Stress, hypothalamic pituitary adrenal axis activity and autonomic nervous system function in adolescents with insomnia

Associations between appetite loss and clinical features as well as inflammatory cytokines in adolescents with major depressive disorder

Background

Appetite loss is common in major depressive disorder (MDD). However, the psychosocial and biological mechanisms behind appetite loss remain unclear, particularly in the adolescent MDD population. Therefore, this study aimed to examine the links between appetite loss and clinical symptoms as well as inflammatory cytokines levels in this population.

Methods

Between January and December 2021, this study included 171 depressed adolescents. A range of scales were used to assess the patients' clinical symptoms, including depression severity, negative life events, insomnia, and alexithymia. Additionally, plasma inflammatory cytokines levels were measured, including interleukin (IL)-1β, IL-6, IL-10, IL-17A and tumor necrosis factor-α (TNF-α).

Results

The prevalence of appetite loss among adolescents with MDD was as high as 76.0%. Univariate analyses showed that patients with appetite loss had higher scores of the Hamilton Depression Scale (HAMD), interpersonal relationships, study pressure, punishment, sense of loss, the Insomnia Severity Index Scale (ISI) and difficulty identifying feelings, as well as higher levels of Log IL-6 (all p < 0.05) Furthermore, regression analyses revealed that appetite loss was independently associated with HAMD score (OR = 1.158, 95% CI = 1.091-1.229, p < 0.001), punishment score (OR = 1.117, 95% CI = 1.039-1.201, p = 0.003), and Log IL-6 level (OR = 5.041, 95% CI = 1.137-22.344, p = 0.033).

Conclusion

Adolescents with MDD face an elevated risk of appetite loss, which may correlate with clinical symptoms such as depression severity and negative life events, as well as elevated IL-6 level. Healthcare professionals should target these risk factors, including inflammation, to mitigate appetite loss.

Sleep disturbances in generalized anxiety Disorder: The central role of insomnia

Generalized anxiety disorder (GAD) is a chronic and disabling mental health condition characterized by excessive, uncontrollable worry and persistent psychological and somatic tension. Affecting approximately 3-6 % of the global population, GAD significantly impairs daily functioning and often coexists with other psychiatric conditions. Among its many symptoms, sleep disturbances-particularly insomnia-are among the most frequently reported and debilitating. Individuals with GAD commonly experience difficulties with sleep initiation, maintenance, and restorative rest, making insomnia one of the most pervasive features of the disorder. Emerging research highlights a bidirectional relationship between GAD and insomnia: while anxiety contributes to cognitive and physiological arousal that interferes with sleep, insomnia in turn exacerbates emotional dysregulation, amplifies worry, and may even precede the development of anxiety disorders. Neurobiological and neuroimaging studies support this reciprocal link, showing shared dysfunctions such as heightened hypothalamic-pituitary-adrenal (HPA) axis activity, increased amygdala reactivity, reduced prefrontal cortical control, and GABAergic deficits. These overlapping mechanisms underscore a common pathophysiological substrate that reinforces both conditions. Recognizing and addressing this interplay is critical, as untreated insomnia may perpetuate or intensify GAD symptoms. Notably, cognitive behavioral therapy for insomnia (CBT-I) has been effective in improving sleep and reducing anxiety severity-even without directly targeting anxiety-supporting a shift toward integrating sleep-focused interventions in the treatment of GAD. This review aimed to elucidate clinical and neurobiological evidence on the bidirectional link between insomnia and GAD, emphasizing shared mechanisms and treatment implications.

Efficacy and underlying mechanisms of three-circle post standing qigong on insomnia in college students: a four-arm, double-blind, randomized controlled trial protocol

BACKGROUND

Insomnia is common in college students, but its impact on health and wellbeing is often neglected. Enhancing sleep quality through targeted interventions could improve overall health and reduce the risk of consequent co-morbidities and mental health problems. Qigong exercises have been shown to significantly improve sleep quality and relieve insomnia. Three-circle Post Standing (TCPS) can help integrate body, breath, and mind, a fundamental principle of Qigong that promotes holistic wellbeing. In this clinical trial, we aim to (1) evaluate the feasibility, safety, and therapeutic efficacy of administering TCPS to improve sleep quality and quality of life in college students with insomnia; (2) explore the neurophysiological mechanisms underlying the mind adjustments mediated by TCPS in insomnia; (3) investigate body and breath pathophysiology mediated by TCPS in insomnia; and (4) assess the long-term efficacy of TCPS in terms of sleep quality and quality of life.

METHODS

This will be a prospective, parallel, four-arm, double-blind randomized controlled trial to investigate the effects and underlying mechanisms of TCPS on college students with insomnia. One hundred college students meeting diagnostic criteria for insomnia will be randomly assigned to receive either 14 weeks of standardized TCPS training (two weeks of centralized training followed by 12 weeks of supervised training) or sham-control Post Standing training. Efficacy outcomes including sleep quality, quality of life, neurophysiological assessments, plantar pressure, biomechanical balance, and physical measures will be collected at baseline, eight weeks (mid-point of supervised training), and 14 weeks (end of supervised training). Sleep quality and quality of life will also be evaluated during the four- and eight-week follow-up.

DISCUSSION

This trial will be an important milestone in the development of new therapeutic approaches for insomnia and should be easily implementable by college students with insomnia. The neuro- and pathophysiological assessments will provide new insights into the mechanisms underlying TCPS.

CLINICAL TRIAL REGISTRATION

This trial has been registered in the China Clinical Trials Registry (registration number: ChiCTR2400080763).