (SAD) is a recurrent form of major depression, particularly occurring in the winter months with a generally spontaneous remission in spring/summer. The predictable nature of this condition provides a potentially unique opportunity to prevent recurrence in sufferers of SAD. The Cochrane Review discussed here examines the evidence for melatonin and agomelatine in preventing SAD, putting its findings into their clinical context.

Seasonal affective disorder and seasonal changes in weight and sleep duration are inversely associated with plasma adiponectin levels

Overlapping pathways between mood and metabolic regulation have increasingly been reported. Although impaired regulation of adiponectin, a major metabolism-regulating hormone, has been implicated in major depressive disorder, its role in seasonal changes in mood and seasonal affective disorder-winter type (SAD), a disorder characterized by onset of mood impairment and metabolic dysregulation (e.g., carbohydrate craving and weight gain) in fall/winter and spontaneous alleviation in spring/summer, has not been previously studied. We studied a convenience sample of 636 Old Order Amish (mean (± SD), 53.6 (±14.8) years; 50.1% males), a population with self-imposed restriction on network electric light at home, and low prevalence of total SAD (t-SAD = syndromal + subsyndromal). We calculated the global seasonality score (GSS), estimated SAD and subsyndromal-SAD after obtaining Seasonal Pattern Assessment Questionnaires (SPAQs), and measured overnight fasting plasma adiponectin levels. We then tested associations between plasma adiponectin levels and GSS, t-SAD, winter-summer difference in self-reported sleep duration, and self-reported seasonal weight change, by using analysis of co-variance (ANCOVA) and linear regression analysis after adjusting for age, gender, and BMI. Participants with t-SAD (N = 14; 2.2%) had significantly lower plasma adiponectin levels (mean ± SEM, 8.76 ± 1.56 μg/mL) than those without t-SAD (mean ± SEM, 11.93 ± 0.22 μg/mL) (p = 0.035). In addition, there was significant negative association between adiponectin levels and winter-summer difference in self-reported sleep duration (p = 0.025) and between adiponectin levels and self-reported seasonal change in weight (p = 0.006). There was no significant association between GSS and adiponectin levels (p = 0.88). To our knowledge, this is the first study testing the association of SAD with adiponectin levels. Replication and extension of our findings longitudinally and, then, interventionally, may implicate low adiponectin as a novel target for therapeutic intervention in SAD.