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Abstract
Inflammation, the body's response to harmful external agents, has long been found to be associated with depressive symptoms. The relationship between inflammation and depression is well established in the general population of people with depression, but is less so among perinatal women. Depression in the perinatal period is a common disorder, however available data do not indicate that there is a specific inflammatory picture associated with perinatal depression. We suggest that perinatal depression may be a heterogeneous construct, and that inflammation may be relevant to it in the context of other inflammatory morbidities of pregnancy. In this review we explore the available support for the hypothesis that inflammation associated with depression can represent a precipitating insult for the development of gestational diabetes, a known inflammatory morbidity of pregnancy.
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Affiliation(s)
- Thalia K Robakis
- Stanford University, Department of Psychiatry and Behavioral Sciences
| | - Linn Aasly
- Stanford University, Department of Psychiatry and Behavioral Sciences
| | | | - Claire Clark
- Palo Alto University, Program in Clinical Psychology
| | - Natalie Rasgon
- Stanford University, Department of Psychiatry and Behavioral Sciences
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Zeitzer JM, Nouriani B, Rissling MB, Sledge GW, Kaplan KA, Aasly L, Palesh O, Jo B, Neri E, Dhabhar FS, Spiegel D. Aberrant nocturnal cortisol and disease progression in women with breast cancer. Breast Cancer Res Treat 2016; 158:43-50. [PMID: 27314577 DOI: 10.1007/s10549-016-3864-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
While a relationship between disruption of circadian rhythms and the progression of cancer has been hypothesized in field and epidemiologic studies, it has never been unequivocally demonstrated. We determined the circadian rhythm of cortisol and sleep in women with advanced breast cancer (ABC) under the conditions necessary to allow for the precise measurement of these variables. Women with ABC (n = 97) and age-matched controls (n = 24) took part in a 24-h intensive physiological monitoring study involving polysomnographic sleep measures and high-density plasma sampling. Sleep was scored using both standard clinical metrics and power spectral analysis. Three-harmonic regression analysis and functional data analysis were used to assess the 24-h and sleep-associated patterns of plasma cortisol, respectively. The circadian pattern of plasma cortisol as described by its timing, timing relative to sleep, or amplitude was indistinguishable between women with ABC and age-matched controls (p's > 0.11, t-tests). There was, however, an aberrant spike of cortisol during the sleep of a subset of women, during which there was an eightfold increase in the amount of objectively measured wake time (p < 0.004, Wilcoxon Signed-Rank). This cortisol aberration was associated with cancer progression such that the larger the aberration, the shorter the disease-free interval (time from initial diagnosis to metastasis; r = -0.30, p = 0.004; linear regression). The same aberrant spike was present in a similar percent of women without ABC and associated with concomitant sleep disruption. A greater understanding of this sleep-related cortisol abnormality, possibly a vulnerability trait, is likely important in our understanding of individual variation in the progression of cancer.
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Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA, 94304, USA.
| | - Bita Nouriani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Michelle B Rissling
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA, 94304, USA
- Durham VA Medical Center, Durham, NC, 27705, USA
| | - George W Sledge
- Department of Medicine/Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Linn Aasly
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Columbia University, New York, NY, 10027, USA
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
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