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Kämpe R, Paul ER, Östman L, Heilig M, Howard DM, Hamilton JP. Contributions of Polygenic Risk and Disease Status to Gray Matter Abnormalities in Major Depression. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 2024; 9:437-446. [PMID: 38142967 DOI: 10.1016/j.bpsc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Gray matter (GM) abnormalities in depression are potentially attributable to some combination of trait, state, and illness history factors. Here, we sought to determine the contributions of polygenic risk for depression, depressive disease status, and the interaction of these factors to these GM abnormalities. METHODS We conducted a cross-sectional comparison using a 2 × 3 factorial design examining effects of polygenic risk for depression (lower vs. upper quartile) and depression status (never depressed, currently depressed, or remitted depression) on regional GM concentration and GM volume. Participants were a subset of magnetic resonance imaging-scanned UK Biobank participants comprising 2682 people (876 men, 1806 women) algorithmically matched on 16 potential confounders. RESULTS In women but not men, we observed that elevated polygenic risk for depression was associated with reduced cerebellar GM volume. This deficit occurred in salience and dorsal attention network regions of the cerebellum and was associated with poorer performance on tests of attention and executive function but not fluid intelligence. Moreover, in women with current depression compared to both women with remitted depression and women who never had depression, we observed GM reductions in ventral and medial prefrontal, insular, and medial temporal regions. These state-related abnormalities remained when accounting for antidepressant medication status. CONCLUSIONS Neuroanatomical deficits attributed broadly to major depression are more likely due to an aggregation of independent factors. Polygenic risk for depression accounted for cerebellar structural abnormalities that themselves accounted for cognitive deficits observed in this disorder. Medial and ventral prefrontal, insular, and temporal cortex deficits constituted a much larger proportion of the aggregate deficit and were attributable to the depressed state.
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Affiliation(s)
- Robin Kämpe
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping, Sweden
| | - Elisabeth R Paul
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping, Sweden
| | - Lars Östman
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping, Sweden; Department of Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping, Sweden; Department of Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - David M Howard
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - J Paul Hamilton
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
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Liu C, Belleau EL, Dong D, Sun X, Xiong G, Pizzagalli DA, Auerbach RP, Wang X, Yao S. Trait- and state-like co-activation pattern dynamics in current and remitted major depressive disorder. J Affect Disord 2023; 337:159-168. [PMID: 37245549 PMCID: PMC10897955 DOI: 10.1016/j.jad.2023.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 05/02/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Distinguishing between trait- and state-like neural alternations in major depressive disorder (MDD) may advance our understanding of this recurring disorder. We aimed to investigate dynamic functional connectivity alternations in unmedicated individuals with current or past MDD using co-activation pattern analyses. METHODS Resting-state functional magnetic resonance imaging data were acquired from individuals with first-episode current MDD (cMDD, n = 50), remitted MDD (rMDD, n = 44), and healthy controls (HCs, n = 64). Using a data-driven consensus clustering technique, four whole-brain states of spatial co-activation were identified and associated metrics (dominance, entries, transition frequency) were analyzed with respect to clinical characteristics. RESULTS Relative to rMDD and HC, cMDD showed increased dominance and entries of state 1 (primarily involving default mode network (DMN)), and decreased dominance of state 4 (mostly involving frontal-parietal network (FPN)). Among cMDD, state 1 entries correlated positively with trait rumination. Conversely, relative to cMDD and HC, individuals with rMDD were characterized by increased state 4 entries. Relative to HC, both MDD groups showed increased state 4-to-1 (FPN to DMN) transition frequency but reduction in state 3 (spanning visual attention, somatosensory, limbic networks), with the former metric specifically related to trait rumination. LIMITATIONS Further confirmation with longitudinal studies are required. CONCLUSIONS Regardless of symptoms, MDD was characterized by increased FPN-to-DMN transitions and reduced dominance of a hybrid network. State-related effect emerged in regions critically implicated in repetitive introspection and cognitive control. Asymptomatic individuals with past MDD were uniquely linked to increased FPN entries. Our findings identify trait-like brain network dynamics that might increase vulnerability to future MDD.
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Affiliation(s)
- Chengwen Liu
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Emily L Belleau
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Daifeng Dong
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Xiaoqiang Sun
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Ge Xiong
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China.
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China.
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van Kleef RS, Kaushik P, Besten M, Marsman JBC, Bockting CLH, van Vugt M, Aleman A, van Tol MJ. Understanding and predicting future relapse in depression from resting state functional connectivity and self-referential processing. J Psychiatr Res 2023; 165:305-314. [PMID: 37556963 DOI: 10.1016/j.jpsychires.2023.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND The recurrent nature of Major Depressive Disorder (MDD) asks for a better understanding of mechanisms underlying relapse. Previously, self-referential processing abnormalities have been linked to vulnerability for relapse. We investigated whether abnormalities in self-referential cognitions and functioning of associated brain-networks persist upon remission and predict relapse. METHODS Remitted recurrent MDD patients (n = 48) and never-depressed controls (n = 23) underwent resting-state fMRI scanning at baseline and were additionally assessed for their implicit depressed self-associations and ruminative behaviour. A template-based dual regression approach was used to investigate between-group differences in default mode, cingulo-opercular and frontoparietal network resting-state functional connectivity (RSFC). Additional prediction of relapse status at 18-month follow-up was investigated within patients using both regression analyses and machine learning classifiers. RESULTS Remitted patients showed higher rumination, but no implicit depressed self-associations or RSFC abnormalities were observed between patients and controls. Nevertheless, relapse was related to i) baseline RSFC between the ventral default mode network and the precuneus, dorsomedial frontal gyrus, and inferior occipital lobe, ii) implicit self-associations, and iii) uncontrollability of ruminative thinking, when controlled for depressive symptomatology. Moreover, preliminary machine learning classifiers demonstrated that RSFC within the investigated networks predicted relapse on an individual basis. CONCLUSIONS Remitted MDD patients seem to be commonly characterized by abnormal rumination, but not by implicit self-associations or abnormalities in relevant brain networks. Nevertheless, relapse was predicted by self-related cognitions and default mode RSFC during remission, suggesting that variations in self-relevant processing play a role in the complex dynamics associated with the vulnerability to developing recurrent depressive episodes. CLINICAL TRIAL REGISTRATION Netherlands Trial Register, August 18, 2015, trial number NL53205.042.15.
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Affiliation(s)
- Rozemarijn S van Kleef
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands.
| | - Pallavi Kaushik
- Bernoulli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, the Netherlands; Department of Computer Science and Engineering, Indian Institute of Technology, Roorkee, India
| | - Marlijn Besten
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands; Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Jan-Bernard C Marsman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marieke van Vugt
- Bernoulli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, the Netherlands
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands; Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Marie-José van Tol
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands
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Xiong G, Dong D, Cheng C, Jiang Y, Sun X, He J, Li C, Gao Y, Zhong X, Zhao H, Wang X, Yao S. Potential structural trait markers of depression in the form of alterations in the structures of subcortical nuclei and structural covariance network properties. Neuroimage Clin 2021; 32:102871. [PMID: 34749291 PMCID: PMC8578037 DOI: 10.1016/j.nicl.2021.102871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022]
Abstract
It has been proposed recently that major depressive disorder (MDD) could represent an adaptation to conserve energy after the perceived loss of an investment in a vital source, such as group identity, personal assets, or relationships. Energy conserving behaviors associated with MDD may form a persistent marker in brain regions and networks involved in cognition and emotion regulation. In this study, we examined whether subcortical regions and volume-based structural covariance networks (SCNs) have state-independent alterations (trait markers). First-episode drug-naïve currently depressed (cMDD) patients (N = 131), remitted MDD (RD) patients (N = 67), and healthy controls (HCs, N = 235) underwent structural magnetic resonance imaging (MRI). Subcortical gray matter volumes (GMVs) were calculated in FreeSurfer software, and group differences in GMVs and SCN were analyzed. Compared to HCs, major findings were decreased GMVs of left pallidum and pulvinar anterior of thalamus in the cMDD and RD groups, indicative of a trait marker. Relative to HCs, subcortical SCNs of both cMDD and RD patients were found to have reduced small-world-ness and path length, which together may represent a trait-like topological feature of depression. In sum, the left pallidum, left pulvinar anterior of thalamus volumetric alterations may represent trait marker and reduced small-world-ness, path length may represent trait-like topological feature of MDD.
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Affiliation(s)
- Ge Xiong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Daifeng Dong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Chang Cheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Yali Jiang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Xiaoqiang Sun
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Jiayue He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Chuting Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China
| | - Yidian Gao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Xue Zhong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Haofei Zhao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan 410011, China.
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Gillard JA, Gormley S, Griffiths K, Hitchcock C, Dalgleish T, Stretton J. Converging evidence for enduring perceptions of low social status in individuals in remission from depression. J Affect Disord 2021; 294:661-670. [PMID: 34333174 PMCID: PMC8411663 DOI: 10.1016/j.jad.2021.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND The risk of depressive relapse and recurrence is associated with social risk factors that may be amplified by a submissive socio-cognitive profile. METHODS In Study 1 we aimed to identify perceptions of low social status in a community sample (N = 613) with a self-reported history of mental health difficulties (n = 232) and, more specifically in Study 2 (N = 122), in individuals in clinical remission from depression (n = 18), relative to a never-depressed control group (n = 64), and relative to a group experiencing a current depressive episode (n = 40). RESULTS In Study 1, a total of 225 of the 232 participants in the self-reported mental health difficulties group opted to provide further information regarding their mental health history, of whom 153 (68%) reported a history of anxiety, 168 (74.7%) reported a history of depression, and 13 (5.8%) reported an unspecified mental health history. Elevated depressive symptoms were associated with perceptions of low social status which significantly differed between individuals with and without a self-reported history of mental health difficulties. In Study 2 we found enduring perceptions of low social status in remitted depressed individuals. LIMITATIONS We were unable to discern between historical or current clinical diagnosis in the community sample of Study 1, as we were reliant on self-report. We were unable to explore the effects of medication or causal relationships between depressive symptoms and social status as the studies were cross-sectional in nature. CONCLUSIONS These findings suggest that evolutionarily rooted socio-cognitive profiles could impact affiliative processes and may confer increased vulnerability to future depressive episodes.
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Affiliation(s)
- Julia A. Gillard
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Siobhan Gormley
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Kirsty Griffiths
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom,Cambridgeshire and Peterborough NHS Foundation Trust, United Kingdom
| | - Jason Stretton
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom.
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Xiong G, Dong D, Cheng C, Jiang Y, Sun X, He J, Li C, Gao Y, Zhong X, Zhao H, Wang X, Yao S. State-independent and -dependent structural alterations in limbic-cortical regions in patients with current and remitted depression. J Affect Disord 2019; 258:1-10. [PMID: 31382099 DOI: 10.1016/j.jad.2019.07.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The high recurrence of major depressive disorder (MDD) may derive from underlying state-independent structural alterations. METHODS First-episode drug-naïve currently depressed (cMDD) patients (N = 97), remitted depressed (RD) patients (N = 72), and healthy controls (HCs, N = 100) underwent structural magnetic resonance imaging (MRI). Group differences in cortical thickness (CT), surface area (SA), and local gyrification index (lGI) were analyzed in FreeSurfer. RESULTS Both groups of depressed patients had significantly decreased CT, relative to HCs, in the left precentral gyrus and significantly increased lGI values in the left superior frontal gyrus (SFG) indicative of state-independent alterations. Relative to HCs, the cMDD group had decreased CT of the SFG, caudal middle frontal gyrus (MFG), posterior cingulate cortex (PCC), and lateral occipital regions as well as increased SA or lGI of the superior temporal gyrus, precuneus, and pericalcarine, whereas the RD group had increased SA or lGI of the SFG, caudal MFG, and supramarginal gyrus; these alterations appeared to be state-dependent. SA or lGI values of the fusiform gyrus, inferior temporal gyrus, and superior parietal lobule differed between the cMDD and RD groups, consistent with state-dependent alterations. Beck depression inventory scores correlated with CT or lGI values of the caudal MFG, lateral occipital cortex in depressed patients. LIMITATIONS The structural features of several subcortical limbic regions were not analyzed. CONCLUSIONS Left precentral gyrus CT and left SFG gyrification alterations may represent state-independent alterations in MDD.
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Affiliation(s)
- Ge Xiong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Daifeng Dong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Chang Cheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Yali Jiang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Xiaoqiang Sun
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Jiayue He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Chuting Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental disorders (Xiangya), Changsha, Hunan 410011, China
| | - Yidian Gao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Xue Zhong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Haofei Zhao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental disorders (Xiangya), Changsha, Hunan 410011, China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medical Psychological Institute of Central South University, Changsha, Hunan 410011, China; China National Clinical Research Center on Mental disorders (Xiangya), Changsha, Hunan 410011, China.
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Dong D, Li C, Ming Q, Zhong X, Zhang X, Sun X, Jiang Y, Gao Y, Wang X, Yao S. Topologically state-independent and dependent functional connectivity patterns in current and remitted depression. J Affect Disord 2019; 250:178-185. [PMID: 30856495 DOI: 10.1016/j.jad.2019.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/23/2019] [Accepted: 03/04/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Identification of state-independent and -dependent neural biomarkers may provide insight into the pathophysiology and effective treatment of major depressive disorder (MDD), therefore we aimed to investigate the state-independent and -dependent topological alterations of MDD. METHOD Brain resting-state functional magnetic resonance imaging (fMRI) data were acquired from 59 patients with unmedicated first episode current MDD (cMDD), 48 patients with remitted MDD (rMDD) and 60 demographically matched healthy controls (HCs). Using graph theory, we systematically studied the topological organization of their whole-brain functional networks at the global and nodal level. RESULTS At a global level, both patient groups showed decreased normalized clustering coefficient in relative to HCs. On a nodal level, both patient groups showed decreased nodal centrality, predominantly in cortex-mood-regulation brain regions including the dorsolateral prefrontal cortex, posterior parietal cortex and posterior cingulate cortex. By comparison to cMDD patients, rMDD group had a higher nodal centrality in right parahippocampal gyrus. LIMITATIONS The present study, an exploratory analysis, may require further confirmation with task-based and experimental studies. CONCLUSIONS Deficits in the topological organization of the whole brain and cortex-mood-regulation brain regions in both rMDD and cMDD represent state-independent biomarkers.
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Affiliation(s)
- Daifeng Dong
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Chuting Li
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Qingsen Ming
- Department of Psychiatry, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Xue Zhong
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Xiaocui Zhang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Xiaoqiang Sun
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Yali Jiang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Yidian Gao
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China.
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Dong D, Ming Q, Zhong X, Pu W, Zhang X, Jiang Y, Gao Y, Sun X, Wang X, Yao S. State-independent alterations of intrinsic brain network in current and remitted depression. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:475-480. [PMID: 30193990 DOI: 10.1016/j.pnpbp.2018.08.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/15/2018] [Accepted: 08/29/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND It has been proposed that state-independent, or trait, neurobiological alterations across illness phases may contribute to the high recurrence of major depressive disorder (MDD). Although intrinsic brain network abnormalities have been implicated consistently in MDD neuropathology, MDD state-independent and -dependent resting-state network alterations have not been clearly studied. METHODS Resting-state functional magnetic resonance imaging (fMRI) data were collected from 57 medication-naive first-episode current MDD patients, 35 remitted MDD patients, and 66 healthy controls (HCs). Independent component analysis (ICA) was used to extract subnetworks of the default mode network (DMN), central executive network (CEN), and salience network (SN). RESULTS Relative to HCs, the current MDD and remitted MDD groups had decreased intra-intrinsic functional connectivity (iFC) in the dorsal lateral prefrontal cortex (dlPFC) of the left CEN, increased inter-FC between the SN and right CEN (rCEN), and decreased inter-FC between the anterior DMN (aDMN) and rCEN. The altered intra-iFC in the left CEN were correlated negatively with the depressive level in the remitted MDD. CONCLUSIONS Hypoactivity of the dlPFC in the left CEN, increased inter-FC between the SN and rCEN, and decreased inter-FC between the aDMN and rCEN may reflect state-independent biomarkers of MDD.
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Affiliation(s)
- Daifeng Dong
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Qingsen Ming
- Dpartment of Psychiatry, The First Affiliated Hospital of Sochoow University, Suzhou, Jiangsu, PR China
| | - Xue Zhong
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Weidan Pu
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Xiaocui Zhang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Yali Jiang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Yidian Gao
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Xiaoqiang Sun
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; Medical Psychological Institute of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, PR China.
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Jenkins LM, Stange JP, Bessette KL, Chang YS, Corwin SD, Skerrett KA, Patrón VG, Zubieta JK, Crane NA, Passarotti AM, Pine DS, Langenecker SA. Differential engagement of cognitive control regions and subgenual cingulate based upon presence or absence of comorbid anxiety with depression. J Affect Disord 2018; 241:371-380. [PMID: 30145507 PMCID: PMC6237191 DOI: 10.1016/j.jad.2018.07.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/30/2018] [Accepted: 07/31/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) and anxiety disorders are highly comorbid, sharing many similar symptoms, including impairments in cognitive control. Deficits in cognitive control could be a potential mechanism underlying impaired emotion regulation in mood disorders. METHODS Participants were 44 individuals with no history of mental illness (healthy controls, HC), 31 individuals in the remitted state of MDD (rMDD), and 18 individuals who met lifetime DSM-IV-TR criteria for rMDD and an anxiety disorder in remission (Comorbid). Participants completed a Parametric Go/No-Go (PGNG) test during fMRI. Event-related analyses modeled activity for cognitive control successes (Hits for Targets, Rejections for Lures) and failures (Commissions on Lures) on the PGNG task. RESULTS The rMDD group showed significantly reduced activity within the cognitive control network (CCN) during Commission errors, including the middle frontal gyrus and inferior parietal lobule (IPL). The Comorbid group showed significantly reduced activity in several clusters within the CCN during correct Rejections, including the left IPL and right inferior frontal gyrus and greater subgenual cingulate. Notably, during correct Rejections, 60% of activation for the Comorbid group was within the Salience and Emotion Network (SEN), with 0% within the CCN. LIMITATIONS The size of the Comorbid subgroup was modest, preventing subanalysis of the different AD subtypes. CONCLUSIONS There is evidence that CCN activity declines in rMDD and that there may be compensatory SEN activity in individuals with Comorbid rMDD and anxiety. Our findings support the identification of comorbid anxiety as a meaningful subtype of MDD that may obscure group differences between rMDD and HCs.
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Affiliation(s)
| | | | | | - Yi-Shin Chang
- The University of Illinois at Chicago, Department of Psychiatry
| | | | | | | | | | | | | | | | - Scott A. Langenecker
- The University of Illinois at Chicago, Department of Psychiatry,Department of Psychiatry, The University of Michigan,Corresponding author: Scott A. Langenecker, Cognitive Neuroscience Center, Department of Psychiatry, The University of Illinois at Chicago, 1601 W Taylor St. Chicago, IL 60612 and
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Marchetti I, Shumake J, Grahek I, Koster EHW. Temperamental factors in remitted depression: The role of effortful control and attentional mechanisms. J Affect Disord 2018; 235:499-505. [PMID: 29684864 DOI: 10.1016/j.jad.2018.04.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/15/2018] [Accepted: 04/07/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Temperamental effortful control and attentional networks are increasingly viewed as important underlying processes in depression and anxiety. However, it is still unknown whether these factors facilitate depressive and anxiety symptoms in the general population and, more specifically, in remitted depressed individuals. METHODS We investigated to what extent effortful control and attentional networks (i.e., Attention Network Task) explain concurrent depressive and anxious symptoms in healthy individuals (n = 270) and remitted depressed individuals (n = 90). Both samples were highly representative of the US population. RESULTS Increased effortful control predicted a substantial decrease in symptoms of both depression and anxiety in the whole sample, whereas decreased efficiency of executive attention predicted a modest increase in depressive symptoms. Remitted depressed individuals did not show less effortful control nor less efficient attentional networks than healthy individuals. Moreover, clinical status did not moderate the relationship between temperamental factors and either depressive or anxiety symptoms. LIMITATIONS Limitations include the cross-sectional nature of the study. CONCLUSIONS Our study shows that temperamental effortful control represents an important transdiagnostic process for depressive and anxiety symptoms in adults.
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Knight MJ, Air T, Baune BT. The role of cognitive impairment in psychosocial functioning in remitted depression. J Affect Disord 2018; 235:129-134. [PMID: 29655074 DOI: 10.1016/j.jad.2018.04.051] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/20/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive dysfunction is a prevalent and disabling symptom of Major Depressive Disorder (MDD), and is often retained in the remitted stage of illness. Emerging evidence suggests that cognitive impairment may be associated with dysfunction in a number of psychosocial domains (e.g., workplace productivity, social relationships). The current study explored the relationship between cognition and psychosocial functioning in remitted MDD and in healthy controls. METHODS Data were obtained from 182 participants of the Cognitive Function and Mood Study (CoFaM-S), a cross-sectional study of cognition, mood, and social cognition in mood disorders. Participants' (Remitted MDD n = 72, Healthy n = 110) cognition was assessed with a battery of cognitive tests including the Repeatable Battery for the Assessment of Neuropsychological Function (RBANS) and other standard measures of cognition (e.g., The Tower of London task). Psychosocial functioning was clinically evaluated with the Functioning Assessment Short Test (FAST). RESULTS The results indicated that executive functioning was the strongest independent predictor of functioning in remitted MDD patients, whereas various cognitive domains predicted psychosocial functioning in healthy individuals. LIMITATIONS Psychosocial functioning was measured with a clinical interview, and was therefore reliant on clinicians' judgement of impairment, as opposed to more objective measures of functioning. CONCLUSIONS These findings suggest that executive cognition plays an important role in functional recovery in remitted depression, and may be a crucial target in adjunctive treatment.
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Affiliation(s)
- Mattew J Knight
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia.
| | - Tracy Air
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia.
| | - Bernhard T Baune
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia.
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Li M, Lu S, Wang G, Feng L, Fu B, Zhong N. Alleviated negative rather than positive attentional bias in patients with depression in remission: an eye-tracking study. J Int Med Res 2016; 44:1072-1086. [PMID: 27688684 PMCID: PMC5536561 DOI: 10.1177/0300060516662134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate attentional bias toward happy and sad faces in remitted depressed (RD) patients compared with healthy control (HC) subjects. Methods This cross-sectional study enrolled RD patients and sex- and age-matched HC subjects. Eye movement data were acquired for all study participants while free viewing a 2 × 2 matrix of emotional faces. The attentional bias toward different emotional faces and whether the attention maintenance components generated attentional bias in the RD patients were analysed by comparing the attentional modes of the RD group with the HC group. Results A total of 27 RD patients and 27 HC subjects were analysed in this study. The RD and HC groups exhibited no significant differences toward first fixation location and initial attentional maintenance. In later attentional maintenance, the RD group showed significantly less attentional bias toward happy faces, but there were no significant differences in their attentional bias toward sad faces, compared with the HC group. Conclusions This present study showed that the negative attentional bias of RD patients was successfully eased, but their positive attentional bias was still insufficient.
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Affiliation(s)
- Mi Li
- The International Web Intelligence Consortium (WIC) Institute, Beijing University of Technology, Beijing, China
- The Beijing International Collaboration Base on Brain Informatics and Wisdom Services, Beijing, China
- The Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Shengfu Lu
- The International Web Intelligence Consortium (WIC) Institute, Beijing University of Technology, Beijing, China
- The Beijing International Collaboration Base on Brain Informatics and Wisdom Services, Beijing, China
- The Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Gang Wang
- Mood Disorders Centre & China Clinical Research Centre for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Centre of Depression, Beijing Institute for Brain Disorders, Beijing, China
| | - Lei Feng
- Mood Disorders Centre & China Clinical Research Centre for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Mental Disorders, Beijing, China
| | - Bingbing Fu
- Mood Disorders Centre & China Clinical Research Centre for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ning Zhong
- The International Web Intelligence Consortium (WIC) Institute, Beijing University of Technology, Beijing, China
- The Beijing International Collaboration Base on Brain Informatics and Wisdom Services, Beijing, China
- The Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- Department of Life Science and Informatics, Maebashi Institute of Technology, Maebashi-City, Japan
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Soltani S, Newman K, Quigley L, Fernandez A, Dobson K, Sears C. Temporal changes in attention to sad and happy faces distinguish currently and remitted depressed individuals from never depressed individuals. Psychiatry Res 2015; 230:454-63. [PMID: 26455760 DOI: 10.1016/j.psychres.2015.09.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/28/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
Abstract
Depression is associated with attentional biases for emotional information that are proposed to reflect stable vulnerability factors for the development and recurrence of depression. A key question for researchers is whether those who have recovered from depression also exhibit attentional biases, and if so, how similar these biases are to those who are currently depressed. To address this question, the present study examined attention to emotional faces in remitted depressed (N=26), currently depressed (N=16), and never depressed (N=33) individuals. Participants viewed sets of four face images (happy, sad, threatening, and neutral) while their eye movements were tracked throughout an 8-s presentation. Like currently depressed participants, remitted depressed participants attended to sad faces significantly more than never depressed participants and attended to happy faces significantly less. Analyzing temporal changes in attention revealed that currently and remitted depressed participants did not reduce their attention to sad faces over the 8-s presentation, unlike never depressed participants. In contrast, remitted depressed participants attended to happy faces similarly to never depressed participants, increasing their attention to happy faces over the 8-s presentation. The implications for cognitive theories of depression and depression vulnerability are discussed.
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Affiliation(s)
- Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kristin Newman
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Leanne Quigley
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Fernandez
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Keith Dobson
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Sears
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
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Huffziger S, Ebner-Priemer U, Zamoscik V, Reinhard I, Kirsch P, Kuehner C. Effects of mood and rumination on cortisol levels in daily life: an ambulatory assessment study in remitted depressed patients and healthy controls. Psychoneuroendocrinology 2013; 38:2258-67. [PMID: 23684479 DOI: 10.1016/j.psyneuen.2013.04.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/08/2013] [Accepted: 04/19/2013] [Indexed: 11/22/2022]
Abstract
The influence of naturally occurring emotional and cognitive experiences on hypothalamic-pituitary-adrenal axis (HPAA) activity is still underinvestigated, particularly in clinical populations. The present study examined effects of mood and rumination on cortisol levels in daily life in remitted depressed patients with recurrent episodes or a chronic precourse (n=31) and healthy controls (n=32). Ambulatory assessment of subjective variables (valence, calmness, energetic-arousal, ruminative self-focus), daily stressors, and saliva cortisol samples was performed five times a day on two consecutive workdays, whereby cortisol was collected 20min after the subjective assessments. In addition, depressive symptoms and trait rumination (brooding, reflection) were measured retrospectively. Multilevel models revealed that remitted depressed patients showed lower cortisol activity compared to healthy controls. Depressive symptoms and trait rumination did not predict HPAA activity, whereas, by controlling for daily stressors, higher daily means of ruminative self-focus and lower daily means of valence, energetic arousal and calmness were associated with higher daily cortisol levels. Separate analyses per group revealed that mean daily ruminative self-focus predicted higher cortisol in both samples. In contrast, lower daily means of calmness, but also of valence and energetic arousal, were significantly linked to higher cortisol output only in healthy controls, but not in the patient sample. These findings indicate that naturally occurring rumination and low mood are associated with increased activation of the HPAA in daily life. Moreover, our data revealed a potentially reduced mood-cortisol coupling in remitted recurrent depression, possibly indicating that during the course of recurrent depression HPAA activation might become less responsive toward subtle emotional experiences in natural contexts.
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