Clinical Study of Serum Serotonin as a Screening Marker for Anxiety and Depression in Patients with Type 2 Diabetes

Neurological and metabolic related pathophysiologies and treatment of comorbid diabetes with depression

BACKGROUND

The comorbidity between diabetes mellitus and depression was revealed, and diabetes mellitus increased the prevalence of depressive disorder, which ranked 13th in the leading causes of disability-adjusted life-years. Insulin resistance, which is common in diabetes mellitus, has increased the risk of depressive symptoms in both humans and animals. However, the mechanisms behind the comorbidity are multi-factorial and complicated. There is still no causal chain to explain the comorbidity exactly. Moreover, Selective serotonin reuptake inhibitors, insulin and metformin, which are recommended for treating diabetes mellitus-induced depression, were found to be a risk factor in some complications of diabetes.

AIMS

Given these problems, many researchers made remarkable efforts to analyze diabetes complicating depression from different aspects, including insulin resistance, stress and Hypothalamic-Pituitary-Adrenal axis, neurological system, oxidative stress, and inflammation. Drug therapy, such as Hydrogen Sulfide, Cannabidiol, Ascorbic Acid and Hesperidin, are conducive to alleviating diabetes mellitus and depression. Here, we reviewed the exact pathophysiology underlying the comorbidity between depressive disorder and diabetes mellitus and drug therapy.

METHODS

The review refers to the available literature in PubMed and Web of Science, searching critical terms related to diabetes mellitus, depression and drug therapy.

RESULTS

In this review, we found that brain structure and function, neurogenesis, brain-derived neurotrophic factor and glucose and lipid metabolism were involved in the pathophysiology of the comorbidity. Obesity might lead to diabetes mellitus and depression through reduced adiponectin and increased leptin and resistin. In addition, drug therapy displayed in this review could expand the region of potential therapy.

CONCLUSIONS

The review summarizes the mechanisms underlying the comorbidity. It also overviews drug therapy with anti-diabetic and anti-depressant effects.

Characterization of serotonin as a candidate biomarker of severity and prognosis of COVID-19 using LC/MS analysis

The coronavirus disease 2019 (COVID-19) pandemic has been associated with high mortality worldwide. Owing to its complicated pathophysiology, diagnostic and prognostic biomarkers for effective patient management remain scarce. We analyzed kynurenine, tryptophan, and serotonin levels in the serum of patients with COVID-19 via liquid chromatography/mass spectrometry analysis. Serum serotonin levels were decreased in patients with more severe COVID-19, along with increased kynurenine and decreased tryptophan concentrations. Patients with moderate disease who subsequently worsened showed significantly lower serotonin concentrations compared with those who did not experience severe disease. Serum serotonin levels may represent a valuable biomarker for COVID-19 severity and prognosis.

Complications of Ethanolic Withdrawal in Hospitalized Patients

Chronic alcohol consumption, also called alcoholism, is a chronic disease characterized by compulsive alcohol consumption, loss of control over alcohol consumption and a negative emotional state in the absence/lack of consumption. Statistics show that the incidence of alcohol consumption in the adult population has been increasing during the isolation due to the pandemic. It is fre-quently associated with the consumption of other substances, in which case mortality is higher than in the case of single alcohol consumption. The patterns of alcohol consumption are varied, being related to a series of demographic, social, psychological and behavioral variables. The most worrying aspect of alcohol consumption is represented by the increase in the frequency of this type of addiction among teenagers and young people. It should also be mentioned that there is an increase in the incidence in females and there are new variables related to the context of consumption: increased boredom, alcohol consumption for the purpose of relaxation and alcohol consumption as an activity in the absence of an entourage. During the pandemic, there was also the myth that alcohol consumption would be the basis for reducing the risk of contamination with the SARS CoV 2 virus, an aspect disproved by specialist studies. The increased consumption of alcohol during the pandemic could be correlated with anxiety and depression determined by the fear of illness and depression due to the loss of the job, the lack of social relations or online education, being unanimously accepted that alcohol has an anxiolytic role. Regarding ethanolic withdrawal (EW) symptoms, studies show that approximately 50% of patients with chronic alcohol consumption will develop withdrawal symptoms when they reduce the quantity of alcohol or stop drinking alcohol.

Profile of the Young Patient with Schizophrenia Socio-Cultural Characteristics

The importance of early diagnosis is closely related to the fact that the possibility of predicting the disease suggested by a somewhat characteristic psycho-behavioral profile of the adolescent with schizophrenia could constitute the basis for suspecting the condition which would at act interventions to prevent or delay the disease. In support of this statement is the fact that from the sample of patients included in this study aged between 18 and 30 years, at the time of admission, 44% were already retired due to the disease. This fact is representative of the dramatic socio-professional consequences of patients diagnosed with schizophrenia, especially considering the fact that in proportion they were with: high school (32%), vocational school (16%) and higher education (10%). From the patients diagnosed with schizophrenia included in the study 31 benefited from family support and 23 from the community they belong to. Studies show that in the absence of social or family support, the isolation of patients with schizophrenia can trigger depression with a higher in-cidence of self-aggressive behavior and suicidal tendencies.

Effects of forest bathing (shinrin-yoku) on serotonin in serum, depressive symptoms and subjective sleep quality in middle-aged males

BACKGROUND

We previously found that a forest bathing (shinrin-yoku) program significantly reduced the scores for depression, anxiety, anger, fatigue, and confusion and increased the score for vigor in the profile of mood states (POMS) test and showed a potential preventive effect on the depressive status in both males and females. In the present study, we investigated the effects of a forest bathing program on the level of serotonin in serum, depressive symptoms and subjective sleep quality in middle-aged males.

METHODS

Twenty healthy male subjects aged 57.3 ± 8.4 years were selected after obtaining informed consent. These subjects took day trips to a forest park, the birthplace of forest bathing in Japan named Akasawa Shizen Kyuyourin, Agematsu, Nagano Prefecture (situated in central Japan), and to an urban area of Nagano Prefecture as a control in June 2019. On both trips, they walked 2.5 km for 2 hours each in the morning and afternoon on Saturday and Sunday, respectively. Blood was sampled in the afternoon before and after each trip. Concentrations of serotonin and lactic acid in serum were measured. The POMS test and a questionnaire for subjective sleep quality were conducted before and after the trips. Ambient temperature and humidity were monitoring during the trips. The Ethics Committees of the Nippon Medical School and Nagano Prefectural Kiso Hospital approved this study.

RESULTS

The forest bathing program significantly increased level of serotonin in serum, and significantly increased the score for vigor and decreased the score for fatigue in the POMS test. The forest bathing program also improved the sleepiness on rising and feeling refreshed (recovery from fatigue) in the Oguri-Shirakawa-Azumi sleep inventory MA version (OSA-MA).

CONCLUSIONS

Taken together, the present study suggests that forest bathing may have potential preventive effects on depression (depressive status).