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Magal N, Rab SL, Goldstein P, Simon L, Jiryis T, Admon R. Predicting Chronic Stress among Healthy Females Using Daily-Life Physiological and Lifestyle Features from Wearable Sensors. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2022; 6:24705470221100987. [PMID: 35911618 PMCID: PMC9329827 DOI: 10.1177/24705470221100987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/29/2022] [Indexed: 12/22/2022]
Abstract
Background Chronic stress is a highly prevalent condition that may stem from different
sources and can substantially impact physiology and behavior, potentially
leading to impaired mental and physical health. Multiple physiological and
behavioral lifestyle features can now be recorded unobtrusively in
daily-life using wearable sensors. The aim of the current study was to
identify a distinct set of physiological and behavioral lifestyle features
that are associated with elevated levels of chronic stress across different
stress sources. Methods For that, 140 healthy female participants completed the Trier inventory for
chronic stress (TICS) before wearing the Fitbit Charge3 sensor for seven
consecutive days while maintaining their daily routine. Physiological and
lifestyle features that were extracted from sensor data, alongside
demographic features, were used to predict high versus low chronic stress
with support vector machine classifiers, applying out-of-sample model
testing. Results The model achieved 79% classification accuracy for chronic stress from a
social tension source. A mixture of physiological (resting heart-rate,
heart-rate circadian characteristics), lifestyle (steps count, sleep onset
and sleep regularity) and non-sensor demographic features (smoking status)
contributed to this classification. Conclusion As wearable technologies continue to rapidly evolve, integration of
daily-life indicators could improve our understanding of chronic stress and
its impact of physiology and behavior.
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Affiliation(s)
- Noa Magal
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Sharona L Rab
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | | | - Lisa Simon
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Talita Jiryis
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Roee Admon
- School of Psychological Sciences, University of Haifa, Haifa, Israel.,The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel
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2
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Brenhouse HC, Bath KG. Bundling the haystack to find the needle: Challenges and opportunities in modeling risk and resilience following early life stress. Front Neuroendocrinol 2019; 54:100768. [PMID: 31175880 PMCID: PMC6708473 DOI: 10.1016/j.yfrne.2019.100768] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022]
Abstract
Various forms of early life adversity (ELA) have been linked with increased risk for negative health outcomes, including neuropsychiatric disorders. Understanding how the complex interplay between types, timing, duration, and severity of ELA, together with individual differences in genetic, socio-cultural, and physiological differences can mediate risk and resilience has proven difficult in population based studies. Use of animal models provides a powerful toolset to isolate key variables underlying risk for altered neural and behavioral maturational trajectories. However, a lack of clarity regarding the unique features of differing forms of adversity, lab differences in the implementation and reporting of methods, and the ability compare across labs and types of ELA has led to some confusion. Here, we highlight the diversity of approaches available, current challenges, and a possible ways forward to increase clarity and drive more meaningful and fruitful implementation and comparison of these approaches.
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Affiliation(s)
- Heather C Brenhouse
- Psychology Department, Northeastern University, 125 Nightingale Hall, Boston, MA 02115, United States.
| | - Kevin G Bath
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, 190 Thayer St. Box 1821, Providence, RI 02912, United States
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3
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Wei Y, Wang G, Wang H, He J, Zhang N, Wu Z, Xiao L, Yang C. Sex-dependent impact of different degrees of maternal separation experience on OFT behavioral performances after adult chronic unpredictable mild stress exposure in rats. Physiol Behav 2018; 194:153-161. [PMID: 29723593 DOI: 10.1016/j.physbeh.2018.04.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 12/15/2022]
Abstract
Early-life social-environmental factors are important for normal development, and different degrees of early-life stress experience have different impacts on adult behaviors and stress responsiveness. The aim of present study was to investigate the long-term effects of different degrees of maternal separation (MS) on male and female rats and subsequent responsiveness to chronic unpredictable mild stress (CUMS) exposure in adults. Sprague-Dawley (SD) newborn pups were exposed to either 15 min/day of MS (MS15), 360 min/day of MS (MS360) or no separation (NS) during postnatal day (PND)4-PND10. At PND56, behavioral tasks, including sucrose preference test (SPT), forced swimming test (FST) and open field test (OFT), were used to explore depressive and anxiety-like behaviors. Then the rats received a series of CUMS for 28 days, behavioral tasks were recorded after CUMS. Prior to CUMS, the behavioral performances in male and female rats were consistent, MS360 led to increased immobile time in FST and decreased activity in OFT, while MS15 rats exhibited behavioral performances similar to NS group. After CUMS, sexual dimorphism was observed in the OFT behavioral responses to adult stress re-exposure, but no differences in FST were observed. CUMS male rats with MS360 experiences showed the worst behavioral performances in OFT compared to those of the other male rats groups, while CUMS female rats without MS experience showed the worst behavioral performances in OFT compared to those of the other female rats groups. Both CUMS male and female rats with MS15 experiences showed better trend in OFT performances than those of CUMS rats with MS360 experience and without MS experiences. These results suggest that brief MS experiences increase the OFT behavioral resilience of rats to adult stress re-exposure, and prolonged MS promotes OFT behavioral resilience of female rats to adult stress re-exposure, while increases vulnerability of male rats to adult stress re-exposure.
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Affiliation(s)
- Yanyan Wei
- Department of Psychiatry, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China.
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Jing He
- Department of Psychiatry, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Nan Zhang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Zuotian Wu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Ling Xiao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
| | - Can Yang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan 430060, Hubei, PR China
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4
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Diamantopoulou A, Kalpachidou T, Aspiotis G, Gampierakis I, Stylianopoulou F, Stamatakis A. An early experience of mild adversity involving temporary denial of maternal contact affects the serotonergic system of adult male rats and leads to a depressive-like phenotype and inability to adapt to a chronic social stress. Physiol Behav 2018; 184:46-54. [DOI: 10.1016/j.physbeh.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/09/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
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5
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Abstract
Stress affects core body temperature (Tc). Many kinds of stress induce transient, monophasic hyperthermia, which diminishes gradually if the stressor is terminated. Stronger stressors produce a longer-lasting effect. Repeated/chronic stress induces anticipatory hyperthermia, reduces diurnal changes in Tc, or slightly increases Tc throughout the day. Animals that are exposed to chronic stress or a cold environment exhibit an enhanced hyperthermic response to a novel stress. These changes persist for several days after cessation of stress exposure. In contrast, long-lasting inescapable stress sometimes induces hypothermia. In healthy humans, psychologic stress induces slight increases in Tc, which are within the normal range of Tc or just above it. Some individuals, however, develop extremely high Tc (up to 41°C) when they are exposed to emotional events or show persistent low-grade high Tc (37-38°C) during or after chronic stress situations. In addition to the nature of the stressor itself, such stress-induced thermal responses are modulated by sex, age, ambient temperature, cage mates, past stressful experiences and cold exposure, and coping. Stress-induced hyperthermia is driven by mechanisms distinct from infectious fever, which requires inflammatory mediators. However, both stress and infection activate the dorsomedial hypothalamus-rostral medullary raphe region-sympathetic nerve axis to increase Tc.
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Affiliation(s)
- Takakazu Oka
- Department of Psychosomatic Medicine, International University of Health and Welfare Hospital, Tochigi-ken, Japan.
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6
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Evaluation of the safety of conventional lighting replacement by artificial daylight. J Microsc Ultrastruct 2017; 5:206-215. [PMID: 30023256 PMCID: PMC6025781 DOI: 10.1016/j.jmau.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/14/2017] [Indexed: 01/05/2023] Open
Abstract
Background Short morning exposure to high illuminance visible electromagnetic radiations termed as artificial daylight is beneficial for the mental health of people living in geographical areas with important seasonal changes in daylight illuminance. However, the commercial success of high illuminance light sources has raised the question of the safety of long hour exposure. Methods We have investigated the effect of the replacement of natural daylight by artificial daylight in Swiss mice raised under natural lighting conditions. Mice were monitored for neurotoxicity and general health changes. They were submitted to a battery of conventional tests for mood, motor and cognitive functions' assessment on exposure day (ED) 14 and ED20. Following sacrifice on ED21 due to marked signs of neurotoxicity, the expression of markers of inflammation and apoptosis was assessed in the entorhinal cortex and neurons were estimated in the hippocampal formation. Results Signs of severe cognitive and motor impairments, mood disorders, and hepatotoxicity were observed in animals exposed to artificial daylight on ED20, unlike on ED14 and unlike groups exposed to natural daylight or conventional lighting. Activated microglia and astrocytes were observed in the entorhinal cortex, as well as dead and dying neurons. Neuronal counts revealed massive neuronal loss in the hippocampal formation. Conclusions These results suggest that long hour exposure to high illuminance visible electromagnetic radiations induced severe alterations in brain function and general health in mice partly mediated by damages to the neocortex-entorhinal cortex-hippocampus axis. These findings raise caution over long hour use of high illuminance artificial light.
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7
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Optimized animal model to mimic the reality of stress-induced depression in the clinic. BMC Psychiatry 2017; 17:171. [PMID: 28477622 PMCID: PMC5420406 DOI: 10.1186/s12888-017-1335-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Animal models are useful tools for verifying the relationship between stress and depression; however, an operational criterion for excluding the resilient animals from the analysis has not been established yet, which hinders the model's ability to more accurately mimic the scenario in humans. METHODS To induce depression-like symptoms, rats received maternal deprivation (MD) during PND1-14, and/or chronic unpredictable stress (CUS) exposure. The latent profile analysis (LPA) was used to determine latent subgroups in treatment naive adult rats. The percentile method was used to distinguish sensitive and non-sensitive behaviors in rats. RESULTS The sucrose preference rate of treatment naive adult rats was fit using a Beta distribution, while immobility time was fit using a Gamma distribution. Indexes of behavioral tests revealed the 4-class model as the best fit for treatment naive adult rats. The incidence of stress-resilience in MD rats was significantly higher than that in CUS rats and MD + CUS rats. There was a significantly higher incidence of stress-resilience in CUS rats compared with MD + CUS rats. Recovery rate of anhedonia-like and sub anhedonia-like behaviors in CUS rats was significantly higher than that in MD and MD + CUS rats. There was a significantly higher recovery rate of anhedonia-like behaviors in MD rats compared to MD + CUS rats. CONCLUSIONS The percentile method is suitable for setting up an operational cutoff to classify depression-like, sub depression-like, and resilient behaviors in rats exposed to MD and CUS.
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8
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Steine IM, Zayats T, Stansberg C, Pallesen S, Mrdalj J, Håvik B, Soulé J, Haavik J, Milde AM, Skrede S, Murison R, Krystal J, Grønli J. Implication of NOTCH1 gene in susceptibility to anxiety and depression among sexual abuse victims. Transl Psychiatry 2016; 6:e977. [PMID: 27959334 PMCID: PMC5290341 DOI: 10.1038/tp.2016.248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 11/22/2022] Open
Abstract
Sexual abuse contributes to the development of multiple forms of psychopathology, including anxiety and depression, but the extent to which genetics contributes to these disorders among sexual abuse victims remains unclear. In this translational study, we first examined gene expression in the brains of rodents exposed to different early-life conditions (long, brief or no maternal separation). Hypothesizing that genes revealing changes in expression may have relevance for psychiatric symptoms later in life, we examined possible association of those genes with symptoms of anxiety and depression in a human sample of sexual abuse victims. Changes in rodent brain gene expression were evaluated by means of correspondence and significance analyses of microarrays by comparing brains of rodents exposed to different early-life conditions. Tag single-nucleotide polymorphisms (SNPs) of resulting candidate genes were genotyped and tested for their association with symptoms of anxiety and depression (Hospital Anxiety and Depression Scale) in a sample of 361 sexual abuse victims, using multinomial logistic regression. False discovery rate was applied to account for multiple testing in the genetic association study, with q-value of 0.05 accepted as significant. We identified four genes showing differential expression among animals subjected to different early-life conditions as well as having potential relevance to neural development or disorders: Notch1, Gabrr1, Plk5 and Zfp644. In the human sample, significant associations were observed for two NOTCH1 tag SNPs: rs11145770 (OR=2.21, q=0.043) and rs3013302 (OR=2.15, q=0.043). Our overall findings provide preliminary evidence that NOTCH1 may be implicated in the susceptibility to anxiety and depression among sexual abuse victims. The study also underscores the potential importance of animal models for future studies on the health consequences of early-life stress and the mechanisms underlying increased risk for psychiatric disorders.
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Affiliation(s)
- I M Steine
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA,Department of Clinical Psychology, University of Bergen, Christiesgate 12, 5015 Bergen, Norway. E-mail:
| | - T Zayats
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - C Stansberg
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway,Genomics Core Facility, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - S Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway,Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - J Mrdalj
- Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, Bergen, Norway,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - B Håvik
- The Norwegian Centre for Mental Disorders Research (NORMENT) and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
| | - J Soulé
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway,Department of Biology, University of Bergen, Bergen, Norway
| | - J Haavik
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - A M Milde
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway,Regional Centre for Child and Youth Mental Health and Child Welfare, Bergen, Norway
| | - S Skrede
- The Norwegian Centre for Mental Disorders Research (NORMENT) and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
| | - R Murison
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - J Krystal
- Clinical Neuroscience Division, VA National Center for PTSD, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - J Grønli
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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9
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Marti AR, Meerlo P, Grønli J, van Hasselt SJ, Mrdalj J, Pallesen S, Pedersen TT, Henriksen TEG, Skrede S. Shift in Food Intake and Changes in Metabolic Regulation and Gene Expression during Simulated Night-Shift Work: A Rat Model. Nutrients 2016; 8:nu8110712. [PMID: 27834804 PMCID: PMC5133098 DOI: 10.3390/nu8110712] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/25/2016] [Accepted: 10/28/2016] [Indexed: 12/22/2022] Open
Abstract
Night-shift work is linked to a shift in food intake toward the normal sleeping period, and to metabolic disturbance. We applied a rat model of night-shift work to assess the immediate effects of such a shift in food intake on metabolism. Male Wistar rats were subjected to 8 h of forced activity during their rest (ZT2-10) or active (ZT14-22) phase. Food intake, body weight, and body temperature were monitored across four work days and eight recovery days. Food intake gradually shifted toward rest-work hours, stabilizing on work day three. A subgroup of animals was euthanized after the third work session for analysis of metabolic gene expression in the liver by real-time polymerase chain reaction (PCR). Results show that work in the rest phase shifted food intake to rest-work hours. Moreover, liver genes related to energy storage and insulin metabolism were upregulated, and genes related to energy breakdown were downregulated compared to non-working time-matched controls. Both working groups lost weight during the protocol and regained weight during recovery, but animals that worked in the rest phase did not fully recover, even after eight days of recovery. In conclusion, three to four days of work in the rest phase is sufficient to induce disruption of several metabolic parameters, which requires more than eight days for full recovery.
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Affiliation(s)
- Andrea Rørvik Marti
- Department of Biological and Medical Psychology, University of Bergen, Bergen 5009, Norway.
| | - Peter Meerlo
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, 9700 CC Groningen, The Netherlands.
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen, Bergen 5009, Norway.
- College of Medical Sciences, Washington State University, Spokane, WA 99210, USA.
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99210, USA.
| | - Sjoerd Johan van Hasselt
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, 9700 CC Groningen, The Netherlands.
| | - Jelena Mrdalj
- Department of Biological and Medical Psychology, University of Bergen, Bergen 5009, Norway.
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen 5021, Norway.
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen 5015, Norway.
- Section of Psychiatry, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen 5021, Norway.
| | - Torhild Thue Pedersen
- Department of Biological and Medical Psychology, University of Bergen, Bergen 5009, Norway.
| | - Tone Elise Gjøtterud Henriksen
- Section of Psychiatry, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen 5021, Norway.
- Division of Mental Health Care, Valen Hospital, Fonna Local Health Authority, Valen 5451, Norway.
| | - Silje Skrede
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland Univeristy Hospital, 5021 Bergen, Norway.
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10
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Mild daily stressors in adulthood may counteract behavioural effects after constant presence of mother during early life. Physiol Behav 2016; 165:313-21. [DOI: 10.1016/j.physbeh.2016.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 01/28/2023]
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11
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Christiansen SL, Højgaard K, Wiborg O, Bouzinova EV. Disturbed diurnal rhythm of three classical phase markers in the chronic mild stress rat model of depression. Neurosci Res 2016; 110:43-8. [PMID: 27033803 DOI: 10.1016/j.neures.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/08/2016] [Accepted: 03/15/2016] [Indexed: 01/08/2023]
Abstract
Disturbances of circadian rhythms have been suggested to be a causal factor in the development of major depressive disorder. However, the mechanisms underlying the association between circadian rhythm abnormalities and mood disorders are still unknown. In the current study the association between diurnal pattern of key phase markers (melatonin, corticosterone, and core body temperature) and anhedonic-like behavior was investigated using the highly validated rat chronic mild stress (CMS) model of depression. Phase marker measurements were done after 3.5 weeks of CMS in 48 control rats and 48 anhedonic-like rats at 6 time points within 24h. The results showed that anhedonic-like behavior associates with changes in all three phase markers: an increased dark phase melatonin secretion, an additional peak in corticosterone level in the beginning of the light phase, and hypothermia in the dark phase. The result adds to the validity of the CMS model in general and in particular to be adequate as a model for studying the chronobiology of depressive disorder.
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Affiliation(s)
- S L Christiansen
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark.
| | - K Højgaard
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark
| | - O Wiborg
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark
| | - E V Bouzinova
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark
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