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Yi PC, Qin YH, Zheng CM, Ren KM, Huang L, Chen W. Tumor markers and depression scores are predictive of non-suicidal self-injury behaviors among adolescents with depressive disorder: A retrospective study. Front Neurosci 2022; 16:953842. [PMID: 36033621 PMCID: PMC9403252 DOI: 10.3389/fnins.2022.953842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background Non-suicidal self-injury (NSSI) is an important risk factor for suicide in adolescents with depressive disorders; therefore, it is important to predict NSSI occurrence as early as possible. Disturbances in biological rhythms are characteristic manifestations of depressive disorders and can lead to immune dysfunction, leading to changes in tumor markers. This study aimed to produce an index that utilizes tumor markers to predict NSSI behaviors among adolescents with depressive disorders. Methods A total of 120 hospitalized adolescent patients with depressive disorders aged 14–24 years were included in this study. Participants were divided into NSSI and non-NSSI groups based on self-reports using the Ottawa Self-Injury Inventory. Demographics, tumor marker concentrations, other peripheral blood indices, Hamilton Depression Rating Scale (HDRS) scores, and Hamilton Anxiety Rating Scale (HAMA) scores were compared between the two groups. Logistic regression analysis was conducted to develop a joint index, and a receiver operating characteristic (ROC) curve was created to predict NSSI behaviors among adolescents with depressive disorders. Results Compared with the non-NSSI group, the NSSI group had significantly higher insight, retardation, insomnia, hopelessness, psychiatric anxiety, total HDRS and HAMA scores, and significantly higher levels of cancer antigen 125 (CA-125), cancer antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA). In addition, a joint index was developed by combining CA-125, CA19-9, CEA, HDRS total score, HAMA total score and age using multiple logistic regression to predict NSSI behaviors. The area under the curve was 0.831, with a sensitivity and specificity of 0.734 and 0.891, respectively. Conclusion A combination of depression score, tumor marker levels, and age can identify NSSI behaviors among adolescents with depressive disorders.
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Affiliation(s)
- Peng-cheng Yi
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Clinical Psychology, The Third People’s Hospital of Xiangshan County, Ningbo, China
| | - Yan-hua Qin
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chun-mei Zheng
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Psychiatry, The Seventh People’s Hospital of Shaoxing, Shaoxing, China
| | - Ke-ming Ren
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lei Huang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Neurobiology of Zhejiang Province, Hangzhou, China
- *Correspondence: Wei Chen,
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El Marzouki H, Aboussaleh Y, Najimi M, Chigr F, Ahami A. Effect of Cold Stress on Neurobehavioral and Physiological Parameters in Rats. Front Physiol 2021; 12:660124. [PMID: 34603068 PMCID: PMC8485037 DOI: 10.3389/fphys.2021.660124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Cold stress is an important current issue and implementing control strategies to limit its sometimes harmful effects is crucial. Cold is a common stressor that can occur in our work and our occupational or leisure time activities every day. There are substantial studies on the effects of chronic stress on memory and behavior, although, the cognitive changes and anxiety disorders that can occur after exposure to chronic intermittent cold stress are not completely characterized. Therefore, the present study was undertaken with an aim to investigate the effects of chronic intermittent cold stress on body weight, food intake and working memory, and to elucidate cold stress related anxiety disorders using cognitive and behavioral test batteries. Methods: We generated a cold stress model by exposing rats to chronic intermittent cold stress for 5 consecutive days and in order to test for the potential presence of sex differences, a comparable number of male and female rats were tested in the current study. Then, we measured the body weights, food intake and the adrenal glands weight. Working memory and recognition memory were assessed using the Y maze and the Novel Object Recognition (NOR) tasks. While, sex differences in the effects of chronic stress on behavior were evaluated by the elevated plus maze (EPM), open field maze (OF), and Marble burying (MB) tests. Results: We found that 2 h exposure to cold (4°C) resulted in an increase in the relative weight of the adrenal glands in male rats. Given the same chronic stress 5 days of cold exposure (2 h per day), increased weight gain in male rats, while females showed decreased food intake and no change in body weight. Both sexes successfully performed the Y maze and object recognition (OR) tasks, indicating intact spatial working memory performance and object recognition abilities in both male and female rats. In addition, we have shown that stress caused an increase in the level of anxiety in male rats. In contrast, the behavior of the female rats was not affected by cold exposure. Conclusion: Overall, the current results provide preliminary evidence that chronic intermittent cold stress model may not be an efficient stressor to female rats. Females exhibit resilience to cold exposure that causes an increase in the level of anxiety in male rats, which demonstrates that they are affected differently by stress and the gender is an important consideration in experimental design.
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Affiliation(s)
- Hajar El Marzouki
- Biology and Health Laboratory, Unit of Clinical and Cognitive-Behavioural Neurosciences and Applied Nutrition Health, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Youssef Aboussaleh
- Biology and Health Laboratory, Unit of Clinical and Cognitive-Behavioural Neurosciences and Applied Nutrition Health, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Mohamed Najimi
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan MoulaySlimane University, Beni Mellal, Morocco
| | - Fatiha Chigr
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan MoulaySlimane University, Beni Mellal, Morocco
| | - Ahmed Ahami
- Biology and Health Laboratory, Unit of Clinical and Cognitive-Behavioural Neurosciences and Applied Nutrition Health, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
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van der Gronde T, Los L, Herremans A, Oosting R, Zorzanelli R, Pieters T. Toward a New Model of Understanding, Preventing, and Treating Adolescent Depression Focusing on Exhaustion and Stress. Front Psychiatry 2020; 11:412. [PMID: 32435213 PMCID: PMC7218067 DOI: 10.3389/fpsyt.2020.00412] [Citation(s) in RCA: 4] [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: 11/05/2019] [Accepted: 04/22/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Adolescent depression is a heterogeneous disorder, with a wide variety of symptoms and inconsistent treatment response, and is not completely understood. A dysregulated stress system is a consistent finding, however, and exhaustion is a consistent trait in adolescent patients. The aim of this paper is to critically assess current hypotheses in adolescent depression research and reframe causes and treatment approaches. METHODS A mixed-method approach involved a review based on publications from PubMed, Embase and PsycInfo, and two exemplary adolescent cases. RESULTS Both cases show a spiral of stress and exhaustion, but with a different profile of symptoms and coping mechanisms. Reframing both cases from the perspective of coping behavior, searching for the sources of experienced stress and exhaustion, showed coping similarities. This proved essential in the successful personalized treatment and recovery process. In combination with recent evidence, both cases support the functional reframing of depression as the outcome of a stress- and exhaustion-related spiralling mechanism. CONCLUSIONS We propose to open up a symptom-based, mood-centered view to a model in which adolescent depression is framed as a consecutive failure of stress coping mechanisms and chronic exhaustion. Addressing exhaustion and coping primarily as a treatment strategy in adolescents and young adults might work in synergy with existing treatments and improve overall outcomes. This perspective warrants further investigation.
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Affiliation(s)
- Toon van der Gronde
- Freudenthal Institute and Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Leontien Los
- Department of Adolescent Psychiatry and Addiction Prevention, Brijder-Jeugd, The Hague, Netherlands
| | - Arnoud Herremans
- Freudenthal Institute and Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Ronald Oosting
- Freudenthal Institute and Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Rafaela Zorzanelli
- Instituto de Medicina Social, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Toine Pieters
- Freudenthal Institute and Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, Netherlands
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Perlman K, Benrimoh D, Israel S, Rollins C, Brown E, Tunteng JF, You R, You E, Tanguay-Sela M, Snook E, Miresco M, Berlim MT. A systematic meta-review of predictors of antidepressant treatment outcome in major depressive disorder. J Affect Disord 2019; 243:503-515. [PMID: 30286415 DOI: 10.1016/j.jad.2018.09.067] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/29/2018] [Accepted: 09/16/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The heterogeneity of symptoms and complex etiology of depression pose a significant challenge to the personalization of treatment. Meanwhile, the current application of generic treatment approaches to patients with vastly differing biological and clinical profiles is far from optimal. Here, we conduct a meta-review to identify predictors of response to antidepressant therapy in order to select robust input features for machine learning models of treatment response. These machine learning models will allow us to learn associations between patient features and treatment response which have predictive value at the individual patient level; this learning can be optimized by selecting high-quality input features for the model. While current research is difficult to directly apply to the clinic, machine learning models built using knowledge gleaned from current research may become useful clinical tools. METHODS The EMBASE and MEDLINE/PubMed online databases were searched from January 1996 to August 2017, using a combination of MeSH terms and keywords to identify relevant literature reviews. We identified a total of 1909 articles, wherein 199 articles met our inclusion criteria. RESULTS An array of genetic, immune, endocrine, neuroimaging, sociodemographic, and symptom-based predictors of treatment response were extracted, varying widely in clinical utility. LIMITATIONS Due to heterogeneous sample sizes, effect sizes, publication biases, and methodological disparities across reviews, we could not accurately assess the strength and directionality of every predictor. CONCLUSION Notwithstanding our cautious interpretation of the results, we have identified a multitude of predictors that can be used to formulate a priori hypotheses regarding the input features for a computational model. We highlight the importance of large-scale research initiatives and clinically accessible biomarkers, as well as the need for replication studies of current findings. In addition, we provide recommendations for future improvement and standardization of research efforts in this field.
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Affiliation(s)
- Kelly Perlman
- Montreal Neurological Institute, McGill University, 3801 Rue Université, Montréal, QC H3A 2B4, Canada.
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada; Faculty of Medicine, McGill University, Montreal, Canada
| | - Sonia Israel
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada
| | - Colleen Rollins
- Department of Psychiatry, University of Cambridge, Cambridge, England, UK
| | - Eleanor Brown
- Montreal Neurological Institute, McGill University, 3801 Rue Université, Montréal, QC H3A 2B4, Canada
| | - Jingla-Fri Tunteng
- Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Raymond You
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Eunice You
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Myriam Tanguay-Sela
- Montreal Neurological Institute, McGill University, 3801 Rue Université, Montréal, QC H3A 2B4, Canada
| | - Emily Snook
- Douglas Mental Health University Institute, Montreal, Canada
| | - Marc Miresco
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada
| | - Marcelo T Berlim
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada
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Canceri JM, Brown R, Watson SR, Browne CJ. Examination of Current Treatments and Symptom Management Strategies Used by Patients With Mal De Debarquement Syndrome. Front Neurol 2018; 9:943. [PMID: 30483208 PMCID: PMC6240763 DOI: 10.3389/fneur.2018.00943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/22/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction: Mal de Debarquement Syndrome (MdDS) is a neurological disorder which affects the vestibular system pathways, manifesting as a constant sensation of movement in the form of rocking, bobbing, or swaying. The mechanism of MdDS is poorly understood and there is a lack of awareness amongst medical professionals about the condition. This study aimed to examine treatments and symptom management strategies used by MdDS patients and evaluate their self-reported effectiveness. Method: Motion-Triggered and Spontaneous/Other onset MdDS patients responded to a set of comprehensive questions as a retrospective survey regarding epidemiological details, diagnostic procedures, onset, and symptom triggers, hormonal influences as well as treatments and symptom management strategies used to reduce symptoms. The Motion-Triggered questionnaire was made available through Survey Monkey and the Spontaneous/Other Onset questionnaire through Qualtrics. The link for each questionnaire was made available on online MdDS support groups and on various research websites. Descriptive statistics were used for epidemiological data and Pearson's Chi Square tests were used for comparisons between and within both subtype groups. Results: A total of 370 patients participated in the surveys, with 287 valid responses collected for the section regarding treatment and symptom management strategies. The success of the treatments and symptom management strategies did not vary between subtypes Benzodiazepines/Antidepressants were reported as being most beneficial in reducing symptoms in both groups. Conclusion: This was the first attempt to evaluate the reported success of treatments and symptom management strategies in MdDS patients by assessing the patients' perceived helpfulness. The treatments and symptom management strategies reported to be the most helpful in managing and/or reducing symptoms are proposed to be effective due to their stress-reducing capacities. We hope this study will broaden MdDS awareness and that this study will increase patient knowledge regarding treatments and symptom management strategies that other patients found helpful.
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Affiliation(s)
- Josephine M Canceri
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
| | - Rachael Brown
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Shaun R Watson
- Prince of Wales Private Hospital, Sydney, NSW, Australia
| | - Cherylea J Browne
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia.,Translational Neuroscience Facility, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
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Dai C, Jiang M, Cao Q. Association between Depression and More Aggressive Inflammatory Bowel Disease. Am J Gastroenterol 2018; 113:773. [PMID: 29487407 DOI: 10.1038/s41395-018-0016-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 01/08/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Cong Dai
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Liaoning Province, Shenyang City, China
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Fischer S, Macare C, Cleare AJ. Hypothalamic-pituitary-adrenal (HPA) axis functioning as predictor of antidepressant response–Meta-analysis. Neurosci Biobehav Rev 2017; 83:200-211. [DOI: 10.1016/j.neubiorev.2017.10.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/05/2017] [Accepted: 10/11/2017] [Indexed: 12/30/2022]
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Lange C, Deutschenbaur L, Borgwardt S, Lang UE, Walter M, Huber CG. Experimentally induced psychosocial stress in schizophrenia spectrum disorders: A systematic review. Schizophr Res 2017; 182:4-12. [PMID: 27733301 DOI: 10.1016/j.schres.2016.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/22/2016] [Accepted: 10/04/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is evidence that exposure to social stress plays a crucial role in the onset and relapse of schizophrenia; however, the reaction of patients with schizophrenia spectrum disorder (SSD) to experimentally induced social stress is not yet fully understood. METHOD Original research published between January 1993 and August 2015 was included in this systematic literature research. Social stress paradigms, reporting subjective responses to stress measures, plasma or saliva cortisol, or heart rate (HR) in patients with SSD were included. 1528 articles were screened, 11 papers (390 patients) were included. RESULTS Three main findings were attained concerning chronically ill patients: (1) overall similar subjective responses to stress ratings between SDD patients and controls, (2) no group differences in cortisol response to psychosocial stress and (3) an increase in HR after the stress exposure was seen in patients and controls. The study examining first-episode patients found higher subjective responses to stress and lower stress-induced cortisol levels. CONCLUSION The results indicate that first-onset medication free patients may show differences in subjective responses to stress measures and cortisol release while chronically ill patients display no differences in subjective and cortisol response. This may be the correlate of a pathophysiological dysfunction of the hypothalamic-pituitary-adrenal axis prior or at the onset of SSD and a subsequent change in dysregulation during the course of the illness. Given the paucity of studies investigating psychosocial stress in SSD and the pathophysiological relevance of psychosocial stress for the illness, there is need for further research. (PROSPERO registration number: CRD42015026525).
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Affiliation(s)
- Claudia Lange
- Department of Psychiatry, University of Basel, Basel, Switzerland.
| | | | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Undine E Lang
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Marc Walter
- Department of Psychiatry, University of Basel, Basel, Switzerland
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Dušková M, Hill M, Bičíková M, Šrámková M, Řípová D, Mohr P, Stárka L. The steroid metabolome in men with mood and anxiety disorders. Physiol Res 2016; 64:S275-82. [PMID: 26680490 DOI: 10.33549/physiolres.933067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The mood and behavior of individuals result from an orchestra of many factors. Among them steroids play an important role; however, only several common hormones have been investigated in this respect. It has been demonstrated that some steroid metabolites long considered merely the products of steroid hormone metabolism in fact possess considerable activity in the CNS. For this reason we studied the steroid metabolome including 50 analytes in 20 men with depression, 20 men with anxiety and 30 healthy controls. Significant differences were found not only between controls and men with either depression or anxiety, but also between men with depression and anxiety. Particularly striking were those steroids until now not generally associated with depression or anxiety, namely conjugated steroid forms, especially sulfates.
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Affiliation(s)
- M Dušková
- Institute of Endocrinology, Prague, Czech Republic.
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Jacobson L. Hypothalamic-pituitary-adrenocortical axis: neuropsychiatric aspects. Compr Physiol 2014; 4:715-38. [PMID: 24715565 DOI: 10.1002/cphy.c130036] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence of aberrant hypothalamic-pituitary-adrenocortical (HPA) activity in many psychiatric disorders, although not universal, has sparked long-standing interest in HPA hormones as biomarkers of disease or treatment response. HPA activity may be chronically elevated in melancholic depression, panic disorder, obsessive-compulsive disorder, and schizophrenia. The HPA axis may be more reactive to stress in social anxiety disorder and autism spectrum disorders. In contrast, HPA activity is more likely to be low in PTSD and atypical depression. Antidepressants are widely considered to inhibit HPA activity, although inhibition is not unanimously reported in the literature. There is evidence, also uneven, that the mood stabilizers lithium and carbamazepine have the potential to augment HPA measures, while benzodiazepines, atypical antipsychotics, and to some extent, typical antipsychotics have the potential to inhibit HPA activity. Currently, the most reliable use of HPA measures in most disorders is to predict the likelihood of relapse, although changes in HPA activity have also been proposed to play a role in the clinical benefits of psychiatric treatments. Greater attention to patient heterogeneity and more consistent approaches to assessing treatment effects on HPA function may solidify the value of HPA measures in predicting treatment response or developing novel strategies to manage psychiatric disease.
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Ventura-Juncá R, Symon A, López P, Fiedler JL, Rojas G, Heskia C, Lara P, Marín F, Guajardo V, Araya AV, Sasso J, Herrera L. Relationship of cortisol levels and genetic polymorphisms to antidepressant response to placebo and fluoxetine in patients with major depressive disorder: a prospective study. BMC Psychiatry 2014; 14:220. [PMID: 25086452 PMCID: PMC4149200 DOI: 10.1186/s12888-014-0220-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/23/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Increased cortisol levels and genetic polymorphisms have been related to both major depressive disorder and antidepressant treatment outcome. The aim of this study is to evaluate the relationship between circadian salivary cortisol levels, cortisol suppression by dexamethasone and genetic polymorphisms in some HPA axis-related genes to the response to placebo and fluoxetine in depressed patients. METHODS The diagnosis and severity of depression were performed using the Mini International Neuropsychiatric Interview (M.I.N.I.) and Hamilton depression scale (HAM-D17), respectively. Euthyroid patients were treated with placebo (one week) followed by fluoxetine (20 mg) (two months). Severity of depression was re-evaluated after placebo, three weeks and two months of fluoxetine treatments. Placebo response was defined as HAM-D17 score reductions of at least 25% and to < 15. Early response and response were reductions of at least 50% after three weeks and two months, and remission with ≤ 7 after two months. Plasma TSH, free-T4, circadian salivary cortisol levels and cortisol suppression by dexamethasone were evaluated. Seven genetic polymorphisms located in the Corticotrophin-releasing-hormone-receptor-1 (rs242939, rs242941, rs1876828), Corticotrophin-releasing-hormone-receptor-2 (rs2270007), Glucocorticoid-receptor (rs41423247), FK506-binding-protein-5 (rs1360780), and Arginine-vasopressin (rs3729965) genes were determined. Association analyses between response to placebo/fluoxetine and polymorphism were performed by chi-square or Fisher exact test. Cortisol levels were compared by t-test, ANOVA and the general linear model for repeated measures. RESULTS 208 depressed patients were recruited, 187 of whom were euthyroid. Placebo responders, fluoxetine responders and remitters exhibited significantly lower circadian cortisol levels than those who did not respond (p-values of 0.014, 0.008 and 0.021 respectively). Patients who abandoned treatment before the third week also exhibited a trend to low cortisol levels (p = 0.057). The polymorphisms rs242939 (CRHR1) and rs2270007 (CRHR2) were not in Hardy-Weinberg equilibrium. Only the rs242939 polymorphism (CRHR1) exhibited association with early response (three weeks) to fluoxetine (p-value = 0.043). No other association between outcomes and polymorphisms was observed. CONCLUSIONS These results support the clinical relevance of low salivary cortisol levels as a predictor of antidepressant response, either to placebo or to fluoxetine. Only one polymorphism in the CRHR1 gene was associated with the early response. Other factors may be involved in antidepressant response, although further studies are needed to identify them.
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Affiliation(s)
- Raúl Ventura-Juncá
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, Independencia, Santiago Chile ,Escuela de Psicología, Universidad de Los Andes, San Carlos de Apoquindo 2200, Las Condes, Santiago, Chile
| | - Adriana Symon
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, Independencia, Santiago Chile
| | - Pamela López
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, Independencia, Santiago Chile
| | - Jenny L Fiedler
- Laboratorio de Neuroplasticidad y Neurogenética, Departamento de Bioquímica y Biología Molecular, Universidad de Chile, Calle Sergio Livingstone Pohlhammer 1007 (ex Olivos), Independencia, Santiago, Chile
| | - Graciela Rojas
- Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago, Chile
| | - Cristóbal Heskia
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, Independencia, Santiago Chile
| | - Pamela Lara
- Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago, Chile
| | - Felipe Marín
- Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago, Chile
| | - Viviana Guajardo
- Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago, Chile
| | - A Verónica Araya
- Departamento de Endocrinología, Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Jaime Sasso
- Instituto de Investigaciones Farmacológicas y Toxicológicas (IFT), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Luisa Herrera
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, Independencia, Santiago Chile
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O'Leary OF, O'Brien FE, O'Connor RM, Cryan JF. Drugs, genes and the blues: Pharmacogenetics of the antidepressant response from mouse to man. Pharmacol Biochem Behav 2014; 123:55-76. [DOI: 10.1016/j.pbb.2013.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/04/2013] [Accepted: 10/16/2013] [Indexed: 12/11/2022]
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Telemonitoring with respect to mood disorders and information and communication technologies: overview and presentation of the PSYCHE project. BIOMED RESEARCH INTERNATIONAL 2014; 2014:104658. [PMID: 25050321 PMCID: PMC4094725 DOI: 10.1155/2014/104658] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/04/2014] [Accepted: 06/08/2014] [Indexed: 12/15/2022]
Abstract
This paper reviews what we know about prediction in relation to mood disorders from the perspective of clinical, biological, and physiological markers. It then also presents how information and communication technologies have developed in the field of mood disorders, from the first steps, for example, the transition from paper and pencil to more sophisticated methods, to the development of ecological momentary assessment methods and, more recently, wearable systems. These recent developments have paved the way for the use of integrative approaches capable of assessing multiple variables. The PSYCHE project stands for Personalised monitoring SYstems for Care in mental HEalth.
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Holland JM, Schatzberg AF, O'Hara R, Marquett RM, Gallagher-Thompson D. Pretreatment cortisol levels predict posttreatment outcomes among older adults with depression in cognitive behavioral therapy. Psychiatry Res 2013; 210:444-50. [PMID: 23953171 PMCID: PMC3818434 DOI: 10.1016/j.psychres.2013.07.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 02/24/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
Previous studies suggest that individuals with elevated levels of cortisol (the "stress hormone") could be particularly resistant to treatment for depression. However, most of these studies have been conducted in the context of antidepressant medications, and no study has examined pretreatment cortisol levels as a predictor of treatment outcomes among older adults with depression in cognitive-behavioral therapy (CBT), despite the relevance of this population for such a research question. The current study includes 54 older adults with depression who provided salivary cortisol samples at baseline and completed measures of depression at pretreatment and posttreatment, following a 12-week course of CBT. Structural equation modeling results suggest that those with higher daily outputs of cortisol and flatter diurnal slopes were less likely to benefit from CBT-a finding which if replicated could have important implications for clinical practice and future research.
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Affiliation(s)
- Jason M. Holland
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV USA
| | - Alan F. Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine Stanford, CA USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine Stanford, CA USA
| | - Renee M. Marquett
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine Stanford, CA USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine Stanford, CA USA
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15
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Abstract
Substantial evidence shows that the hypophyseal–pituitary–adrenal (HPA) axis and corticosteroids are involved in the process of addiction to a variety of agents, and the adrenal cortex has a key role. In general, plasma concentrations of cortisol (or corticosterone in rats or mice) increase on drug withdrawal in a manner that suggests correlation with the behavioural and symptomatic sequelae both in man and in experimental animals. Corticosteroid levels fall back to normal values in resumption of drug intake. The possible interactions between brain corticotrophin releasing hormone (CRH) and proopiomelanocortin (POMC) products and the systemic HPA, and additionally with the local CRH–POMC system in the adrenal gland itself, are complex. Nevertheless, the evidence increasingly suggests that all may be interlinked and that CRH in the brain and brain POMC products interact with the blood-borne HPA directly or indirectly. Corticosteroids themselves are known to affect mood profoundly and may themselves be addictive. Additionally, there is a heightened susceptibility for addicted subjects to relapse in conditions that are associated with change in HPA activity, such as in stress, or at different times of the day. Recent studies give compelling evidence that a significant part of the array of addictive symptoms is directly attributable to the secretory activity of the adrenal cortex and the actions of corticosteroids. Additionally, sex differences in addiction may also be attributable to adrenocortical function: in humans, males may be protected through higher secretion of DHEA (and DHEAS), and in rats, females may be more susceptible because of higher corticosterone secretion.
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16
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Quach L, Yang FM, Berry SD, Newton E, Jones RN, Burr JA, Lipsitz LA. Depression, antidepressants, and falls among community-dwelling elderly people: the MOBILIZE Boston study. J Gerontol A Biol Sci Med Sci 2013; 68:1575-81. [PMID: 23817088 DOI: 10.1093/gerona/glt084] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The mechanisms linking falls and depression are still unknown. The aim of the study is to examine the association between depression and antidepressants, with indoor and outdoor falls, and to investigate how antidepressants mediate this relationship. METHODS The study included 763 men and women aged 70 and older with baseline measures for depression and antidepressant use are captured with prospective data on falls from the "Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly" (MOBILIZE) Boston study, which is a population-based longitudinal study (from 2005 to 2009). RESULTS Overall, the rate of falls was 26 falls/100 person-years. Seventeen percent of participants had clinically significant depressive symptoms (CSDS), and 12% used antidepressants. CSDS increased the risk of indoor and outdoor falls (incidence rate ratio [IRR] = 1.6, 95% confidence interval [CI] = 1.2-2.3, p < .01; IRR = 1.6, 95% CI = 1.2-2.2, p < .01). Antidepressant use increased the risk of outdoor falls by 70% and partially mediated the association between CSDS and outdoor falls (IRR = 1.7, 95% CI = 1.2-2.5, p < .05). There was no relationship between antidepressant use and indoor falls. Similar results were observed when depression was considered as a continuous variable. CONCLUSIONS Depression increased the risk of indoor and outdoor falls. Antidepressant use among older adults with CSDS increased the risk of outdoor, but not indoor falls. Clinicians should carefully consider the role of antidepressants among older adults with CSDS and their potential increase for the risk of outdoor falls.
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Affiliation(s)
- Lien Quach
- MS, Department of Gerontology, University of Massachusetts, Boston, MA 02125.
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17
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Kumar A, Rinwa P, Kaur G, Machawal L. Stress: Neurobiology, consequences and management. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2013; 5:91-7. [PMID: 23833514 PMCID: PMC3697199 DOI: 10.4103/0975-7406.111818] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 11/21/2012] [Accepted: 12/11/2012] [Indexed: 11/04/2022] Open
Abstract
Stress, both physical and psychological, is attracting increasing attention among neuroresearchers. In the last 20 decades, there has been a surge of interest in the research of stress-induced manifestations and this approach has resulted in the development of more appropriate animal models for stress-associated pathologies and its therapeutic management. These stress models are an easy and convenient method for inducing both psychological and physical stress. To understand the behavioral changes underlying major depression, molecular and cellular studies are required. Dysregulation of the stress system may lead to disturbances in growth and development, and may this may further lead to the development of various other psychiatric disorders. This article reviews the different types of stress and their neurobiology, including the different neurotransmitters affected. There are various complications associated with stress and their management through various pharmacological and non-pharmacological techniques. The use of herbs in the treatment of stress-related problems is practiced in both Indian and Western societies, and it has a vast market in terms of anti-stress medications and treatments. Non-pharmacological techniques such as meditation and yoga are nowadays becoming very popular as a stress-relieving therapy because of their greater effectiveness and no associated side effects. Therefore, this review highlights the changes under stress and stressor and their impact on different animal models in understanding the mechanisms of stress along with their effective and safe management.
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Affiliation(s)
- Anil Kumar
- Department of Pharmacology, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study, Panjab University, Chandigarh, India
| | - Puneet Rinwa
- Department of Pharmacology, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study, Panjab University, Chandigarh, India
| | - Gurleen Kaur
- Department of Pharmacology, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study, Panjab University, Chandigarh, India
| | - Lalit Machawal
- Department of Pharmacology, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study, Panjab University, Chandigarh, India
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18
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Abstract
BACKGROUND Mood disorders are expressed in many heterogeneous forms, varying from anxiety to severe major clinical depression. The disorders are expressed in individual variety through manifestations governed by co-morbidities, symptom frequency, severity, and duration, and the effects of genes on phenotypes. The underlying etiologies of mood disorders consist of complex interactive operations of genetic and environmental factors. The notion of endophenotypes, which encompasses the markers of several underlying liabilities to the disorders, may facilitate efforts to detect and define, through staging, the genetic risks inherent to the extreme complexity of disease state. AIMS This review evaluates the role of genetic biomarkers in assisting clinical diagnosis, identification of risk factors, and treatment of mood disorders. METHODS Through a systematic assessment of studies investigating the epigenetic basis for mood disorders, the present review examines the interaction of genes and environment underlying the pathophysiology of these disorders. RESULTS The majority of research findings suggest that the notion of endophenotypes, which encompasses the markers of several underlying liabilities to the disorders, may facilitate efforts to detect and define, through staging, the genetic risks inherent to the extreme complexity of the disease states. Several strategies under development and refinement show the propensity for derivation of essential elements in the etiopathogenesis of the disorders affecting drug-efficacy, drug metabolism, and drug adverse effects, e.g., with regard to selective serotonin reuptake inhibitors. These include: transporter gene expression and genes encoding receptor systems, hypothalamic-pituitary-adrenal axis factors, neurotrophic factors, and inflammatory factors affecting neuroimmune function. Nevertheless, procedural considerations of pharmacogenetics presume the parallel investment of policies and regulations to withstand eventual attempts at misuse, thereby ensuring patient integrity. CONCLUSIONS Identification of genetic biomarkers facilitates choice of treatment, prediction of response, and prognosis of outcome over a wide spectrum of symptoms associated with affective states, thereby optimizing clinical practice procedures. Epigenetic regulation of primary brain signaling, e.g., serotonin and hypothalamic-pituitary-adrenal function, and factors governing their metabolism are necessary considerations. The participation of neurotrophic factors remains indispensable for neurogenesis, survival, and functional maintenance of brain systems.
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Affiliation(s)
- T Archer
- Department of Psychology, University of Gothenburg, Box 500, SE-40530 Gothenburg, Sweden
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Fernández-Guasti A, Fiedler JL, Herrera L, Handa RJ. Sex, stress, and mood disorders: at the intersection of adrenal and gonadal hormones. Horm Metab Res 2012; 44:607-18. [PMID: 22581646 PMCID: PMC3584173 DOI: 10.1055/s-0032-1312592] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The risk for neuropsychiatric illnesses has a strong sex bias, and for major depressive disorder (MDD), females show a more than 2-fold greater risk compared to males. Such mood disorders are commonly associated with a dysregulation of the hypothalamo-pituitary-adrenal (HPA) axis. Thus, sex differences in the incidence of MDD may be related with the levels of gonadal steroid hormone in adulthood or during early development as well as with the sex differences in HPA axis function. In rodents, organizational and activational effects of gonadal steroid hormones have been described for the regulation of HPA axis function and, if consistent with humans, this may underlie the increased risk of mood disorders in women. Other developmental factors, such as prenatal stress and prenatal overexposure to glucocorticoids can also impact behaviors and neuroendocrine responses to stress in adulthood and these effects are also reported to occur with sex differences. Similarly, in humans, the clinical benefits of antidepressants are associated with the normalization of the dysregulated HPA axis, and genetic polymorphisms have been found in some genes involved in controlling the stress response. This review examines some potential factors contributing to the sex difference in the risk of affective disorders with a focus on adrenal and gonadal hormones as potential modulators. Genetic and environmental factors that contribute to individual risk for affective disorders are also described. Ultimately, future treatment strategies for depression should consider all of these biological elements in their design.
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Affiliation(s)
| | - J. L. Fiedler
- Laboratory of Neuroplasticity and Neurogenetics, Department of Biochemistry and Molecular Biology, Faculty of Chemical and Pharmaceutical Sciences, Universidad de Chile, Santiago, Chile
| | - L. Herrera
- Human Genetics Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - R. J. Handa
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, USA
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20
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Liu W, Zhou C. Corticosterone reduces brain mitochondrial function and expression of mitofusin, BDNF in depression-like rodents regardless of exercise preconditioning. Psychoneuroendocrinology 2012; 37:1057-70. [PMID: 22244747 DOI: 10.1016/j.psyneuen.2011.12.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/15/2011] [Accepted: 12/02/2011] [Indexed: 12/13/2022]
Abstract
Both chronic mild stress and an injection of corticosterone induce depression-like states in rodents. To further link mitochondrial dysfunction to the pathophysiology of major depression, here we describe two rat models of a depressive-like state induced by chronic unpredictable mild stress (CUMS) or corticosterone treatment (CORT). It is also a model that allows the simultaneous study of effects of exercise preconditioning on behavioral, electrophysiological, biochemical and molecular markers in the same animal. Exercise preconditioning ahead of CUMS and CORT treatment prevents many behavioral abnormalities resulted from CUMS. The changes in mitochondrial activity in brain and reduced expressions of superoxide dismutase (SOD1, SOD2), mitofusin (Mfn1, Mfn2) as well as brain-derived neurotrophic factor (BDNF) suggest that both CORT and CUMS may impair mitochondrial function and/or expressions of mitofusion and antioxidant enzymes that, in turn, may increase oxidative stress and reduce energy production in brain with depression-like behaviors. These findings suggest an underlying mechanism by which CORT, as well as CUMS, induces brain mitochondrial dysfunction that is associated with depressive-like states. Remarkably, physical exercise is identified as a helpful and preventive measure to promote mitochondrial function and expressions of mitofusin, BDNF and antioxidant enzymes in brain, so as to protect brain energy metabolism against CUMS, rather than the compound of corticosterone.
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Affiliation(s)
- Weina Liu
- Department of Health & Exercise Science, Tianjin University of Sport, Tianjin, China
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21
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Hodgson K, Mufti SJ, Uher R, McGuffin P. Genome-wide approaches to antidepressant treatment: working towards understanding and predicting response. Genome Med 2012; 4:52. [PMID: 22738351 PMCID: PMC3698532 DOI: 10.1186/gm351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Antidepressants are among the most commonly prescribed drugs, and a range of medications are available. However, treatment response to a particular drug varies greatly between patients, with only 30% of patients responding well to the first treatment administered. Given evidence that antidepressant treatment response is a heritable trait, together with technological advances in genetic research, three recently published genome-wide investigations into antidepressant responses have examined the determinants of variability in treatment outcomes between depressed patients. Here, we review these studies within the context of wider research efforts to identify treatment response predictors. Some interesting genes have been implicated, but no variants have yet been robustly and reliably linked to response. This may suggest that genetic effect sizes are smaller than originally anticipated. Candidate gene approaches in these samples have lent support to the involvement of serotonergic, glutamatergic and stress-response systems in treatment response, although corroborative evidence from genome-wide analyses indicates these results should be interpreted cautiously. Closer examination of antidepressant response, considering it as a complex trait, has indicated that multiple genes of small effect are likely to be involved. Furthermore, there is some evidence that genetic influence on response to treatment may vary between patients with different symptom profiles or environmental exposures. This has implications for the translation of pharmacogenetic findings into clinical practice: genotypic information from multiple loci and data on non-genetic factors are likely to be needed to tailor antidepressant treatment to the individual patient.
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Affiliation(s)
- Karen Hodgson
- MRC SGDP Centre, Institute of Psychiatry, King's College London, London, SE5 A8F, UK.
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22
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Abstract
Response to antidepressants is interindividually variable. It has been suggested that this variability is a direct consequence of etiological heterogeneity. Therefore, the same genes, environments, and gene-environment interactions implicated in different etiological pathways to depression may also predict response to treatment. This article reviews the evidence relevant to this hypothesis by first outlining the roles of genes, environments, and gene-environment interplay in the etiology of depression, and then considering the same factors in treatment response. Environmental exposures, such as childhood maltreatment, are potent predictors of both depression and treatment response. Although alone genetic factors have failed to consistently predict either phenotype, several polymorphisms have been shown to moderate the effects of environmental adversity on the development of depression and treatment response. These findings suggest that the dissection of etiological pathways to depression may provide the key to understanding and predicting response to antidepressants.
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Dubovsky AN, Arvikar S, Stern TA, Axelrod L. The Neuropsychiatric Complications of Glucocorticoid Use: Steroid Psychosis Revisited. PSYCHOSOMATICS 2012; 53:103-15. [DOI: 10.1016/j.psym.2011.12.007] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 12/08/2011] [Accepted: 12/12/2011] [Indexed: 12/21/2022]
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Abstract
AbstractMajor depressive disorder (MDD) is a pervasive and debilitating illness, with a recurrent course and chronic prognosis. Although effective treatments for MDD exist, there is a pressing need to characterize relapse vulnerability in order to design effective prophylactic care. To date, heterogeneity within depression neuroimaging research has made it difficult to establish a reliable biomarker of disorder susceptibility. In this paper, we review neuroimaging evidence for the assessment of MDD vulnerability, theorizing that current findings can be broadly distinguished between those indicating the presence of depressive episodes and those indicating MDD vulnerability during symptom remission. We argue that unlike the amygdala hyperactivity and prefrontal hypoactivity observed during MDD episodes, prefrontal hyperactivity may be a characteristic of dysphoric cognition during symptom remission that indicates MDD vulnerability and relapse risk. Drawing on current research of normative emotion regulation, we describe a potential test of MDD vulnerability, employing emotional challenge paradigms that induce cognitive reactivity — the increased endorsement of negative self-descriptions during a transient dysphoric mood. Relative to a normative model of prefrontal function, the neuroimaging assessment of cognitive reactivity may provide a reliable indicator of MDD vulnerability, advancing the field of biomarker research as well as the delivery of preventative treatment on an individual basis.
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