Stress, depression and the activation of the immune system

Examining the Use of Antidepressants for Adolescents with Depression/Anxiety Who Regularly Use Cannabis: A Narrative Review

Depression and anxiety disorders are two of the most common and growing mental health concerns in adolescents. Consequently, antidepressant medication (AD) use has increased widely during the last decades. Several classes of antidepressants are used mainly to treat depression, anxiety, and obsessive-compulsive disorders by targeting relevant brain neurochemical pathways. Almost all randomized clinical trials of antidepressants examined patients with no concomitant medications or drugs. This does not address the expected course of therapy and outcome in cannabis users. Cannabis is the most commonly used illicit substance globally. Substantial changes in its regulation are recently taking place. Many countries and US states are becoming more permissive towards its medical and recreational use. The psychological and physiological effects of cannabis (mainly of its major components, tetrahydrocannabinol (THC) and cannabidiol (CBD)) have been extensively characterized. Cannabis use can be a risk factor for depressive and anxiety symptoms, but some constituents or mixtures may have antidepressant and/or anxiolytic potential. The aim of this literature review is to explore whether simultaneous use of AD and cannabis in adolescence can affect AD treatment outcomes. Based on the current literature, it is reasonable to assume that antidepressants are less effective for adolescents with depression/anxiety who frequently use cannabis. The mechanisms of action of antidepressants and cannabis point to several similarities and conjunctions that merit future investigation regarding the potential effectiveness of antidepressants among adolescents who consume cannabis regularly.

Increased levels of neurofilament light chain in suicide attempters' serum

Background

A specific biological vulnerability underlies suicidal behavior. Recent findings have suggested a possible role of inflammation and neuroaxonal injury. However, the relationship between inflammation and clinical symptoms in this disorder is still unclear. The objective of this study is applying novel blood markers of neuroaxonal integrity such as neurofilament light chain (NfL) and comparing the results with the healthy control subjects.

Methods

In this cross-sectional study patients with suicide attempts were evaluated. The serum concentration of NfL on admission was measured by enzyme-linked immunosorbent assays.

Results

A total of 50 patients with a suicide attempts and 35 healthy controls were included in the study. The levels of NfL in attempted suicide patients were significantly higher in comparison with healthy controls (40.52 ± 33.54 vs 13.73 ± 5.11, P < 0.001). A significant association between serum levels of NfL and risk factors for suicide was not found.

Conclusion

These findings indicate that axonal damage may be an underlying neuropathological component of suicide attempt patients, although no correlation was observed with clinical features. This line of work could lead to new horizons in understanding the neurobiology of suicidal attempts and the development of better management strategies for these patients.

Relationship Between Public Mental Health and Immune Status During the COVID-19 Pandemic: Cross-Sectional Data from Saudi Arabia

PURPOSE

Coronavirus disease 2019 (COVID-19) has evolved into a worldwide pandemic and continues to escalate exponentially in many countries across the globe. Recently, higher rates of psychological distress have been reported in several countries during the pandemic. Accordingly, the study aim was to investigate the relationship between public mental health and immune status during the COVID-19 pandemic.

METHODS

Participants of this cross-sectional study were 2252 national and foreign residents of Saudi Arabia. We used a web-based self-rated questionnaire to measure the association between psychological distress (Depression, Anxiety and Stress Scales [DASS-21]) and immune status (Immune Status Questionnaire [ISQ]) during the COVID-19 pandemic. We also investigated predictors of reduced immune status using binary logistic regression analyses.

RESULTS

Data from 1721 respondents showed that 17.5% of participants scored below the immune status cutoff (ISQ ˂ 6). Mean (± standard deviation) depression, anxiety, and stress scores in the reduced immune status group (ISQ ˂ 6) indicated moderate depression, anxiety, and stress (19.1 ± 11.4; 15.0 ± 9.6; 21.8 ± 11.2, respectively) and were significantly higher than scores in the normal immune status group (ISQ ≥ 6) (8.6 ± 9.1, P ˂ 0.0001; 5.0 ± 6.7, P ˂ 0.0001; 9.3 ± 9.3, P ˂ 0.0001, respectively). The regression analysis showed that age, anxiety, and stress were the only factors that significantly predicted the presence of reduced immune status.

CONCLUSION

There is an association between mental health problems during the COVID-19 pandemic and immune response in the public, especially in elderly people.

Fibrinogen Levels and the Risk of Cerebrovascular Events in Older Adults With Both Depressive Symptoms and Cognitive Impairment: A Prospective Study

Depression and cognitive impairment have been identified as risk factors for cerebrovascular events (CVE), and one of their potential etiological pathways is inflammatory status. This prospective study aims to investigate the association between inflammatory markers and the risk of CVE in a population of 2659 older adults, enrolled in the Progetto Veneto Anziani (Pro.V.A.), with depressive symptoms, cognitive impairment, or both conditions. For each individual, we assessed at baseline the presence of depressive symptoms (defined as a Geriatric Depression Scale ≥11), cognitive impairment (defined as a Mini-Mental State Examination <24), and serum levels of fibrinogen, white blood cells (WBC), and erythrocyte sedimentation rate (ESR). During a 4.4-year follow-up, 188 (7.1%) participants had CVE. Among the inflammatory markers, high fibrinogen values were associated with a 50% higher risk of CVE in the whole sample, and with a 4-fold higher risk in individuals with both depressive symptoms and cognitive impairment (hazard ratio = 4.04, 95% confidence interval: 1.45-11.23). Elevated WBC were associated with a 5% higher risk of CVE in the whole sample and in those with both conditions. No significant association was observed with the ESR. In conclusion, our study found that high fibrinogen levels may predict the risk of CVE in older people with concomitant depressive symptoms and cognitive impairment. Therefore, fibrinogen could be considered as an easily accessible aging biomarker, which might estimate the chronic inflammatory status and its potential detrimental effects on the most vulnerable older adults.

Antidepressant efficacy and immune effects of bilateral theta burst stimulation monotherapy in major depression: A randomized, double-blind, sham-controlled study

Inflammation theory has been consolidated by accumulating evidence, and many studies have suggested that the peripheral cytokine levels could be biomarkers for disease status and treatment outcome in major depressive disorder (MDD). Theta burst stimulation (TBS), a new form of repetitive transcranial magnetic stimulation (TMS) for MDD, has been demonstrated to improve depression via modulating dysfunctional neural network or hypothalamic–pituitary–adrenal axis hyperactivities in MDD. However, there is lack of exploratory studies investigating its effect on serum inflammatory cytokines. Here, we aimed to investigate the antidepressant efficacy of bilateral TBS monotherapy and its effects on the serum cytokine levels in MDD. We conducted a double-blind, randomized, sham-controlled trial, with 53 MDD patients who exhibited no responses to at least one adequate antidepressant treatment for the prevailing episode assigned randomly to one of two groups: bilateral TBS monotherapy (n = 27) or sham stimulation (n = 26). The TBS treatment period was 22 days. Blood samples from 31 study subjects were obtained for analyses. The bilateral TBS group exhibited significantly greater decreases in depression scores than the sham group at week 4 (56.5% vs. 33.1%; p < 0.001 [effect size (Cohen ’ s d) = 1.00]) and during the 20-week follow-up periods. Significantly more responders were also found at week 4 (70.3% vs. 23.1%, p = 0.001) and during the 20-week follow-up periods. However, we did not detect any significant effects of TBS on the cytokine panels or any correlations between improvement in depressive symptoms and changes in serum inflammatory markers. Our findings provided the first evidence that the antidepressant efficacy of bilateral TBS monotherapy might not work via immune-modulating mechanisms.

Biochemical Mechanisms and Translational Relevance of Hippocampal Vulnerability to Distant Focal Brain Injury: The Price of Stress Response

Focal brain injuries (in particular, stroke and traumatic brain injury) induce with high probability the development of delayed (months, years) cognitive and depressive disturbances which are frequently comorbid. The association of these complications with hippocampal alterations (in spite of the lack of a primary injury of this structure), as well as the lack of a clear dependence between the probability of depression and dementia development and primary damage severity and localization served as the basis for a new hypothesis on the distant hippocampal damage as a key link in the pathogenesis of cognitive and psychiatric disturbances. According to this hypothesis, the excess of corticosteroids secreted after a focal brain damage, in particular in patients with abnormal stress-response due to hypothalamic-pituitary-adrenal axis (HPAA) dysfunction, interacts with corticosteroid receptors in the hippocampus inducing signaling pathways which stimulate neuroinflammation and subsequent events including disturbances in neurogenesis and hippocampal neurodegeneration. In this article, the molecular and cellular mechanisms associated with the regulatory role of the HPAA and multiple functions of brain corticosteroid receptors in the hippocampus are analyzed. Functional and structural damage to the hippocampus, a brain region selectively vulnerable to external factors and responding to them by increased cytokine secretion, forms the basis for cognitive function disturbances and psychopathology development. This concept is confirmed by our own experimental data, results of other groups and by prospective clinical studies of post-stroke complications. Clinically relevant biochemical approaches to predict the risks and probability of post-stroke/post-trauma cognitive and depressive disturbances are suggested using the evaluation of biochemical markers of patients' individual stress-response. Pathogenetically justified ways for preventing these consequences of focal brain damage are proposed by targeting key molecular mechanisms underlying hippocampal dysfunction.

Crocin ameliorates chronic obstructive pulmonary disease-induced depression via PI3K/Akt mediated suppression of inflammation

Clinical studies have indicated the co-occurrence of chronic obstructive pulmonary disease (COPD) and psychiatric disorders, for example, comorbid depression. However, the underlying mechanism is rarely addressed. The present study aimed to investigate the mechanism of COPD-induced depression and the psychological and physiological effects of crocin, an active constituent of Crocus sativus L. C57BL/6 mice were randomly exposed to cigarette smoke for 7 weeks to establish COPD animal model. Crocin (50 mg/kg), Dexamethasone (2 mg/kg) and IGF-1 (2 mg/kg) were respectively injected to mice once a day. The FEV1/FVC ratio and the mean alveolus area of lung tissue demonstrated the COPD model was successfully established by cigarette smoke. Crocin administration significantly reversed markers of depression [loss of body weight, sucrose preference, and elevation of immobile time in tail-suspension tests (TST) and in forced swimming tests (FST)]. Besides, crocin treatment significantly inhibited the numbers of inflammatory cells (macrophages, neutrophils, and lymphocytes), suppressed the infiltration of peribronchial inflammatory cells, and reduced the concentration of proinflammatory cytokines in bronchoalveolar lavage (BAL) fluid and lung tissue. Crocin also reduced proinflammatory cytokines in the hippocampus. In exploring associated mechanisms, we discovered that crocin blunted cigarette smoke-induced IκB phosphorylation and degradation, and NF-κBp65 nuclear translocation. IGF-1, an activator of PI3K, abrogated the effect of crocin against cigarette smoke-induced activation of the NF-κB pathway. Together, these results showed that an inflammatory mechanism might be involved in the pathogenesis of COPD with comorbid depression. Crocin exhibited significant effects through the regulation of PI3K/Akt-mediated inflammatory pathways.

Interleukin, tumor necrosis factor-α and C-reactive protein profiles in melancholic and non-melancholic depression: A systematic review

OBJECTIVE

The current diagnostic criteria for major depressive disorder (MDD) do not allow prediction of prognosis and therapeutic response. A possible strategy to improve this situation is the identification of depression subtypes on the bases of biomarkers reflecting underlying pathological processes such as neuro-inflammation.

METHODS

The PubMed/Medline database was searched until Apr 25th, 2017. In the initial search 1018 articles were retrieved, which were subsequently screened and only selected when the inclusion and exclusion criteria were fulfilled.

RESULTS

Eight eligible studies were found. Overall, serum interleukin-6 and 1β values were increased in the melancholic MDD subtype compared to controls and the non-melancholic MDD subtype. C-reactive protein was increased in non-melancholic MDD in 2 out of 4 studies, while there was no difference for tumor necrosis factor-α and interleukin-2 and 10.

CONCLUSION

Given the paucity of eligible studies the tentative conclusion must be drawn that peripheral inflammation markers have limited added value thus far to distinguish between melancholic and non-melancholic depression. To allow for a more definitive conclusion, further research is warranted using a broader panel of inflammatory markers in MDD subtypes, preferably based on a general consensus regarding diagnostic criteria and subtype definitions.

Neuroinflammation in suicide: Toward a comprehensive model

OBJECTIVES

Suicidal behaviour (SB) entered the DSM-5, underlying a specific biological vulnerability. Then, recent findings suggested a possible role of the immune system in SB pathogenesis. The objective of this review is to present these main immune factors involved in SB pathogenesis.

METHODS

We conducted a review using Preferred Reporting Items for Systematic reviews and Meta-Analysis criteria, and combined ("Inflammation") AND ("Suicidal ideation" OR "Suicidal attempt" OR "suicide").

RESULTS

Post mortem studies demonstrated associations between suicide and inflammatory cytokines in the orbitofrontal cortex, a brain region involved in suicidal vulnerability. Also, microgliosis and monocyte-macrophage system activation may be a useful marker of suicide neurobiology. Kynurenine may influence inflammatory processes, and related molecular pathways may be involved in SB pathophysiology. Few recent studies associated inflammatory markers with suicidal vulnerability: serotonin dysfunction, impulsivity and childhood trauma. Interestingly, the perception of threat that leads suicidal individuals to contemplate suicide may activate biological stress responses, including inflammatory responses.

CONCLUSIONS

Translational projects would be crucial to identify a specific marker in SB disorders, to investigate its clinical correlations, and the interaction between inflammatory cytokines and monoamine systems in SB. These researches might lead to new biomarkers and novel directions for therapeutic strategies.

The Trier Social Stress Test: Principles and practice

Researchers interested in the neurobiology of the acute stress response in humans require a valid and reliable acute stressor that can be used under experimental conditions. The Trier Social Stress Test (TSST) provides such a testing platform. It induces stress by requiring participants to make an interview-style presentation, followed by a surprise mental arithmetic test, in front of an interview panel who do not provide feedback or encouragement. In this review, we outline the methodology of the TSST, and discuss key findings under conditions of health and stress-related disorder. The TSST has unveiled differences in males and females, as well as different age groups, in their neurobiological response to acute stress. The TSST has also deepened our understanding of how genotype may moderate the cognitive neurobiology of acute stress, and exciting new inroads have been made in understanding epigenetic contributions to the biological regulation of the acute stress response using the TSST. A number of innovative adaptations have been developed which allow for the TSST to be used in group settings, with children, in combination with brain imaging, and with virtual committees. Future applications may incorporate the emerging links between the gut microbiome and the stress response. Future research should also maximise use of behavioural data generated by the TSST. Alternative acute stress paradigms may have utility over the TSST in certain situations, such as those that require repeat testing. Nonetheless, we expect that the TSST remains the gold standard for examining the cognitive neurobiology of acute stress in humans.

•

The TSST is the human experimental gold standard for evaluating the neurobiology of acute stress.

•

The HPA axis response to the TSST is higher in males and lower in older adults.

•

Genotype and epigenetic factors moderate the neurobiological response to the TSST.

•

Multiple adaptations of the TSST are available for different testing contexts.

Endocrine and mood responses to two working days in female teachers

Currently, a considerable amount of work stress is present in school teachers, one of the occupational groups with the highest levels of job strain and burnout. As chronic stress produces significant modifications in emotional adjustment and neuroendocrine functioning, we aimed to investigate the role of these work stress constructs in the endocrine and mood responses of a group of female teachers during two working days (WD) at different moments in the academic year. We studied mood as well as levels of cortisol and testosterone, representative of a predominant catabolic or anabolic balance. Our results showed that higher "control" was associated with higher positive mood (p = .028 on WD1 and p = .057 on WD2) and salivary testosterone (Tsal) (p = .022 on WD1), whereas "demands" and "total job strain" were related to negative mood (p = .011 and p = .015, respectively). Participants with higher scores on "total burnout" and "emotional exhaustion" also had higher negative mood (p < .05 in all cases). Depersonalization correlated positively with negative mood (p = .019 and p = .006 on WD1 and WD2, respectively). Finally, personal accomplishment showed an inverse relationship with negative mood (p = .038 on WD2). These results are useful for job risk prevention and interventions that should focus on the control dimension of the job strain questionnaire and on personal accomplishment from the burnout scale.

Association of depression with inflammation in hospitalized patients of myocardial infarction

OBJECTIVE

The aim of this study was to examine the associations between depression and inflammatory markers in patients admitted to the hospital for myocardial infarction.

METHODS

Inflammatory cytokines, including high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) were assessed in a group of 75 depressed participants (score of ≥ 12) and compared to a control group of 75 nondepressed participants (score < 12), all who had been admitted to the hospital for myocardial infarction. The presence of depressive symptoms was assessed using the Beck Depressive Symptoms Inventory II Scale (BDI-II).

RESULTS

Depressed myocardial infarction participants had significantly greater levels of TNF-α (t = 2.070, P < 0.05) compared with control myocardial infarction participants. The BDI-II score was positively correlated with TNF-α levels (r = 0.222, P < 0.05).

CONCLUSIONS

These results indicate that the presence of depressive symptoms is positively associated with TNF-α levels among patients who have suffered from myocardial infarction.

Telomere length - a cellular aging marker for depression and Post-traumatic Stress Disorder

Telomeres play a central role in cell fate and aging by adjusting the cellular response to both biological and psychological stress. Human telomeres are regions of tandem TTAGGG repeats at chromosomal ends that protect chromosomes from degradation, fusion, and recombination. They are made up of approximately 1000-2500 copies of the repeated DNA sequence. Over time, at each cell division, the telomere ends become shorter. Thus, telomere length (TL) has been considered a cellular marker for age-related diseases. In addition to biochemical stressors such as oxidation and inflammation, psychosocial traumatic stress has also been linked to shorter telomeres. TL is significantly inversely correlated with long-term depression, even after controlling for age. Average TL in depressed subjects, who were above the median of lifetime depression, was 281 base pairs shorter than that in controls, corresponding to approximately 7years of accelerated cell aging. Several recent studies have also demonstrated an inverse relationship between leukocyte telomere length (LTL) and the risk of PTSD. TL was inversely correlated with the duration of caregiving and PTSD. Here, we focus on the discussion of findings in studies of the relationships between stress-related disorders (e.g., depression and PTSD) and telomeres. We also present direct evidence that TL is associated with traumatic stress, depression, and PTSD, and hypothesize that traumatic stress affects not only mental disorders but also cellular aging. The nature of this relationship between stress and TL warrants further evaluation in psychiatry.

Polymorphisms of the TLR4 gene and risk of gastric cancer

OBJECTIVE

Toll-like receptor 4 (TLR4) is an important lipo-polysaccharide (LPS) receptor in gastric epithelial cell signaling transduction and plays critical roles in the development and progression of gastric cancer (GC). We investigated the effects of TLR4 gene polymorphisms and gene-environmental interactions on the risk of GC in Northeastern China.

METHODS

We genotyped two single-nucleotide polymorphisms (SNPs) in TLR4 (rs10116253 and rs1927911) in 217 GC patients and 294 cancer-free controls using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Odds ratio (OR) and 95% confidence intervals (CIs) were estimated by unconditional logistic-regression models.

RESULTS

Individuals carrying CC genotype of rs10116253 and TT genotype of rs1927911 had a significantly decreased risk of GC (adjusted OR=0.33, 95% CI 0.18-0.60, P<0.001 and adjusted OR=0.37, 95% CI 0.21-0.67, P=0.001 respectively), compared with TT genotype of rs10116253 and CC genotype of rs1927911. In addition, the SNP effects were additive to the effects of some known environmental factors without any interaction between them in the susceptibility to GC.

CONCLUSION

Our data suggested that TLR4 gene polymorphisms may be associated with a decreased risk of GC in Chinese population. And these SNPs and their combined effects with environmental factors may be associated with the risk of GC.

Interleukin-1β is associated with depressive episode in major depression but not in bipolar disorder

Our work was sought to investigate possible changes in peripheral levels of interleukin-1β (IL-1β) according to the diagnosis of major depression (MD) and bipolar disorder (BD) and in different mood episodes. This is a cross-sectional nested in a population-based study comparing 240 young adults (80 controls, 80 MD and 80 BD), balanced for age and gender. Serum levels of IL-1β were significantly higher in MD when compared to control or BD subjects. In addition, when divided by current mood episode, MD subjects in current depression presented higher IL-1β levels than controls. No differences in IL-1β levels were found between different episodes of BD (euthymic, depressed, mania or mixed). Moreover, the use of psychiatric medication was very low in our sample and not associated with changes in IL-1β levels. In conclusion, increased peripheral IL-1β might be a useful marker associated with a depressive episode in the context of MD.

Neurobiology of major depressive disorder

We survey studies which relate abnormal neurogenesis to major depressive disorder. Clinically, descriptive gene and protein expression analysis and genetic and functional studies revised here show that individual alterations of a complex signaling network, which includes the hypothalamic-pituitary-adrenal axis; the production of neurotrophins and growth factors; the expression of miRNAs; the production of proinflammatory cytokines; and, even, the abnormal delivery of gastrointestinal signaling peptides, are able to induce major mood alterations. Furthermore, all of these factors modulate neurogenesis in brain regions involved in MDD, and are functionally interconnected in such a fashion that initial alteration in one of them results in abnormalities in the others. We highlight data of potential diagnostic significance and the relevance of this information to develop new therapeutic approaches. Controversial issues, such as whether neurogenesis is the basis of the disease or whether it is a response induced by antidepressant treatments, are also discussed.

Lower CSF interleukin-6 predicts future depression in a population-based sample of older women followed for 17 years

OBJECTIVE

The literature regarding cerebrospinal fluid (CSF) cytokines in geriatric depression is sparse. The aim of this study was to examine associations between CSF interleukin-6 (IL-6) and related proinflammatory cytokines and current and future depression in a population-based sample of older women who were followed for 17 years.

METHODS

83 non-demented women aged 70-84 years who participated in the Prospective Population Study of Women in Gothenburg, Sweden took part in a lumbar puncture in 1992-3. CSF- IL-6, interleukin-1β (IL-1β), interleukin- 8 (IL-8) and tumor necrosis factor-α (TNF-α) were measured. Psychiatric symptoms were rated with the Comprehensive Psychopathological Rating Scale at baseline and at three subsequent face-to-face examinations. Depression (major or minor) was diagnosed in accordance with DSM-IV/DSM-IV research criteria.

RESULTS

At baseline, women with ongoing depression had lower levels of IL-6 (p<0.04), IL-8 (p<0.05) and TNF-α (p<0.05) compared with those without depression. In women without depression at baseline, lower CSF IL-6 levels predicted depression at one or more follow-up examination (p<0.03). Results from the generalized linear mixed logistic model using all baseline and follow-up data on depression status and Mini Mental State Examination score showed a significant relationship between IL-6 and depression (p=0.005 OR 0.370 CI [0.184-0.744]).

CONCLUSION

Lower levels of CSF IL-6 were associated with current depression and with future depression during a follow-up of almost two decades. Our findings suggest that lower levels of CSF IL-6 may be related to depression vulnerability in later life.

Chronic mild stress eliminates the neuroprotective effect of Copaxone after CNS injury

Copolymer (Cop)-1, also known as glatiramer acetate, is an active compound of Copaxone, a drug widely used by patients with multiple sclerosis (MS). Copaxone functions in MS through two mechanisms of action, namely immunomodulation and neuroprotection. Because the immune system is suppressed or altered in depressed individuals, and since depression is often associated with neurological conditions, we were interested in examining whether the neuroprotective effect of Copaxone persists under conditions of stress-induced depressive behavior. We exposed mice to unpredictable chronic mild stress for 4 weeks and then treated them with three doses of Copaxone at 3-day intervals, with the last dose given immediately before the mice underwent a crush injury to the optic nerve. Whereas nonstressed mice exhibited a strong neuroprotective response after Copaxone treatment, this effect was completely absent in mice that underwent chronic mild stress. Interestingly, when Copaxone was combined with Prozac, the neuroprotective effect of Copaxone was regained, suggesting that chronic mild stress interferes with the neuroprotective effect of Copaxone. These results may shed a light on mechanism of action of Copaxone and lead to new combined therapies for neurodegenerative and neuroinflammatory disorders.

Depressive symptoms and cortisol rhythmicity predict survival in patients with renal cell carcinoma: role of inflammatory signaling

Purpose

Evidence has supported the association between psychological factors and cancer biology; however, findings are equivocal on the role of psychosocial factors in cancer progression. This study generates a hypothesis of mechanistic variables by examining the clinical effects of psychosocial factors and cortisol dysregulation in patients with metastatic renal cell carcinoma (RCC) and examines associated activation of transcription control pathways.

Methods

Patients with metastatic RCC (n = 217) were prospectively enrolled in this study. Patients completed questionnaires (Centers for Epidemiologic Studies – Depression; SF-36 Health Status Survey; Duke Social Support Index; Coping Operations Preference Enquiry; organized and non-organized religious activity; and intrinsic religiosity), and provided blood and saliva samples. Cortisol levels and whole genome transcriptional profiling were assessed to identify potential alterations in circadian rhythms and genomic pathways.

Results

Separate Cox regression models, controlling for disease risk category, revealed that CES-D scores (p = 0.05, HR = 1.5, 95% CI for HR: 1.00–2.23) and cortisol slope (p = 0.002; HR = 1.9; 95%CI for HR: 1.27–2.97) were significantly associated with decreased survival. Only cortisol slope and risk category remained significant in the complete model. Functional genomic analyses linked depressive symptoms to increased expression of pro-inflammatory and pro-metastatic genes in circulating leukocytes. 116 transcripts were found to be upregulated by an average of 50% or more in high CES-D patients, and 57 transcripts downregulated by at least 50%. These changes were also found in the tumor in a subset of patients.

Conclusion

These findings identify depressive symptoms as a key predictor of survival in renal cell carcinoma patients with potential links to dysregulation of cortisol and inflammatory biology.

Depression and leukocyte telomere length in patients with coronary heart disease: data from the Heart and Soul Study

OBJECTIVE

Shortened telomere length has been associated with mortality in patients with coronary heart disease (CHD) and is considered as an emerging marker of biologic age. Whether depression is associated with telomere length or trajectory has not been evaluated in patients with CHD.

METHODS

In a prospective cohort study, we measured leukocyte telomere length in 952 participants with stable CHD at baseline and in 608 of these participants after 5 years of follow-up. The presence of major depressive disorder in the past month was assessed using the computerized diagnostic interview schedule at baseline. We used linear and logistic regression models to evaluate the association of depression with baseline and 5-year change in leukocyte telomere length.

RESULTS

Of the 952 participants, 206 (22%) had major depression at baseline. After the adjustment for age and sex, the patients with current major depressive disorder had shorter baseline telomere length than those without depression (mean [standard error] = 0.86 [0.02] versus 0.90 [0.01]; p = .02). This association was similar (but no longer statistically significant) after adjustment for body mass index, smoking, diabetes, left ventricular ejection fraction, statin use, antidepressant use, physical inactivity, and anxiety (0.85 [0.02] versus 0.89 [0.01], p = .06). Depression was not predictive of 5-year change in telomere length after adjustment for the mentioned covariates and baseline telomere length.

CONCLUSIONS

Depression is associated with reduced leukocyte telomere length in patients with CHD but does not predict 5-year change in telomere length. Future research is necessary to elucidate the potential mechanisms underlying the association between depression and telomere length.

Endocrinological and psychological responses to job stressors: an experimental test of the job demand--control model

The buffer hypothesis of the Job Demand-Control Model predicts that high levels of job control compensate for the negative effects of high job demands on well-being and health. Several studies have tested this hypothesis, but the results are far from consistent. The objective of this study was to test the buffer hypothesis with respect to psychological (subjective well-being) and physiological (salivary cortisol) indicators of job strain, using an experimental study design. Seventy-seven men and women worked at a simulated computer workplace for more than two hours. Job demands and job control were manipulated in a 2 (job demands: high vs. low)×2 (job control: high vs. low)×7 (time of measurement) study design. Demands were operationalized in terms of workload, and pacing control (self-paced vs. machine-paced) was used as a job control manipulation. As dependent variables, subjective well-being and salivary cortisol were measured at seven time points during the experiment (T1-T7). In line with the buffer hypothesis, high control eliminated the impact of high demands on salivary cortisol responses. The hypothesis was supported by a predicted significant three-way interaction of demands, control and time of measurement (p<.001), qualified by the absence of significant effects of the independent variables at T1 and T2 due to lagged cortisol reactions, and significant two-way interactions of demands and control, as predicted by the model, at the five remaining times of measurement (T3-T7): high demands led to increased cortisol reactions only in the low control condition. In contrast, no main or interaction effects of the independent variables were found for subjective well-being. This discrepancy between physiological and psychological stress reactions might be due to the lack of specificity inherent in measures of subjective well-being, due to lagged psychological reactions, or due to self-report biases in the subjective measures. In sum, this study provides the first clear-cut experimental evidence for the idea that the negative impact of high job demands on endocrinological responses can be buffered by high levels of job control.

Neuropsychiatric symptoms in patients with aortic aneurysms

Background

Emerging evidence suggests that vascular disease confers vulnerability to a late-onset of depressive illness and the impairment of specific cognitive functions, most notably in the domains of memory storage and retrieval. Lower limb athero-thrombosis and abdominal aortic aneurysm (AAA) have both been previously associated with neuropsychiatric symptoms possibly due to associated intracerebral vascular disease or systemic inflammation, hence suggesting that these illnesses may be regarded as models to investigate the vascular genesis of neuropsychiatric symptoms. The aim of this study was to compare neuropsychiatric symptoms such as depression, anxiety and a variety of cognitive domains in patients who had symptoms of peripheral athero-thrombosis (intermittent claudication) and those who had an asymptomatic abdominal aortic aneurysm AAA.

Methodology/Principal Findings

In a cross-sectional study, 26 participants with either intermittent claudication or AAA were assessed using a detailed neuropsychiatric assessment battery for various cognitive domains and depression and anxiety symptoms (Hamilton Depression and Anxiety Scales). Student t test and linear regression analyses were applied to compare neuropsychiatric symptoms between patient groups. AAA participants showed greater levels of cognitive impairment in the domains of immediate and delayed memory as compared to patients who had intermittent claudication. Cognitive dysfunction was best predicted by increasing aortic diameter. CRP was positively related to AAA diameter, but not to cognitive function. AAA and aortic diameter in particular were associated with cognitive dysfunction in this study.

Conclusions/Significance

AAA patients are at a higher risk for cognitive impairment than intermittent claudication patients. Validation of this finding is required in a larger study, but if confirmed could suggest that systemic factors peculiar to AAA may impact on cognitive function.

Leukocyte telomere length in major depression: correlations with chronicity, inflammation and oxidative stress--preliminary findings

BACKGROUND

Depression is associated with an unusually high rate of aging-related illnesses and early mortality. One aspect of "accelerated aging" in depression may be shortened leukocyte telomeres. When telomeres critically shorten, as often occurs with repeated mitoses or in response to oxidation and inflammation, cells may die. Indeed, leukocyte telomere shortening predicts early mortality and medical illnesses in non-depressed populations. We sought to determine if leukocyte telomeres are shortened in Major Depressive Disorder (MDD), whether this is a function of lifetime depression exposure and whether this is related to putative mediators, oxidation and inflammation.

METHODOLOGY

Leukocyte telomere length was compared between 18 unmedicated MDD subjects and 17 controls and was correlated with lifetime depression chronicity and peripheral markers of oxidation (F2-isoprostane/Vitamin C ratio) and inflammation (IL-6). Analyses were controlled for age and sex.

PRINCIPAL FINDINGS

The depressed group, as a whole, did not differ from the controls in telomere length. However, telomere length was significantly inversely correlated with lifetime depression exposure, even after controlling for age (p<0.05). Average telomere length in the depressed subjects who were above the median of lifetime depression exposure (≥9.2 years' cumulative duration) was 281 base pairs shorter than that in controls (p<0.05), corresponding to approximately seven years of "accelerated cell aging." Telomere length was inversely correlated with oxidative stress in the depressed subjects (p<0.01) and in the controls (p<0.05) and with inflammation in the depressed subjects (p<0.05).

CONCLUSIONS

These preliminary data indicate that accelerated aging at the level of leukocyte telomeres is proportional to lifetime exposure to MDD. This might be related to cumulative exposure to oxidative stress and inflammation in MDD. This suggest that telomere shortening does not antedate depression and is not an intrinsic feature. Rather, telomere shortening may progress in proportion to lifetime depression exposure.

Stress, coping, and depression: testing a new hypothesis in a prospectively studied general population sample of U.S.-born Whites and Blacks

The scarcity of empirically supported explanations for the Black/White prevalence difference in depression in the U.S. is a conspicuous gap in the literature. Recent evidence suggests that the paradoxical observation of decreased risk of depression but elevated rates of physical illness among Blacks in the U.S. compared with Whites may be accounted for by the use of coping behaviors (e.g., alcohol and nicotine consumption, overeating) among Blacks exposed to high stress levels. Such coping behaviors may mitigate deleterious effects of stressful exposures on mental health while increasing the risk of physical ailments. The racial patterning in mental and physical health outcomes could therefore be explained by this mechanism if a) these behaviors were more prevalent among Blacks than Whites and/or b) the effect of these behavioral responses to stress was differential by race. The present study challenges this hypothesis using longitudinal, nationally-representative data with comprehensive DSM-IV diagnoses. Data are drawn from 34,653 individuals sampled in Waves 1 (2001-2002) and 2 (2004-2005) as part of the US National Epidemiologic Survey on Alcohol and Related Conditions. Results showed that a) Blacks were less likely to engage in alcohol or nicotine consumption at low, moderate, and high levels of stress compared to Whites, and b) there was a significant three-way interaction between race, stress, and coping behavior for BMI only (F = 2.11, df = 12, p = 0.03), but, contrary to the hypothesis, elevated BMI was protective against depression in Blacks at low, not high, levels of stress. Further, engagement in unhealthy behaviors, especially at pathological levels, did not protect against depression in Blacks or in Whites. In sum, the impact of stress and coping processes on depression does not appear to operate differently in Blacks versus Whites. Further research testing innovative hypotheses that would explain the difference in Black/White depression prevalence is warranted.

Neural substrates of psychostimulant withdrawal-induced anhedonia

Psychostimulant drugs have powerful reinforcing and hedonic properties and are frequently abused. Cessation of psychostimulant administration results in a withdrawal syndrome characterized by anhedonia (i.e., an inability to experience pleasure). In humans, psychostimulant withdrawal-induced anhedonia can be debilitating and has been hypothesized to play an important role in relapse to drug use. Hence, understanding the neural substrates involved in psychostimulant withdrawal-induced anhedonia is essential. In this review, we first summarize the theoretical perspectives of psychostimulant withdrawal-induced anhedonia. Experimental procedures and measures used to assess anhedonia in experimental animals are also discussed. The review then focuses on neural substrates hypothesized to play an important role in anhedonia experienced after termination of psychostimulant administration, such as with cocaine, amphetamine-like drugs, and nicotine. Both neural substrates that have been extensively investigated and some that need further evaluation with respect to psychostimulant withdrawal-induced anhedonia are reviewed. In the context of reviewing the various neurosubstrates of psychostimulant withdrawal, we also discuss pharmacological medications that have been used to treat psychostimulant withdrawal in humans. This literature review indicates that great progress has been made in understanding the neural substrates of anhedonia associated with psychostimulant withdrawal. These advances in our understanding of the neurobiology of anhedonia may also shed light on the neurobiology of nondrug-induced anhedonia, such as that seen as a core symptom of depression and a negative symptom of schizophrenia.

Interleukin-1 receptor antagonist and incident depressive symptoms over 6 years in older persons: the InCHIANTI study

BACKGROUND

We test the hypothesis that in older persons higher plasma levels of inflammatory markers predict the development of depressive symptoms during a 6-year follow-up.

METHOD

This study is part of the InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) study, a prospective population-based study of older persons. The sample consisted of 991 participants, ages 65 years and older. Serum levels of C-reactive protein, interleukin (IL)-1beta, IL-1 receptor antagonist (ra), tumor necrosis factor-alpha, IL-6, IL-6 receptor, and IL-18 were measured. Depressive symptoms were assessed at baseline and at the 3- and 6-year follow-ups with the Center for Epidemiological Studies-Depression Scale (CES-D). Depressed mood was defined as CES-D > 20. Potential confounders were baseline variables related to sociodemographic, somatic health, and functional status.

RESULTS

At baseline, IL-1ra levels were significantly higher (p = .004) in depressed compared with nondepressed participants. After adjustment for confounders, among subjects free of depression at baseline, those in the third and fourth IL-1ra quartiles compared with those in the lowest quartile had, respectively, a 2.32-fold (95% confidence interval: 1.21-4.42, p = .01) and 2.78-fold (95% confidence interval: 1.47-5.26, p = .002) higher risk of developing depressed mood during a 6-year follow-up.

CONCLUSIONS

In old age, persons with high plasma levels of IL1-ra had a higher risk of developing depressive symptoms over time. These findings suggest a potential causal role for inflammation in the development of depressive symptoms in older persons.

Immunomodulatory effects of Abnormal Savda Munsiq, a traditional Uighur medicine, on the combined stress mice

OBJECTIVE

To investigate the immunomodulatory effects of ASMq, a herbal preparation used in Traditional Uighur Medicine, on the combined stress mice.

MATERIALS AND METHODS

The combined stress was induced on mice by application of the electric-foot shock in a cold-dry environment and three different doses of ASMq were orally administered to the animals for 14 days. The effect of ASMq on the immune apparatus weight index, lymphocytes proliferation, serum levels of the cytokines, immunoglobulins, hemolysin and NK cells as well as the phagocytic activity of the macrophages were evaluated.

RESULTS

Oral administration of ASMq was found to increase the thymus and spleen indices, lymphocytes proliferation induced by Con A and LPS, the percentage of CD4(+) in thymus, spleen and peripheral blood and restore the CD4(+)/CD8(+) ratio. The serum concentrations of INF-beta, IL-2, IL-6, IgG, NK cells and hemolysin were also increased. The macrophage phagocytic activity was also enhanced.

Differential modulation of cytokine production in major depressive disorder by cortisol and dexamethasone

In major depressive disorder (MDD), there is increasing evidence of a relationship between neuroendocrine and immunological alterations. Therefore, we investigated the influence of cortisol and dexamethasone on the in vitro production of TNF-alpha and IL-6 in blood cells of depressed inpatients at admission, in the course of MDD and in healthy controls. Patients were psychopathologically classified as responders and non-responders after a 6-week antidepressant treatment. At admission in the responder subgroup, incubation with both steroids under basal conditions resulted in an increase of TNF-alpha levels, which decreased after treatment. After stimulation with phytohemagglutinin, an enhancement of TNF-alpha suppression by steroids was detectable after successful antidepressive treatment. A significant relationship was seen between the cortisol-induced modulation of TNF-alpha levels and the psychopathology in this subgroup. Under basal conditions, IL-6 levels were increased after treatment with both steroids. The data suggest a normalization of the altered effects of glucocorticoids on TNF-alpha production in the responder subgroup only.

Depressive Störungen

Das Spektrum depressiver Erkrankungen macht den Hauptteil affektiver Störungen aus und gehört mit einer Inzidenz von ca. 8–20% zu den häufigsten psychischen Erkrankungen. Depressionen werden nach wie vor zu selten einer adäquaten Therapie (Antidepressiva, störungsspezifische Psychotherapie wie z. B. kognitive Verhaltenstherapie) zugeführt.

Imbalance between pro-inflammatory and anti-inflammatory cytokines in bipolar disorder

BACKGROUND

The role of cytokines in bipolar disorder is still controversial. Although a few studies have found alterations of cytokines in bipolar disorder, their findings were inconsistent. The aim of this study was to determine whether the cytokines are involved in the pathophysiology of bipolar disorder.

METHODS

A total of 37 manic patients with bipolar disorder and 74 control subjects were recruited. The mitogen-induced production of tumor necrosis factor (TNF)-alpha, interleukin-6 (IL-6), IL-4, interferon (IFN)-gamma, and IL-2 was measured using quantitative sandwich ELISA at the time of admission and 6 weeks after mood stabilizer treatment.

RESULTS

IL-6 and TNF-alpha production of bipolar manic patients was significantly higher than those of normal controls, while IL-4 values of the patients were significantly lower than normal controls. IL-6/IL-4, TNF-alpha/IL-4, IL-2/IL-4, and IFN-gamma/IL-4 ratios were significantly higher in bipolar manic patients than in normal controls. After 6 weeks of treatment, the levels of IL-6 significantly decreased compared with baseline.

LIMITATIONS

The effect of various types of mood stabilizers on cytokine production should be considered.

CONCLUSIONS

These findings suggest that the increased activity of pro-inflammatory cytokines and an imbalance between pro-inflammatory and anti-inflammatory cytokines may play a role in the pathophysiology of bipolar disorder.

T-helper 1/T-helper 2 cytokine imbalance and clinical phenotypes of acute-phase major depression

Several studies have discussed the relationships between T-helper 1 (Th1) or Th2 cytokines and major depression. The aim of the present study was to investigate the relationships between Th1/Th2 cytokine balance and clinical phenotypes of acute-phase major depression. A total of 82 subjects including 42 patients with major depressive disorder and 40 healthy controls were recruited. Serum cytokine levels of interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) and IL-10 were examined. Using ancova with age and body mass index (BMI) adjustments, there were no significant differences in serum IL-1beta, TNF-alpha, and IL-10 levels between patients with major depressive disorder and healthy controls. However, using ANCOVA with BMI adjustment only, the results showed that patients with major depressive disorder had significantly higher TNF-alpha levels than control subjects. In addition, using ANCOVA with age and BMI adjustments, significantly higher serum IL-1beta level and IL-1beta/IL-10 ratio were noted in patients with melancholic features than patients with non-melancholic features. However, there were no significant differences in serum IL-1beta, TNF-alpha and IL-10 levels between patients with and without suicide attempt. In conclusion, serum TNF-alpha, IL-1beta level and IL-1beta/IL-10 ratio might play an important role in the psychopathology of acute-phase major depressive disorder.

Salivary cortisol in response to acute social rejection and acceptance by peers

Past research indicates that social rejection predicts a wide range of psychological problems (e.g., depression), but laboratory studies examining self-reports of negative affect after social rejection have reported inconsistent results. Salivary cortisol was measured before and after a social rejection/acceptance manipulation for objective assessment of psychological distress subsequent to peer rejection. Rejected participants were predicted to show significantly greater salivary cortisol than accepted or control participants. The present research also examined several factors that may moderate the relationship between acute rejection and cortisol. As predicted, rejected participants exhibited significantly higher cortisol than accepted or control participants. Defensiveness moderated the relationship between rejection and cortisol; highly defensive rejected participants showed significantly lower cortisol than less defensive rejected participants after peer rejection. Results indicate that social rejection causes psychological distress, but highly defensive individuals appear to be less susceptible than less defensive individuals to increases in salivary cortisol after acute social rejection.

Cardioversion of persistent atrial arrhythmia after treatment with venlafaxine in successful management of major depression and posttraumatic stress disorder

There is increasing evidence linking depression and cardiovascular disease. However, the authors could find no literature directly linking depression with atrial fibrillation or atrial flutter. The authors report the case of a patient with uncontrolled atrial arrhythmia who cardioverted to normal sinus rhythm after treatment of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) with venlafaxine. The authors discuss comorbidity of MDD and atrial fibrillation, and explore evidence of venlafaxine as an antiarrhythmic agent. Further research is needed to establish the clinical role of venlafaxine as a Class 1 antiarrhythmic agent and any association between atrial arrhythmias and MDD and PTSD.

Prenatal stress has pro-inflammatory consequences on the immune system in adult rats

The in utero environment is critical for initiating the ontogeny of several physiological systems, including the immune surveillance. Yet, little is known about adverse early experiences on the offspring's immunity and vulnerability to disease. The present work aimed at investigating the impact of restraint prenatal stress (PS) on the development and responsiveness of in vitro and in vivo cellular and humoral immunity of male progeny aged 7 weeks and 6 months. In adult 6-month-old rats, we detected increased circulating CD8(+)-expressing and NK cells in PS rats as compared to controls, associated with higher mRNA expression of IFN-gamma. In addition, in vitro stimulation with phytohemagglutinin-A induced an increase in both the proliferation of T lymphocytes and the secretion of IFN-gamma in PS rats. Interestingly, these alterations were undetectable in younger PS rats (7-week old), except for a slight increase in the mRNA expression of several pro-inflammatory cytokines in peripheral blood mononuclear cells. Moreover, in vivo neutralization of IFN-gamma in young rats had no effects in PS group. In conclusion, we report for the first time long-lasting pro-inflammatory consequences of PS in rats.

Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women

HIV-related stigmatization remains a potent stressor for HIV-positive people. This study examined the relationships among stigma-related experiences and depression, medication adherence, serostatus disclosure, and sexual risk among 221 HIV-positive men and women. In bivariate analyses that controlled for background characteristics, stigma was associated with depressive symptoms, receiving recent psychiatric care, and greater HIV-related symptoms. Stigma was also associated with poorer adherence and more frequent serostatus disclosure to people other than sexual partners, but showed no association to sexual risk behavior. In a multivariate analysis that controlled for all correlates, depression, poor adherence, and serostatus disclosure remained as independent correlates of stigma-related experiences. Findings confirm that stigma is associated with psychological adjustment and adherence difficulties and is experienced more commonly among people who disclose their HIV status to a broad range of social contacts. Stigma should be addressed in stress management, health promotion, and medication adherence interventions for HIV-positive people.

Multiple vaccine and pyridostigmine bromide interactions in the common marmoset Callithrix jacchus: immunological and endocrinological effects

Following active service during the 1990/1991 Gulf Conflict, a number of UK and US veterans presented with a diverse range of symptoms, collectively known as Gulf Veterans Illnesses (GVI). The administration of vaccines and/or the pretreatment against possible nerve agent poisoning, pyridostigmine bromide (PB), given to Armed Forces personnel during the Gulf Conflict has been implicated as a possible factor in the aetiology of these illnesses. The possibility that adverse health effects may result from the administration of these vaccines (anthrax, pertussis, plague, yellow fever, polio, typhoid, tetanus, hepatitis B, meningococcal meningitis and cholera) and/or PB, have been investigated over an eighteen month period, in a non-human primate model, the common marmoset. This study reports immunological indices, including leukocyte phenotypes, intracellular cytokines IFN-gamma and IL-4 and antibody responses against vaccine antigens. Using human isotyping reagents previously shown to cross react with marmoset immunoglobulins (ibid) it was shown that marmosets responded strongly against anthrax PA and pertussis and weakly against killed whole cell plague, cholera and typhoid. At the end of the study the immune response to a previously unseen T-cell dependent antigen, keyhole limpet haemocyanin (KLH), was examined in order to determine whether immune function had been compromised by the compounds administered. Statistically equivalent, robust antibody responses were measured against KLH in all treatment groups indicating that the immune system had not been compromised by any of the treatments. In addition, urinary cortisol was measured at key points throughout the study as an index of physiological stress which may have been induced by the treatments. There were no effects of treatment on urinary cortisol secretion. With respect to the other immunological indices measured, there were no statistical differences between the treatment groups during the period of the study.

Preliminary study on immunological and behavioural effects of Thymus broussonetii Boiss., an endemic species in Morocco

In the present work, we had tried to evaluate the immunotropic and behavioural effects of Thymus broussonetii Boiss. So, we tested the neurostimulant effects of four extracts. This preliminary study allowed to identify both the immunostimulant and the neurotropic antistress effects of the studied extracts. Among the four extracts, only the aqueous and ethyl acetate ones showed an apparent effect on the tested biological activities, whereas the butanolic extract and the essential oil did not show any interesting effect (data not shown). These results showed that the aqueous and ethyl extracts of this endemic species are of interest for two reasons: stimulation of the immunizing system and protection against the stress by a neurotropic activity. Thyme extracts increased in vivo the number of leucocyte categories studied including polynuclears, total lymphocytes, TCD4+, TCD8+ and NK cells. These data suggest that the intraperitoneal administration of Thymus broussonetii extract has a potent direct effect on leucocytes in vivo. The elevation of leucocyte and thrombocyte counts produced by thyme in the peripheral blood was already reported in the literature. These results could be of practical importance in the field of phytotherapy in the treatment of some cases of human immunodeficiency such as cancer, leukaemia and AIDS.

Rapid modulation of TRH and TRH-like peptide levels in rat brain and peripheral tissues by corticosterone

Disturbance of glucocorticoid signaling has been implicated in several neuropsychiatric disorders including unipolar and bipolar depression and anxiety induced by maternal deprivation. Antidepressants have been shown to be neuroprotective and able to reverse damage to glia and neurons. Thyrotropin-releasing hormone (TRH) is an endogenous antidepressant that reduces the expression of glycogen synthase kinase-3beta (GSK-3beta), an enzyme that hyperphosphorylates tau and is implicated in bipolar depression, diabetes and Alzheimer's disease. In order to understand the potential role of TRH and TRH-like peptides both as mediators of the depressogenic effects of glucocorticoids and as potential therapeutics for neuropsychiatric disease, 300 g male Sprague-Dawley rats were injected i.p. with 4 mg corticosterone/0.5 ml 50% DMSO+50% ethanol and sacrificed 0, 2, 4 and 8h later. Levels of TRH and TRH-like peptides were measured in various brain regions involved in mood regulation and pancreas and reproductive tissues that mediate the metabolic and reproductive impairments associated with high glucocorticoid levels. Significant increases, ranging from 2- to 12-fold, in TRH or TRH-like peptide levels were observed in almost all brain regions studied at 4h after corticosterone injection. In cerebellum, TRH and TRH-like peptides increased 4-14-fold by 8h. TRH-like peptide levels fell 86-98% at 4h after treatment in testis. TRH, derived only from Leydig cells, was not affected. TRH and TRH-like peptides increased 2-4-fold at 8h in pancreas. TRH and TRH-like peptide concentrations in prostate were not affected by corticosterone up to 8h after injection. The 4h needed to detect a highly significant change in the TRH and TRH-like peptide levels in brain and peripheral tissues is consistent with the mediation of most corticosterone-effects via alterations in gene transcription.

Glucocorticoid exposure in preterm babies predicts saliva cortisol response to immunization at 4 months

Preterm babies are exposed to multiple stressors and this may have long-term effects. In particular, high levels of endogenous cortisol might have a programming effect on the hypothalamic-pituitary-adrenal axis as may administered glucocorticoids. In this study, we aimed to test the hypothesis that the level of endogenous and exogenous glucocorticoid exposure during the neonatal period predicts the saliva cortisol response to immunization at 4 mo of age. We followed 45 babies born below 32 wk gestation. We showed that their concentration of plasma cortisol during the first 4 wk was 358, 314, 231, and 195 nmol/L cortisol, respectively (geometric mean). This is four to seven times higher than fetal levels at the same gestational age range. We used routine immunization at 4 mo and 12 mo as a stressor and measured the change in saliva cortisol as the stress response. Mean circulating cortisol in the first 4 wk predicted the cortisol response at 4 but not at 12 mo. Path analysis showed that birthweight for gestational age, therapeutic antenatal steroids, and therapeutic postnatal steroids also contributed to the magnitude of the saliva cortisol response at 4 mo. This provides evidence that the magnitude of glucocorticoid exposure, both endogenous and exogenous, may have an effect on later stress responses.

Stress and depression-induced immune dysfunction: implications for the development and progression of cancer

The persistent activation of the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary axes in chronic stress response and in depression impairs the immune response and contributes to the development and progression of some types of cancer. This overview presents results from experimental animal models, human studies, and clinical evidence that various cellular and molecular immunological parameters are compromised in chronic stress and depression. At the cellular level, stressed and depressed patients had overall leukocytosis, high concentrations of circulating neutrophils, reduced mitogen-stimulated lymphocyte proliferation and neutrophil phagocytosis. At the molecular level, high levels of serum basal cortisol, acute phase proteins, specific antibodies against herpes simplex virus type 1 and Epstein Barr virus, plasma concentration of interleukins IL-1, IL-6, and TNF-alpha, and a shift in the balance of Th1 and Th2 immune response were observed. Both stress and depression were associated with the decreased cytotoxic T-cell and natural killer cell activities affecting the processes of the immune surveillance of tumours, and the events that modulate the development and the accumulation of somatic mutations and genomic instability. DNA damage, growth and angiogenic factors, proteases, matrix metalloproteinases, and reactive oxygen species were also related to the chronic stress response and depression. Behavioural strategies, psychological, and psychopharmacotherapeutic interventions that enhance effective coping and reduce affective distress showed beneficial effects in cancer patients. A better understanding of the bidirectional communication between the neuroendocrine and immune systems could contribute to novel clinical and treatment strategies in oncology.

Anxiety in relation to inflammation and coagulation markers, among healthy adults: the ATTICA study

BACKGROUND

Anxiety is a complex feeling of uneasiness, fear and worry, which has been associated with pulmonary, cardiovascular and other adverse health conditions. The aim of this work is to examine the association of the anxious state with inflammation and coagulation factors, in persons free of cardiovascular disease.

METHODS

From May 2001 to December 2002 we randomly enrolled 453 men (19 to 89 years old) and 400 women (18 to 84 years old) stratified by age and gender, from Attica area, Greece. Among others, various inflammation and coagulation markers (C-reactive protein (CRP), amyloid-A, interleukin-6, tumor necrosis factor-alpha, white blood cell (WBC), homocysteine and fibrinogen) were evaluated in relation to the anxious state (assessed by the Spielberger State Anxiety Inventory, STAI) of participants, after several adjustments made for potential confounders.

RESULTS

STAI score was positively correlated with C-reactive protein (rho = 0.18, p = 0.01), tumor necrosis factor-alpha (rho = 0.11, p = 0.03), interleukin-6 (rho = 0.09, p=0.03), homocysteine (rho = 0.10, p = 0.03) and fibrinogen levels (rho = 0.08, p = 0.04), in men, and positively correlated with C-reactive protein (rho = 0.22, p = 0.01), white blood cell counts (rho = 0.15, p = 0.02), interleukin-6 (rho = 0.12, p = 0.02), homocysteine (rho = 0.07, p = 0.04) and fibrinogen levels (rho = 0.07, p = 0.04), in women. These associations remained significant even after various adjustments were made.

CONCLUSION

This study revealed that anxiety was associated with inflammation and coagulation markers in cardiovascular disease-free people. This may raise a hypothesis of a pathway leading to increased cardiovascular events in anxious individuals.

Lymphocyte subsets and mood states in panic disorder patients

This study was conducted to examine lymphocyte subset counts and mood states in panic disorder patients. Twenty patients with panic disorder and 20 age- and gender-matched normal healthy subjects were recruited for the study. We used the Spielberger State (STAIS) & Trait (STAIT) Anxiety Inventory, Hamilton Depression Rating scale (HAMD) and Hamilton Anxiety Rating scale (HAMA) to measure mood states in all subjects. Lymphocyte subsets counts were made by flow cytometry. Panic patients showed significantly higher scores for anxiety and depression than normal subjects. Panic patients showed no differences in terms of the numbers of immune cells, as compared with normal healthy subjects, other than a lower proportion of T suppressor cells and a higher T helper cell/T suppressor cell ratio. HAMA and STAIS scores were common factors that could predict T cell numbers and proportions, T helper cell numbers, and natural killer cell proportions in panic disorder patients. We suggest that anxiety levels are related to the T-cell population in panic disorder patients and that quantitative immune differences may reflect altered immunity in this disorder.

Severe Acute Respiratory Syndrome and sport: facts and fallacies

Severe Acute Respiratory Syndrome (SARS) not only paralysed economic activities in SARS-affected cities, it also affected sporting activities. SARS was identified in Hong Kong in late February 2003 and the WHO issued a global alert on 12 March, 2003. The incubation period of SARS is usually 4–6 days and patients commonly present with high fever (temperature >38°C), dry cough, chills and rigor, dyspnoea and diarrhoea. Although a specific antiviral agent and vaccines for SARS are not available at the time of writing, a standard treatment protocol for SARS has been developed. The average mortality rate is about 16% in Hong Kong.

The coronavirus is a common pathogen for upper respiratory tract infection and is the most probable pathogen for SARS. Transmission methods may, therefore, be similar for both these infections. Transmission is possible when aerosolised viral particles come into contact with the susceptible host’s mucous membrane, most commonly the nose, but also the mouth and eyes.

With appropriate preventive measures to avoid contact with virus, the probability of infection is minimal. Isolation of those who have had close contact with confirmed or suspected SARS patients and/or who have persistent fever will be the most effective and practical method of avoiding contact. Maintaining personal hygiene and frequent hand washing can also reduce the risk of infection. Using diluted bleach (1 part bleach in 99 parts water) to cleanse training areas and equipment is also recommended.

With proper event planning to conform with quarantine measures, special travel arrangements, facility sterilisation and use of venues with good ventilation and filtering systems, sport competition can still proceed.