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Klinger-König J, Ittermann T, Martin II, Marx S, Schroeder HWS, Nauck M, Völzke H, Bülow R, Grabe HJ. Pituitary gland volumes and stress: Results of a population-based adult sample. J Psychiatr Res 2023; 168:325-333. [PMID: 37950977 DOI: 10.1016/j.jpsychires.2023.10.047] [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: 06/29/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/13/2023]
Abstract
Early and chronic stress was reported to alter the hypothalamic-pituitary-adrenal axis functioning which regulates the secretion of cortisol. Nevertheless, few studies mainly focused on specific study populations (e.g. adolescents, pregnant women, and psychiatric patients), and researched interactive associations of pituitary volumes and single stress markers. The present study used pituitary volumes of two adult general-population cohorts of the Study of Health in Pomerania (SHIP-START-2: N = 1026, 54% Men, 30-90 years; SHIP-TREND-0: N = 1868, 53% Men, 21-82 years). In linear regression models, main effects of the pituitary volumes as well as interaction effects with childhood abuse and neglect (Childhood Trauma Questionnaire) were estimated using depressive symptoms (Beck Depression Inventory-II), and serum cortisol concentrations as outcome variables. The results of both cohorts were integrated via meta-analyses. No main effect between pituitary volumes and depressive symptoms was observed (START-2: β = -0.004 [-0.082; 0.075], p = .929; TREND-0: β = 0.020 [-0.033; 0.073], p = .466; Meta-analysis: β = 0.012 [-0.031; 0.056], p = .580). However, larger pituitary volumes were associated with more depressive symptoms in participants with more severe childhood neglect (START-2: β = 0.051 [-0.024; 0.126], p = .183; TREND-0: β = 0.083 [0.006; 0.159], p = .034; Meta-analysis: β = 0.066 [0.013; 0.120], p = .015). Further, larger pituitary volumes were associated with lower serum cortisol concentrations in participants with more severe depressive symptoms (START-2: β = -0.087 [-0.145; -0.030], p = .003; TREND-0: β = -0.053 [-0.091; -0.015], p = .006; Meta-analysis: β = -0.063 [-0.095; -0.032], p = 8.39e-05). Summarizing, larger pituitary volumes were associated with more severe psychopathological symptoms, particularly in participants reporting early life stress. This was supported by stronger associations between pituitary volumes and cortisol concentrations in participants with more severe depressive symptoms. Future studies are needed to transfer these results into developmental stages of high hormonal changes and patient samples.
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Affiliation(s)
- Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Insa I Martin
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Sascha Marx
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany; Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, University Medicine Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
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Wallensten J, Ljunggren G, Nager A, Wachtler C, Bogdanovic N, Petrovic P, Carlsson AC. Stress, depression, and risk of dementia - a cohort study in the total population between 18 and 65 years old in Region Stockholm. Alzheimers Res Ther 2023; 15:161. [PMID: 37779209 PMCID: PMC10544453 DOI: 10.1186/s13195-023-01308-4] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Chronic stress and depression are potential risk factors for mild cognitive impairment and dementia, including Alzheimer disease. The aim was to investigate whether any such risk is additive. METHODS Cohort study including 1 362 548 people (665 997 women, 696 551 men) with records in the Region Stockholm administrative healthcare database (VAL). Exposure was a recorded ICD-10 diagnosis of chronic stress, depression, or both, recorded in 2012 or 2013. Outcome was a diagnosis of Alzheimer disease, other dementia, or mild cognitive impairment recorded from 2014 through 2022. Odds ratios with 99% confidence intervals (CI) adjusted for age, sex, neighborhood socioeconomic status, diabetes, and cardiovascular disorders were calculated. RESULTS During the exposure period, 4 346 patients were diagnosed with chronic stress, 40 101 with depression, and 1 898 with both. The average age at baseline was around 40 years in all groups. In the fully adjusted model, the odds ratio of Alzheimer disease was 2.45 (99% CI 1.22-4.91) in patients with chronic stress, 2.32 (99% CI 1.85-2.90) in patients with depression, and 4.00 (99% CI 1.67-9.58) in patients with chronic stress and depression. The odds ratio of mild cognitive impairment was 1.87 (99% CI 1.20-2.91) in patients with chronic stress, 2.85 (99% CI 2.53-3.22) in patients with depression, and 3.87 (99% CI 2.39-6.27) in patients with both. When other dementia was analyzed, the odds ratio was significant only in patients with depression, 2.39 (99% CI 1.92-2.96). CONCLUSIONS Documented chronic stress increased the risk of mild cognitive impairment and Alzheimer disease. The same was seen with depression. The novel finding is the potential additive effect of chronic stress to depression, on risk of MCI and AD.
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Affiliation(s)
- Johanna Wallensten
- Department of Clinical Sciences, Danderyd Hospital, 18288, Stockholm, Sweden.
- Academic Primary Health Care Centre, Solnavägen 1E, 104 31, Stockholm, Sweden.
| | - Gunnar Ljunggren
- Academic Primary Health Care Centre, Solnavägen 1E, 104 31, Stockholm, Sweden
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Anna Nager
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Caroline Wachtler
- Academic Primary Health Care Centre, Solnavägen 1E, 104 31, Stockholm, Sweden
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Nenad Bogdanovic
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Predrag Petrovic
- Center for Cognitive Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Cognitive and Computational Neurosceince (CCNP), Karolinska Institutet, Stockholm, Sweden
| | - Axel C Carlsson
- Academic Primary Health Care Centre, Solnavägen 1E, 104 31, Stockholm, Sweden
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
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Petersson EL, Forsén E, Björkelund C, Hammarbäck L, Hessman E, Weineland S, Svenningsson I. Examining the description of the concept "treatment as usual" for patients with depression, anxiety and stress-related mental disorders in primary health care research - A systematic review. J Affect Disord 2023; 326:1-10. [PMID: 36708952 DOI: 10.1016/j.jad.2023.01.076] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND In randomized controlled trials (RCTs) within medical research, applied interventions are compared to treatment-as-usual (TAU) as the control condition. The aim of the current study was to examine how the concept of TAU is described when used as control condition in RCTs evaluating treatments for depression, anxiety syndromes, and stress-related mental disorders in primary care. METHOD A systematic review of RCTs utilizing TAU as control group in the RCT in accordance with PRISMA standards was conducted. We used one multidisciplinary database (Scopus), one database focused on nursing (Cinahl), and one medical database (PubMed). The searches were conducted in November 2021 and May 2022. RESULTS The included 32 studies comprised of 7803 participants. The content of TAU was classified as follows: 1) Basic descriptions of TAU lacking a detailed account as well as reference to local or national guidelines, 2) Moderate description of TAU including reference to national or local guidelines or a detailed description 3) Advanced description of TAU including references to national guidelines and a detailed description containing five key concepts: early assessment, accessibility, psychological treatment, medication, somatic examination. 18 studies had basic, 11 moderate, and 3 advanced descriptions of TAU. LIMITATIONS The limitations were that only studies published in English were included. CONCLUSIONS The current study provides an assessment tool with three classification levels for TAU. The description of TAU is still insufficient in RCT studies conducted in primary care, which may affect the interpretation of results. In future research a detailed description of TAU is recommended.
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Affiliation(s)
- E-L Petersson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - E Forsén
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - C Björkelund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - L Hammarbäck
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - E Hessman
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - S Weineland
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - I Svenningsson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.
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Mei L, Gao Y, Chen M, Zhang X, Yue W, Zhang D, Yu H. Overlapping common genetic architecture between major depressive disorders and anxiety and stress-related disorders. Prog Neuropsychopharmacol Biol Psychiatry 2022; 113:110450. [PMID: 34634379 DOI: 10.1016/j.pnpbp.2021.110450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/24/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/21/2022]
Abstract
Major depressive disorders (MDDs) and anxiety and stress-related disorders (ASRDs) have overlapping symptoms and high rates of comorbidity. However, the underlying mechanisms remain largely unknown. Here, we aimed to examine whether MDD and ASRD share genetic risk factors utilizing recent large-scale genome-wide association studies (GWASs). To examine the genetic overlap between MDD and ASRD, we applied genetic correlation analysis to analyze GWAS summary statistics for MDD (16,823 cases and 25,632 controls) and ASRD (12,665 cases and 19,225 controls). We found positive and significant genetic correlations between MDD and ASRD (GNOVA: rho = 0.59, se = 0.01, P = 5.32 × 10-45). Our latent causal variable (LCV) analysis indicated the genetic correlation result from pleiotropic effects (gcp = -0.56, se = 0.31, Pgcp = 0.1). Based on pleiotropic enrichment, we performed a cross-trait meta-analysis of MDD and ASRD GWAS and fine-mapped the identified loci. In total, we identified 5 pleiotropic loci simultaneously associated with MDD and ASRD at P < 5 × 10-8. At the gene level, we further demonstrated that MDD- and ASRD-inferred gene expression overlapped across 48 tissues and highlighted the NUP210L gene as a potential mediator of the genetic correlation. Our study highlights a shared underlying genetic risk for MDD and ASRD, which may help to improve the understanding of high comorbidity and overlapping genetic mechanisms between the two traits.
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Affiliation(s)
- Liwei Mei
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China
| | - Yan Gao
- Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300070, China; Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China
| | - Min Chen
- Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China
| | - Xiao Zhang
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China
| | - Weihua Yue
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Dai Zhang
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China.
| | - Hao Yu
- Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China.
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Harvey BH, Uys MM, Viljoen FP, Shahid M, Sonntag Q, Meyer LCR. Hippocampal monoamine changes in the Flinders sensitive line rat: A case for the possible use of selective α 2C-AR-antagonists in stress and anxiety disorders in companion animals. Res Vet Sci 2021; 135:175-183. [PMID: 33529845 DOI: 10.1016/j.rvsc.2021.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 12/21/2022]
Abstract
Non-selective α2-adrenoreceptor (AR) stimulation delivers favourable sedative, analgesic, muscle relaxant and anxiolytic actions in companion animals, but is associated with cardiovascular and respiratory side effects. Anxiety conditions underscore monoamine disturbances amenable to α2-AR modulation. We investigated sub-chronic (14 day s.c.) treatment with the selective α2C-AR antagonist, ORM-10921 (0.03, 0.1, 0.3 mg/kg/d) on hippocampal noradrenaline (NA), dopamine (DA), serotonin (5-HT) and their turnover levels in stress sensitive Flinders Sensitive Line (FSL) rats versus Flinders Resistant Line (FRL) controls, using high performance liquid chromatography. The effects of ORM-10921 were compared to the non-selective α2-AR antagonist, idazoxan (IDAZ; 3 mg/kg/d), and to imipramine (IMI; 15 mg/kg/d), a reference antidepressant in this model. FSL rats displayed significantly reduced 5-HT (p = 0.03) and DA (p = 0.02) levels vs. FRL controls, while NA levels showed a similar trend. ORM-10921 significantly increased NA (all doses p ≤ 0.02), 5-HT (0.1 and 0.3 mg/kg p ≤ 0.03) and DA levels (all doses p ≤ 0.03), which correlated with decreased monoamine turnover. In contrast, IDAZ significantly elevated NA (p < 0.005) and DA (p < 0.004) but not 5-HT levels. IMI also significantly increased 5-HT (p < 0.009), with a tendency to increase NA (p = 0.09) but not DA. ORM-10921 exerts similar albeit broader effects on hippocampal monoamines than IDAZ, explaining earlier established efficacy associated with α2C-AR antagonism in animal models of depression and cognitive dysfunction. These and the current studies encourage application of ORM-10921 in depression in humans, as well as raise the intriguing possibility that selective α2C-AR antagonists may be beneficial in anxiety and stress-related disorders in companion animals. Both warrant further study.
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Affiliation(s)
- Brian H Harvey
- Division of Pharmacology, Center of Excellence for Pharmaceutical Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa; South African MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Madeleine M Uys
- Division of Pharmacology, Center of Excellence for Pharmaceutical Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Francois P Viljoen
- Division of Pharmacology, Center of Excellence for Pharmaceutical Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | | | - Quixi Sonntag
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Leith C R Meyer
- Centre for Veterinary Wildlife Studies and Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
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Grensman A, Acharya BD, Wändell P, Nilsson GH, Falkenberg T, Sundin Ö, Werner S. Effect of traditional yoga, mindfulness-based cognitive therapy, and cognitive behavioral therapy, on health related quality of life: a randomized controlled trial on patients on sick leave because of burnout. BMC Complement Altern Med 2018; 18:80. [PMID: 29510704 PMCID: PMC5839058 DOI: 10.1186/s12906-018-2141-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 02/22/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND To explore if health related quality of life(HRQoL) increased after traditional yoga(TY), mindfulness based cognitive therapy(MBCT), or cognitive behavioral therapy(CBT), in patients on sick leave because of burnout. METHODS Randomized controlled trial, blinded, in ninety-four primary health care patients, block randomized to TY, MBCT or CBT (active control) between September 2007 and November 2009. Patients were living in the Stockholm metropolitan area, Sweden, were aged 18-65 years and were on 50%-100% sick leave. A group treatment for 20 weeks, three hours per week, with homework four hours per week. HRQoL was measured by the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, each with a separate index, and scores from 0 (worse) to 100 (best). SWED-QUAL covers aspects of physical and emotional well-being, cognitive function, sleep, general health and social and sexual functioning. Statistics: Wilcoxon's rank sum and Wilcoxon's sign rank tests, Bonett-Price for medians and confidence intervals, and Cohen's D. RESULTS Twenty-six patients in the TY (21 women), and 27 patients in both the MBCT (24 women) and in the CBT (25 women), were analyzed. Ten subscales in TY and seven subscales in MBCT and CBT showed improvements, p < 0.05, in several of the main domains affected in burnout, e.g. emotional well-being, physical well-being, cognitive function and sleep. The median improvement ranged from 0 to 27 points in TY, from 4 to 25 points in CBT and from 0 to 25 points in MBCT. The effect size was mainly medium or large. Comparison of treatments showed no statistical differences, but better effect (small) of both TY and MBCT compared to CBT. When comparing the effect of TY and MBCT, both showed a better effect (small) in two subscales each. CONCLUSIONS A 20 week group treatment with TY, CBT or MBCT had equal effects on HRQoL, and particularly on main domains affected in burnout. This indicates that TY, MBCT and CBT can be used as both treatment and prevention, to improve HRQoL in patients on sick leave because of burnout, reducing the risk of future morbidity. TRIAL REGISTRATION July 22, 2012, retrospectively registered. ClinicalTrails.gov NCT01168661 . FUNDING Stockholm County Council, grant 2003-5.
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Affiliation(s)
- Astrid Grensman
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Alfred Nobels allé 23, 141 83 Stockholm, Sweden
| | - Bikash Dev Acharya
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Alfred Nobels allé 23, 141 83 Stockholm, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Alfred Nobels allé 23, 141 83 Stockholm, Sweden
| | - Gunnar H. Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Alfred Nobels allé 23, 141 83 Stockholm, Sweden
| | - Torkel Falkenberg
- Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Karolinska Institutet, Stockholm, Sweden
- Centre for Social Sustainability, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Sundin
- Faculty of Human Sciences, Department of Social Sciences, Mid Sweden University, Östersund, Sweden
| | - Sigbritt Werner
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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