Pathophysiology of Major Depression by Clinical Stages

The comprehension of the pathophysiology of the major depressive disorder (MDD) is essential to the strengthening of precision psychiatry. In order to determine the relationship between the pathophysiology of the MDD and its clinical progression, analyzed by severity of the depressive symptoms and sleep quality, we conducted a study assessing different peripheral molecular biomarkers, including the levels of plasma C-reactive protein (CRP), serum mature brain-derived neurotrophic factor (mBDNF), serum cortisol (SC), and salivary cortisol awakening response (CAR), of patients with MDD (n = 58) and a control group of healthy volunteers (n = 62). Patients with the first episode of MDD (n = 30) had significantly higher levels of CAR and SC than controls (n = 32) and similar levels of mBDNF of controls. Patients with treatment-resistant depression (TRD, n = 28) presented significantly lower levels of SC and CAR, and higher levels of mBDNF and CRP than controls (n = 30). An increased severity of depressive symptoms and worse sleep quality were correlated with levels low of SC and CAR, and with high levels of mBDNF. These results point out a strong relationship between the stages clinical of MDD and changes in a range of relevant biological markers. This can assist in the development of precision psychiatry and future research on the biological tests for depression.

Download Full-text

Potential biomarkers of major depression diagnosis and chronicity

PLoS ONE ◽

10.1371/journal.pone.0257251 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257251

Author(s):

Ana Cecília de Menezes Galvão ◽

Raíssa Nobrega Almeida ◽

Geovan Menezes de Sousa Júnior ◽

Mário André Leocadio-Miguel ◽

Fernanda Palhano-Fontes ◽

...

Keyword(s):

Major Depression ◽

Rating Scale ◽

Serum Cortisol ◽

First Episode ◽

Major Depression Disorder ◽

Reactive Protein ◽

Mature Brain ◽

Healthy Control ◽

Depression Disorder ◽

Potential Use

Background Molecular biomarkers are promising tools to be routinely used in clinical psychiatry. Among psychiatric diseases, major depression disorder (MDD) has gotten attention due to its growing prevalence and morbidity. Methods We tested some peripheral molecular parameters such as serum mature Brain-Derived Neurotrophic Factor (mBDNF), plasma C-Reactive Protein (CRP), serum cortisol (SC), and the salivary Cortisol Awakening Response (CAR), as well as the Pittsburgh sleep quality inventory (PSQI), as part of a multibiomarker panel for potential use in MDD diagnosis and evaluation of disease’s chronicity using regression models, and ROC curve. Results For diagnosis model, two groups were analyzed: patients in the first episode of major depression (MD: n = 30) and a healthy control (CG: n = 32). None of those diagnosis models tested had greater power than Hamilton Depression Rating Scale-6. For MDD chronicity, a group of patients with treatment-resistant major depression (TRD: n = 28) was tested across the MD group. The best chronicity model (p < 0.05) that discriminated between MD and TRD included four parameters, namely PSQI, CAR, SC, and mBDNF (AUC ROC = 0.99), with 96% of sensitivity and 93% of specificity. Conclusion These results indicate that changes in specific biomarkers (CAR, SC, mBDNF and PSQI) have potential on the evaluation of MDD chronicity, but not for its diagnosis. Therefore, these findings can contribute for further studies aiming the development of a stronger model to be commercially available and used in psychiatry clinical practice.

Download Full-text

Poor sleep quality in systemic lupus erythematosus: does it depend on depressive symptoms?

Lupus ◽

10.1177/0961203314540762 ◽

2014 ◽

Vol 23 (13) ◽

pp. 1350-1357 ◽

Cited By ~ 22

Author(s):

L Palagini ◽

C Tani ◽

R M Bruno ◽

A Gemignani ◽

M Mauri ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Depressive Symptoms ◽

Sleep Quality ◽

Lupus Erythematosus ◽

Sleep Disturbances ◽

Control Group ◽

Poor Sleep ◽

Systemic Lupus ◽

Poor Sleep Quality ◽

Obstructive Sleep

Objectives Sleep disturbances are frequently observed in rheumatic diseases including systemic lupus erythematosus (SLE). This study aimed at evaluating the prevalence of insomnia, poor sleep quality and their determinants in a cohort of SLE patients. Methods Eighty-one consecutive SLE female patients were evaluated in a cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Beck Depression Inventory (BDI) and the Self-rating Anxiety Scale (SAS) were administered. Patients with previous diagnosis of obstructive sleep apnea or restless legs syndrome were excluded. Fifty-three women with hypertension (without SLE) were enrolled as control group (H). Results In the SLE cohort poor sleep quality (65.4% vs 39.6%, p < 0.01) and difficulty in maintaining sleep and/or early morning awakening (65.4% vs 22.6%, p < 0.001), but not insomnia (33.3% vs 22.6%, p = ns), were more prevalent than in H. Depressive symptoms were present in 34.6% of SLE vs 13.2% H patients ( p < 0.001) while state anxiety was more common in H patients (H 35.8% vs SLE 17.3%, p < 0.005). SLE was associated with a 2.5-times higher probability of presenting poor sleep quality in comparison to H (OR 2.5 [CI 1.21–5.16]). After adjusting for confounders, both depressive symptoms (OR 4.4, [1.4–14.3]) and use of immunosuppressive drugs (OR 4.3 [CI 1.3–14.8]) were significantly associated with poor sleep quality in SLE patients. Furthermore, poor sleep quality was not associated either with disease duration or activity. Conclusions In a cohort of SLE women, insomnia and poor sleep quality, especially difficulties in maintaining sleep, were common. Depressive symptoms might be responsible for the higher prevalence of poor sleep quality in SLE.

Download Full-text

Effectiveness of a Mindfulness-Based Group Intervention for Chinese University Students with Sleep Problems

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020755 ◽

2022 ◽

Vol 19 (2) ◽

pp. 755

Author(s):

Lin Fu ◽

Shuang Wei ◽

Jin Cheng ◽

Xueqi Wang ◽

Yueyue Zhou ◽

...

Keyword(s):

Depressive Symptoms ◽

University Students ◽

Sleep Quality ◽

Repeated Measures ◽

Group Intervention ◽

Sleep Problems ◽

Intervention Group ◽

Control Group ◽

Emotional Symptoms ◽

Chinese University

The increasing prevalence of sleep disorders among university students should be taken seriously. Group counseling involving a mindfulness-based strategy may help prevent students from developing insomnia and subsequent mental health disorders. This study aimed to evaluate the ameliorating effects of a mindfulness-based group intervention on sleep problems and emotional symptoms in university students in China. Twenty-one university students (16 females, 22.71 ± 4.28 years) who were not on medication were recruited and assigned to the intervention group based on the criterion of high levels of sleep problems. Additionally, twenty-four university students (19 females, 24.50 ± 0.93 years) were included as a nonrandomized control group. Individuals in the intervention group participated in a two-hour group intervention once a week for eight sessions. All participants completed self-reported questionnaire baseline tests, postintervention tests, and one-month follow-ups on mindfulness, sleep quality, anxiety and depressive symptoms. Repeated-measures ANOVA was performed. The results revealed significant intervention effects, with significant differences observed between the two groups in mindfulness and sleep quality. However, there was no significant effect of the intervention on anxiety and depressive symptoms. This study contributes to a better understanding of the effectiveness of mindfulness-based intervention in addressing sleep problems in university students.

Download Full-text

Severe Affective and Behavioral Dysregulation in Youths Is Associated with a Proinflammatory State 1MH and LP contributed equally to the paper

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000255 ◽

2013 ◽

Vol 41 (6) ◽

pp. 393-399 ◽

Cited By ~ 8

Author(s):

Martin Holtmann ◽

Luise Poustka ◽

Florian D. Zepf ◽

Tobias Banaschewski ◽

Josef Priller ◽

...

Keyword(s):

Child Behavior Checklist ◽

Clinical Sample ◽

Serum Levels ◽

Attention Problems ◽

Future Research ◽

Control Group ◽

Global Functioning ◽

Reactive Protein ◽

Behavioral Dysregulation ◽

Duration Of Illness

Objective: A heritable behavioral phenotype, the so-called Dysregulation Profile (DP), characterized by extreme scores on the syndrome scales Anxious/Depressed (A/D), Attention Problems (AP), and Aggressive Behavior (AGG), has been identified on the Child Behavior Checklist (CBCL). It characterizes children with severe affective and behavioral dysregulation. The present study examined possible alterations of the inflammatory system in CBCL-DP using a clinical sample of n = 133 children and adolescents. Method: Participants with the CBCL-DP scoring ≥ 2.5 SDs above average constituted the CBCL-DP subgroup (n = 51). Those with CBCL-DP scores of 1 SD or less above average were regarded as controls (n = 82). Groups were compared in terms of serum levels of C-reactive protein (CRP) and albumin. Results: Participants showing the CBCL-DP exhibited increased CRP and decreased albumin levels compared to controls. CRP was correlated with AGG, AP, and the CBCL-DP total score. A negative correlation was observed between albumin and AGG, AP, the CBCL-DP score, and A/D. These associations could not be attributed to differences in age, sex, weight, socioeconomic status, global functioning, or duration of illness. Conclusions: This is the first study to demonstrate associations between the CBCL-DP and a proinflammatory state. Limitations include the lack of a healthy control group, the use of a single measurement of inflammatory markers, and the lack of follow-up data. Future research should address whether inflammatory diathesis in these children confers increased susceptibility to later development of cardiovascular disease and other medical morbidities.

Download Full-text

Psychophysiological responses to group cognitive-behavioral therapy in depressive patients

10.21203/rs.3.rs-62867/v1 ◽

2020 ◽

Author(s):

Yves Martins Varela ◽

Raíssa Nóbrega De Almeida ◽

Ana Cecília de Menezes Galvão ◽

Geovan Menezes Sousa Junior ◽

Ana Cecília Lopes de Lima ◽

...

Keyword(s):

Sleep Quality ◽

Behavioral Therapy ◽

Low Cost ◽

Serum Cortisol ◽

Self Esteem ◽

Control Group ◽

Major Depressive ◽

Healthy Control ◽

Depressive Patients ◽

Drug Free

Abstract BackgroundCognitive-Behavioral Therapy (CBT) has a significant adjunctive effect in the treatment of Major Depressive Disorder (MDD), however its uses as monotherapy is less explored, mainly the group-based approaches.MethodsWe assessed the responses of distinct psychophysiological domains after a intervention using group-based CBT (gCBT, 16 weeks) in drug-free patients with mild-moderate MDD (n = 20; women = 11) and to compare with a healthy control group (n = 25, women = 13).ResultsTreatment resulted in 65% of response and 55% of remission rates. Reductions in depressive and anxiety symptoms and increase in self-esteem and sleep quality were observed as responses of gCBT. After treatment patients regulated their previous deregulated salivary cortisol awakening response (CAR) and sleep quality to healthy parameters. These improvements were correlated among themselves and dependent of remission condition. Remitted patients showed large progresses than non-remitted patients, who significantly changed only serum cortisol and self-perceived depressive symptoms. Further, better baseline sleep quality was predictor of remission.ConclusionThese psychophysiological changes in response of gCBT support its use as tool with low cost and no side effects for treatment of mild-moderate major depression, as well as suggests a stronger exploration of these psychological domains in psychotherapies and stimulates furthers studies of neurobiology of MDD and alternatives treatments.Trial registrationU1111-1215-4472. Registered 21 August 2018, http://www.ensaiosclinicos.gov.br/rg/RBR-3npbf8/

Download Full-text

Cognitive Behavioral Therapy plus Coping Management for Depression and Anxiety on Improving Sleep Quality and Health for Patients with Breast Cancer

Brain Sciences ◽

10.3390/brainsci11121614 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1614

Author(s):

Hui-Ling Lai ◽

Chun-I Chen ◽

Chu-Yun Lu ◽

Chiung-Yu Huang

Keyword(s):

Breast Cancer ◽

Depressive Symptoms ◽

Sleep Quality ◽

Coping Skills ◽

Behavioral Therapy ◽

Control Group ◽

Health Related Qol ◽

Health Related ◽

Experimental Group ◽

Over Time

Cancer-related treatments may lead to side effects that undermine a patients’ quality of life (QOL). Although cognitive behavioral therapy plus coping management (CBTM) may appear to improve health-related QOL in cancer patients, limited documentation exists on the effectiveness of psychosocial interventions for patients with breast cancer (BC) during recovery. The purpose of this study was to examine the effectiveness of CBTM for sleep quality, anxiety, depression, and health among patients with BC. An experimental study was conducted to assess the efficacy of a CBTM intervention (experimental group = 36, control group = 34). The experimental group received a 12-week CBTM intervention focused on their identity, challenges, the replacement of dysfunctional beliefs, coping skills, relaxation, and rehabilitation exercises, while the control group received usual care. The follow-up evaluations were performed immediately after the intervention (T1), and at one (T2) and three months (T3). The generalized estimating equation (GEE) model showed significant effects from the CBTM intervention over time. The experimental group showed significant improvement in sleep quality, anxiety and depressive symptoms, and significant increases in their mental and physical QOL from baseline, T1, T2, and T3—except for the mental and physical QOL showing no significant change at T3—while the control group receiving usual care showed no changes over time. The results suggest that CBTM increases sleep quality, reduces anxiety and depressive symptoms, and enhances health-related QOL for participants. CBTM is efficacious and can be provided by nurses to enhance patients’ coping skills and consequently improve their QOL.

Download Full-text

Effectiveness of a Qigong program on sleep quality among community-dwelling older adults with mild to moderate depression

Journal of Health Research ◽

10.1108/jhr-04-2019-0091 ◽

2020 ◽

Vol 34 (4) ◽

pp. 305-315

Author(s):

Phenphop Phansuea ◽

Sookjaroen Tangwongchai ◽

Thanapoom Rattananupong ◽

Vitool Lohsoonthorn ◽

Somrat Lertmaharit

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Sleep Quality ◽

Community Dwelling ◽

Control Group ◽

Subjective Sleep Quality ◽

Content Type ◽

Subjective Sleep ◽

Moderate Depression ◽

Significant Difference

PurposeThe purpose of this study was to determine the effectiveness of a Qigong program on older adults in the Thai community suffering from mild to moderate depression.Design/methodology/approachA randomized controlled trial study was conducted in a public health service (PHS) center setting. Sixty-six older adults aged 60–90 years with mild to moderate depressive symptoms measured by the Thai Geriatric Depression Scale (TGDS: scores 13–24) were recruited and randomly allocated into two groups. The subjective sleep quality was assessed using the Thai version of the Pittsburgh Sleep Quality Index (TPSQI). The Qigong program group was given 12 weeks of Qigong training including three sessions per week, while the control group followed normal PHS activities (singing and praying). The outcome measure was the change in the TGDS from baseline to 12 weeks.FindingsParticipants in the Qigong program group had a significantly improved TPSQI global score (p < 0.001), subjective sleep quality (p < 0.001), and sleep latency (p < 0.05) after 12 weeks of intervention, while those in the control group showed no significant difference in sleep quality. Compared with the control group, the Qigong program group reported significantly better sleep quality throughout the 12-week period. The prevalence of poor sleep quality in this population was 82 percent.Originality/valueThis study confirmed that the Qigong program could improve sleep quality in older adults with mild to moderate depressive symptoms as the Qigong program conferred more significant improvements than the usual program.

Download Full-text

Effects of Lactobacillus plantarum PS128 on Depressive Symptoms and Sleep Quality in Self-Reported Insomniacs: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial

Nutrients ◽

10.3390/nu13082820 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2820

Author(s):

Yu-Ting Ho ◽

Ying-Chieh Tsai ◽

Terry B. J. Kuo ◽

Cheryl C. H. Yang

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Lactobacillus Plantarum ◽

Animal Studies ◽

Sleep Stage ◽

Pilot Trial ◽

Control Group ◽

Deep Sleep ◽

Daily Consumption ◽

Double Blind

Recent animal studies have supported that Lactobacillus plantarum PS128 (PS128) can reduce the severity of anxiety and depression. However, previous studies did not focus on the sleep quality and mood of humans. This study determines whether PS128 reduces the severity of anxiety and depressive symptoms, regulates autonomic nervous system function, and improves sleep quality. Forty participants between 20 and 40 years of age with self-reported insomnia were randomly assigned to two groups, a PS128 group and a placebo group, in a double-blind trial. Participants took two capsules of either PS128 or a placebo after dinner for 30 days. Study measures included subjective depressive symptoms, anxiety and sleep questionnaires, and miniature-polysomnography recordings at baseline and on the 15th and 30th days of taking capsules. Overall, all outcomes were comparable between the two groups at baseline and within the 30-day period, yet some differences were still found. Compared to the control group, the PS128 group showed significant decreases in Beck Depression Inventory-II scores, fatigue levels, brainwave activity, and awakenings during the deep sleep stage. Their improved depressive symptoms were related to changes in brain waves and sleep maintenance. These findings suggest that daily administration of PS128 may lead to a decrease in depressive symptoms, fatigue level, cortical excitation, and an improvement in sleep quality during the deep sleep stage. Daily consumption of PS128 as a dietary supplement may improve the depressive symptoms and sleep quality of insomniacs, although further investigation is warranted.

Download Full-text

Prevalence and correlates of depressive symptoms among professional drivers in Saudi Arabia: a cross-sectional study

BJPsych Open ◽

10.1192/bjo.2021.751 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S282-S282

Author(s):

Adnan Raed Alnaser ◽

Osama A. Zitoun ◽

Tawfik Rajab ◽

Abdullah Khojah ◽

Juliann Saquib ◽

...

Keyword(s):

Saudi Arabia ◽

Depressive Symptoms ◽

Sleep Quality ◽

Sexual Activity ◽

Mental Illnesses ◽

Future Research ◽

Poor Sleep ◽

Unhealthy Lifestyle ◽

Cross Sectional ◽

Professional Drivers

AimsDue to the nature of their work, professional drivers face a considerable risk of developing depression and other mental illnesses. We sought to assess the prevalence and the factors influencing depressive symptoms among professional drivers in Saudi Arabia.MethodUsing convenience sampling, we have conducted an interviewer-administered survey on 324 professional drivers in Qassim Region in Saudi Arabia using Depression subscale from the Depression, Anxiety and Stress Scale 21 (DASS-21). Participants were interviewed in their native language, and responses were outlined directly into an online form in English. Data were then extracted and analyzed using SPSS software.ResultParticipants’ mean age was 38.6 years, and mean driving hours per day were 9.86 hours/day. The mean DASS-21 depression score among the professional drivers was 2.88. Overall, 21.9% of the included drivers had variable degrees of depressive symptoms, with 7.4% suffered from extremely severe symptoms. Depressive symptoms were influenced by the driver's nationality, educational level, vehicle type, driving years, BMI, presence of chronic medical conditions, physical activity, and sexual activity. Moreover, poor sleep quality increased the risk of developing depressive symptoms among the drivers by 31.9 times (OR: 31.9, CI: 9.03–112.63, P < 0.001).ConclusionNearly one-fifth of professional drivers in Saudi Arabia (Qassim region) suffer from depressive symptoms. Unhealthy lifestyle practices (i.e. being obese and physically inactive) have been closely related to depressive symptoms. Education, sexual activity, type of driven vehicle, and the number of chronic conditions were also associated with depressive symptoms. Also, poor and fair sleep quality was strongly associated with the development of depressive symptoms as compared with excellent sleep quality. As drivers are always on the move and hardly reachable, we would propose psychological support and counseling to be administered via telemedicine services. Future research is needed to better comprehend the needs of this vulnerable population.

Download Full-text

Light as an Aid for Recovery in Psychiatric Inpatients: A Randomized Controlled Effectiveness Pilot Trial

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.148 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S287-S288

Author(s):

N. Okkels ◽

L.G. Jensen ◽

R. Arendt ◽

A.B. Blicker ◽

J. Hjortdal ◽

...

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Clinical Care ◽

Intervention Group ◽

Psychiatric Inpatients ◽

Well Being ◽

Mean Difference ◽

Control Group ◽

Randomized Controlled ◽

Lighting Environment

IntroductionElectric indoor lighting can disturb sleep and increase depressive symptoms; both common complaints in psychiatric inpatients.AimsTo improve quality of sleep in patients using an indoor hospital lighting environment simulating nature in intensity, color, and circadian timing.MethodsInvestigator-blinded parallel group randomized controlled effectiveness trial supplied with qualitative interviews in an inpatient psychiatric ward with fully automatic and adjustable lighting. Admitted patients received a room with a naturalistic lighting environment (intervention group) or lighting as usual (control group). The primary outcome was the Pittsburg Sleep Quality Index and secondary outcomes included the Major Depression Inventory and WHO-five Well- Being Index.ResultsIn this ongoing trial, we included 28 patients (16 treated and 12 controls). Patients in the intervention group reported higher subjective sleep quality and sleep efficiency, lower use of sleep medication (mean difference, 4.68 mg; 95% CI, 0.54; 53.5), fewer depressive symptoms (mean difference, 5; 95% CI,–2; 13), but lower well-being (difference,–4 percentage points; 95% CI,–20; 16), compared with the control group. At discharge, fewer patients in the intervention group had experienced use of involuntary treatment. Qualitative data indicated no side effects apart from issues in performing indoor leisure activities in dim light.ConclusionsA naturalistic lighting environment was safe and improved sleep and mood in our small patient sample. The trial integrated well with routine clinical care and our sample reflected the heterogeneity of the target population (Funded by Region Midtjylland and others; Clinicaltrials.gov number, NCT02653040)Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text