Low serum albumin and high ferritin levels in chronic hemodialysis patients with major depression

Nrf2 regulates iron-dependent hippocampal synapses and functional connectivity damage in depression

Neuronal iron overload contributes to synaptic damage and neuropsychiatric disorders. However, the molecular mechanisms underlying iron deposition in depression remain largely unexplored. Our study aims to investigate how nuclear factor-erythroid 2 (NF-E2)-related factor 2 (Nrf2) ameliorates hippocampal synaptic dysfunction and reduces brain functional connectivity (FC) associated with excessive iron in depression. We treated mice with chronic unpredictable mild stress (CUMS) with the iron chelator deferoxamine mesylate (DFOM) and a high-iron diet (2.5% carbonyl iron) to examine the role of iron overload in synaptic plasticity. The involvement of Nrf2 in iron metabolism and brain function was assessed using molecular biological techniques and in vivo resting-state functional magnetic resonance imaging (rs-fMRI) through genetic deletion or pharmacologic activation of Nrf2. The results demonstrated a significant correlation between elevated serum iron levels and impaired hippocampal functional connectivity (FC), which contributed to the development of depression-induced CUMS. Iron overload plays a crucial role in CUMS-induced depression and synaptic dysfunction, as evidenced by the therapeutic effects of a high-iron diet and DFOM. The observed iron overload in this study was associated with decreased Nrf2 levels and increased expression of transferrin receptors (TfR). Notably, inhibition of iron accumulation effectively attenuated CUMS-induced synaptic damage mediated by downregulation of brain-derived neurotrophic factor (BDNF). Nrf2-/- mice exhibited compromised FC within the limbic system and the basal ganglia, particularly in the hippocampus, and inhibition of iron accumulation effectively attenuated CUMS-induced synaptic damage mediated by downregulation of brain-derived neurotrophic factor (BDNF). Activation of Nrf2 restored iron homeostasis and reversed vulnerability to depression. Mechanistically, we further identified that Nrf2 deletion promoted iron overload via upregulation of TfR and downregulation of ferritin light chain (FtL), leading to BDNF-mediated synapse damage in the hippocampus. Therefore, our findings unveil a novel role for Nrf2 in regulating iron homeostasis while providing mechanistic insights into poststress susceptibility to depression. Targeting Nrf2-mediated iron metabolism may offer promising strategies for developing more effective antidepressant therapies.

The association between serum albumin and depressive symptoms: a cross-sectional study of NHANES data during 2005-2018

AIMS

The association between serum albumin and depressive symptoms has been unclear in previous epidemiological studies. We explored whether serum albumin is associated with depressive symptoms based on the National Health and Nutrition Examination Survey (NHANES) data.

METHODS

This cross-sectional study included 13,681 participants aged ≥ 20 years from the NHANES performed during 2005-2018, which produced nationally representative database. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Serum albumin concentration was measured using the bromocresol purple dye method, and participants were divided into quartiles of serum albumin concentrations. Weighted data were calculated according to analytical guidelines. Logistics regression and linear regression models were used to assess and quantify the association between serum albumin and depressive symptoms. Univariate and stratified analyses were also performed.

RESULTS

There were 1551 (10.23%) adults (aged ≥ 20 years) with depressive symptoms among the 13,681. A negative association was found between serum albumin concentration and depressive symptoms. Compared with the lowest albumin quartile, the multivariate-adjusted effect size (95% confidence interval) for depressive symptoms of the fully adjusted model in the highest albumin quartile was 0.77 (0.60 to 0.99) and - 0.38 (- 0.66 to - 0.09) using logistics regression and linear regression models respectively. Current smoking status modified the association between serum albumin concentration and PHQ-9 scores (p for interaction = 0.033).

CONCLUSION

This cross-sectional study revealed that albumin concentration is significantly more likely to be a protective factor for depressive symptoms, with the association being more pronounced in non-smokers.

High neutrophil-to-lymphocyte ratio is a significant predictor of depressive symptoms in maintenance hemodialysis patients: a cross-sectional study

BACKGROUND

Depression is one of the most important psychiatric disorders in chronic kidney disease patients who undergo maintenance hemodialysis (MHD). Previous studies have shown that low-grade inflammation is involved in the progression of depressive symptoms. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that is inexpensive and easy to measure. However, the association between NLR and depression symptoms in MHD patients has not been examined.

METHODS

In this single-center, cross-sectional study, we included 160 patients undergoing MHD. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. NLR was calculated as the ratio of neutrophils to lymphocytes. Multinomial logistic regression and multivariate linear regression analyses were used to examine the association between NLR and depressive symptoms in MHD patients.

RESULTS

Depressive symptoms were detected in 36.7% of the 160 MHD patients. Multinomial logistic regression showed that NLR was a significant predictor of mild (odds ratio [OR]: 1.383, 95% confidence interval [CI]: 1.015-1.884, p = 0.04) and moderate/moderately severe depressive symptoms (OR: 1.441, 95% CI: 1.017-2.042, p = 0.04) in MHD patients, adjusted for age, sex, Kt/V, dialysis duration, history of kidney transplantation, history of hypertension, and Charlson comorbidity index score. In addition, multivariate linear regression analysis showed that NLR was an independent influencing factor for PHQ-9 score in MHD patients, after adjusting for confounding factors.

CONCLUSIONS

These findings suggest that NLR can be used as a biomarker for predicting depressive symptoms in MHD patients.

Study of the acute and repeated dose 28-day oral toxicity in mice treated with PT-31, a molecule with potential antipsychotic profile

Schizophrenia is a psychiatric disorder that affects 1% of the world population and is treated with antipsychotics, which may induce important biochemical and hematological alterations. Since it is necessary to verify the safety of new molecules with antipsychotic potential, the present study aimed to evaluate the oral toxicity of PT-31, a putative α₂-adrenoreceptor agonist, after acute (2000 mg/kg) and repeated doses (28 days) gavage treatment, in three different doses: minimum effective dose in animal models (10 mg/kg), twice the dose (20 mg/kg), and four times the dose (40 mg/kg), as recommended by the OECD guidelines. Balb/C female adult mice were used, and biochemical, hematological, and histopathological analyses were performed. PT-31 10 and 20 mg/kg did not cause biochemical alterations related to hepatic and renal toxicity, and neither altered glycemic and lipid profiles. The preclinical dose of PT-31 also did not promote mice histopathological changes in the liver, kidney, and brain. In the hematimetric parameters, PT-31 only increased HGB at 20 mg/kg, and MCH and MCHC at 40 mg/kg. However, all the tested doses of PT-31 showed platelet increase, which must be better investigated. Therefore, further studies are needed to investigate the safety of PT-31 as a potential antipsychotic drug.

Attenuated initial serum ferritin concentration in critically ill coronavirus disease 2019 geriatric patients with comorbid psychiatric conditions

We examined the effects of psychiatric comorbidity, sex, and ICU admission on serum ferritin concentration in 628 elderly patients (79.7 ± 8.5 years) with positive SARS-CoV-2 PCR test. Hospitalization was required in 96% of patients and 17% required ICU admission. Patients with COVID-19 and psychiatric comorbidities (n = 212) compared to patients without psychiatric comorbidities (n = 416) had significantly lower ferritin concentration (570.4 ± 900.1 vs. 744.1 ± 965, P = 0.029), a greater incidence of delirium (22.6 vs. 14.4%, P = 0.013) and higher mortality (35.3 vs. 27.6%, P = 0.015). Furthermore, we found significant effects for sex (P = 0.002) and ICU admission (P = 0.007). Among patients without comorbid psychiatric conditions, males had significantly higher ferritin compared to females (1,098.3 ± 78.4 vs. 651.5 ± 94.4, P < 0.001). ICU patients without comorbid psychiatric conditions had significantly higher serum ferritin compared to ICU patients with comorbid psychiatric conditions: (1,126.6 ± 110.7 vs. 668.6 ± 156.5, P < 0.001). Our results suggest that the presence of comorbid psychiatric conditions in elderly patients with COVID-19 is associated with higher rates of delirium and mortality and lower ferritin levels during severe illness. Whether high serum ferritin is protective during severe infection requires further investigation.

Examining the relationship between nutrition, quality of life, and depression in hemodialysis patients

PURPOSE

Lifestyle changes associated with end-stage renal disease may be a factor in depression and quality of life (QOL) for patients receiving hemodialysis. This cross-sectional study examined the relationship between nutritional status, QOL, and depression in 124 hemodialysis patients.

METHODS

Nutritional markers included serum albumin, normalized protein catabolic rate (nPCR), body mass index (BMI), body fat percentage, and daily protein intake. Physical and Mental dimension scores of the Kidney Disease QOL-Short Form (KDQOL-SF), and the Center for Epidemiological Studies of Depression (CESD) survey were used to measure QOL and depression, respectively. Data were analyzed using regression analyses. Measures of effect size were used for interpretation.

RESULTS

Nutritional status indicators explained a moderate amount of the variability of the Physical dimension of QOL (crude R² = .14, covariate-adjusted ΔR² = .06) but had weak explanatory ability for the Mental dimension of QOL (crude R² = .05, covariate-adjusted ΔR² = .02) and CESD (crude R² = .02, covariate-adjusted ΔR² = .005). Additional findings suggested the presence of non-linear relationships between protein intake and both the Physical and Mental QOL dimension scores. Longer dialysis vintage was also correlated with lower psychosocial patient outcomes.

CONCLUSION

While nutritional status is an important element in predicting hemodialysis patient outcomes, its relationship to depression and QOL, in this sample, demonstrated only moderate explanatory ability. However, dialysis vintage and level of education had a significant relationship with depression and QOL. These findings suggest that patients with longer dialysis vintage and limited health literacy require unique plans of care. Future studies aimed at understanding the interrelationships between non-modifiable patient characteristics and psychosocial outcomes are imperative.

Association between Serum-Ferritin Levels and Sleep Duration, Stress, Depression, and Suicidal Ideation in Older Koreans: Fifth Korea National Health and Nutrition Examination Survey 2010-2012

BACKGROUND

Serum-ferritin levels may be associated with psychiatric symptoms among the elderly; however, this association has not been extensively studied. The aim of this study was to evaluate the association between serumferritin levels and mental health issues in older Koreans.

METHODS

This cross-sectional study included large-scale national data from the Korea National Health and Nutrition Examination Survey 2010-2012. In total, 1,802 older Koreans (≥65 years old) were included. The assessed psychiatric symptoms included short sleep duration, stress, depressed mood, and suicidal ideation. Any association between serum-ferritin levels and mental health issues according to sex was examined using logistic regression analysis.

RESULTS

The prevalence of short sleep duration, stress, depressed mood, and suicidal ideation was 50.9%, 21.7%, 18.2%, and 22.5%, respectively. In men, suicidal ideation decreased with increased serum-ferritin levels after multivariate adjustment for sociodemographic and lifestyle factors and comorbidities. The odds ratios (OR) and 95% confidence interval (CI) of suicidal ideation by quartiles of serum-ferritin level were 1 (reference), 1.132 (95% CI, 0.569-2.252), 0.453 (95% CI, 0.217-0.945), and 0.608 (95% CI, 0.295-1.253), respectively, (P for trend=0.039). In women, no trend was observed. However, compared to the lowest quartile, short sleep duration (<7 h) and stress perception were significantly decreased in the third quartile, with odds ratios of 0.601 (95% CI, 0.461-0.888), and 0.606 (95% CI, 0.386-0.952), respectively.

CONCLUSION

Moderate serum-ferritin levels were associated with decreased risk for suicide ideation in men, and were associated with decreased short sleep duration and stress perception in women.

Inverse association between serum albumin and depressive symptoms among drug-free individuals with a recent suicide attempt

Background and aim: Albumin is a protein with multifaceted functions in the human body. According to many studies, lower serum albumin may be associated with depression in various groups of psychiatric and non-psychiatric patients, as well as with attempted suicide. As more severe depressive symptoms have been identified as a reliable risk factor for suicide in patients with high suicide risk, it would be of interest to study whether, the inverse association between depressive symptoms and albumin may exist among patients with attempted suicide. Therefore, the aim of the study was to investigate the possible association between albumin and depressive symptoms among individuals who recently attempted suicide. Methods: One-hundred twenty-seven individuals with a recent suicide attempt were involved in the study between 1987 and 2001. Albumin was analyzed in serum. Patients were evaluated with the Comprehensive Psychopathological Rating Scale (CPRS) from which the Montgomery-Åsberg Depression Rating Scale (MADRS) and the item assessing Apparent sadness were derived. Results: Only among patients aged ≥45, serum albumin levels were significantly and negatively correlated with total scores of MADRS and the item Apparent sadness (all p values <.00625). Conclusions: Our findings indicate an inverse association between serum albumin and the severity of depressive symptoms in individuals who attempted suicide, older than 45 years.

Association of serum ferritin level and depression with respect to the body mass index in Korean male adults

BACKGROUND/OBJECTIVES

Obesity is globally a major public health issue. Evidence suggests that elevated ferritin levels are associated with obesity, dyslipidemia, insulin resistance, and metabolic syndrome. This study was undertaken to examine the relationship between the serum ferritin level and depression in Korean male adults with respect to classification of the prevailing obesity.

SUBJECTS/METHODS

This was a case-control study; subjects were classified into obese group (≥ 25.0 kg/m², 28 subjects) and normal group (18.5–22.9 kg/m², 27 subjects). A survey was conducted to assess the depression levels as per the guidelines suggested by the Center program for Epidemiological Studies-Depression (CES-D). Blood was collected from each group for assessing biomarkers, and isolated plasma was evaluated for fasting glucose, insulin, quantitative insulin sensitivity check index, and ferritin levels. Data were analyzed, and groups were compared with respect to Body Mass Index (BMI), depression scale and biomarkers.

RESULTS

The average depression score of the obesity group was 16.86, which was higher than the normal group (12.56). Subjects scoring more than 16 points comprised 53.6% of the population in the obese group, which was more than double that in the normal group, as assessed by the CES-D program. Furthermore, the serum ferritin level of the obesity group was 207.12 ng/mL, which was higher than that of the normal group (132.66 ng/mL). Lastly, the BMI appeared to be significantly correlated with both depression (r = 0.320, P = 0.017) and elevated ferritin levels (r = 0.352, P = 0.008).

CONCLUSION

This study provides evidence of existing correlation between ferritin and depression with obesity.

Association between decreased serum albumin levels and depressive symptoms in patients with schizophrenia in a Chinese Han population: A pilot study

Albumin is a metal-binding protein with free-radical scavenging properties and is recognized as a vital antioxidant. Moreover, an excess of free radicals may contribute to depressive symptoms and the psychopathology of psychiatric disorders. This study examined serum albumin levels, depressive symptoms, and their association in patients with schizophrenia. Thirty-four patients with schizophrenia (diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition) and 136 healthy controls were consecutively enrolled in this case-control study. The clinical psychiatric symptoms in patients with schizophrenia were assessed using the Positive and Negative Syndrome Scale (PANSS). Serum albumin levels were measured in all participants using an immunoturbidimetric method. This study was conducted between 2016 and 2017. Serum albumin levels were significantly lower in patients with schizophrenia compared to healthy controls after adjusting for gender, age and education (F = 16.04, p = 0.000). Serum albumin levels were negatively correlated with the depressive score of PANSS in patients with schizophrenia (r = -0.37, p = 0.03). Additionally, a further stepwise multivariate regression analysis showed that serum albumin levels were significantly associated with the depressive score of PANSS in patients with schizophrenia (ß = -0.37, t = -2.25, p = 0.03). Our data suggested that decreased serum albumin levels may contribute to the psychopathology of schizophrenia and that a decline in serum albumin levels was associated with the severity of depressive symptoms in patients with schizophrenia.

Predictive markers of depression in hypertension

Hypertension and depression, as 2 major public health issues, are closely related. For patients having hypertension, in particular, depression is a risk factor for mortality and jeopardizes their wellbeing. The aim of the study is to apply support vector machine (SVM) learning to blood tests and vital signs to classify patients having hypertension complicated by depression and patients having hypertension alone for the identification of novel markers.Data on patients having both hypertension and depression (n = 147) and patients having hypertension alone (n = 147) were obtained from electronic medical records of admissions containing the records on blood tests and vital signs. Using SVM, we distinguished patients having both hypertension and depression from gender- and age-matched patients having hypertension alone.SVM-based classification achieved 73.5% accuracy by 10-fold cross-validation between patients having both hypertension and depression and those having hypertension alone. Twelve features were selected to compose the optimal feature sets, including body temperature (T), glucose (GLU), creatine kinase (CK), albumin (ALB), hydroxybutyrate dehydrogenase (HBDH), blood urea nitrogen (BUN), uric Acid (UA), creatinine (Crea), cholesterol (TC), total protein (TP), pulse (P), and respiration (R).SVM can be used to distinguish patients having both hypertension and depression from those having hypertension alone. A significant association was identified between depression and blood tests and vital signs. This approach can be helpful for clinical diagnosis of depression, but further studies are needed to verify the role of these candidate markers for depression diagnosis.

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in major depression: a observational and retrospective study on 703 subjects

Background

Several studies have investigated the prevalence and risk factors of depression in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in major depression. The aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of individuals with major depression.

Methods

Data from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in major depression.

Results

The prevalence of moderate to severe obstructive sleep apnea syndrome in major depression is 13.94%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower insomnia complaint, presence of metabolic syndrome, age ≥ 50 years, BMI >30 kg/m², ferritin >300 μg/L, CRP >7 mg/L and duration of sleep ≥8 h were significant risk factors of moderate to severe obstructive sleep apnea syndrome in major depression.

Conclusion

Moderate to severe obstructive sleep apnea syndrome is a common pathology in major depression. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in major depression.

Serum albumin levels and depression in people living with Human Immunodeficiency Virus infection: a cross-sectional study

BACKGROUND

Lower serum albumin levels and depression are common among HIV-infected persons. High serum albumin levels may provide protection against depression through its defensive role in inflammation and infection. We tested the hypothesis of an independent relationship between serum albumin levels and depressive symptoms in a cohort of HIV-infected persons.

METHODS

A cross-sectional survey was conducted among 310 HIV-infected persons (176 men and 134 women) aged 20-60years residing in the Kathmandu Valley, Nepal. The bromocresol green method was used to measure serum albumin levels and the Beck Depression Inventory method was used to measure depressive symptoms, with a cut off score of 20 or higher indicating likely depression. The relationship between serum albumin levels and depressive symptoms was assessed using both multiple linear regression analysis and multiple logistic regression analysis, with adjustment for sociodemographic, cardiovascular, life-style, and HIV-related clinical and treatment confounding factors.

RESULTS

Serum albumin levels were inversely associated with depressive symptoms scores (beta for 1 unit change in serum albumin levels: β=-3.91; p=0.001) for the total participant sample. This inverse association was significant in both men (β=-3.93; p=0.009) and women (β=-4.47; p=0.03). A significantly decreased risk of depression was observed among participants with the highest serum albumin levels, with odds ratio and 95% CI for those with >5.0g/dL versus <4.0g/dL of 0.22 (0.06-0.80) (p=0.01).

CONCLUSION

Serum albumin levels were inversely associated with depressive symptoms scores in HIV-infected persons.

Association between Serum Ferritin Concentrations and Depressive Symptoms among Chinese Adults: A Population Study from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIHealth) Cohort Study

Depressive symptoms have become the most important global public health issue. Iron plays an important role in brain function, cognition, and behavior, and its impacts on depressive symptoms may be multifactorial with both positive and negative effects. Previous observational studies focusing on the association between iron status and depressive symptoms showed inconsistent results. Ferritin is a ubiquitous intracellular protein that can store and release iron and is widely used as a clinical biomarker to evaluate iron status. We performed a cross-sectional study to examine the relationship between serum ferritin and depressive symptoms among 3,839 subjects who were from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIHealth) cohort. Depressive symptoms were assessed using the Chinese version of 20-item self-rating Depression Scale (SDS) with 4 cutoffs (40, 45, 48 and 50) to indicate elevated depressive symptoms (40 was the primary cut-off). The prevalence of depressive symptoms was 36.5%, 17.6%, 11.0% and 7.0% for SDS ≥40, ≥45, ≥48 and ≥50, respectively. With the primary cut-off point of 40, multiple potential confounding factors were adjusted and the odds ratios (95% confidence interval) of having elevated depressive symptoms by quartiles of serum ferritin concentrations were 1.00 (reference), 1.10 (0.91, 1.34), 0.81 (0.66, 1.01) and 1.02 (0.81, 1.28) for the first, second, third and fourth quartile, respectively (P for trend = 0.76). Similar relations were observed with the use of other cut-offs as a definition of depressive symptoms. In conclusion, there is no significant relationship between serum ferritin concentrations and depressive symptoms among Chinese adults.

The association between serum ferritin levels and post-stroke depression

BACKGROUND

Post-stroke depression (PSD) is a common neuropsychiatric affective disorder occurring after stroke. Elevated serum ferritin levels have been reported to contribute to depression. Our aim was to determine whether there is a relationship between serum ferritin levels and PSD.

METHODS

196 ischemic stroke patients were consecutively recruited within the first 24h of stroke onset and were followed up for 2 months. Serum ferritin levels were assayed by electrochemiluminescence immunoassay at hospital admission. Clinical depression was diagnosed according to DSM-IV criteria and a HAMD -17 score of ≥ 7. Meanwhile, 100 normal control subjects were also recruited.

RESULTS

We found that 56 stroke patients (28.6%) were diagnosed with PSD at two months. There was a significant intergroup difference in serum ferritin levels within 24h after admission (F=25.044, P<0.001). Serum ferritin levels were significantly higher at admission in PSD patients than in non-PSD patients and normal controls. There was a positive correlation between serum ferritin levels and hs-CRP at admission in PSD patients (r=0.129, P=0.042). In multivariate analyses, serum levels of ferritin ≥ 130.15 µg/L were independently associated with PSD at two months [odds ratio OR=5.388, 95%CI:1.725-16.829; P=0.004] after adjusting for all possible variables.

LIMITATIONS

We excluded patients with severe aphasia and with serious conditions.In addition, the information for dietary intake was not recorded, which may influence body iron stores.

CONCLUSION

Our findings show that elevated serum ferritin levels at admission are associated with PSD and may predict its development at 2 months post-stroke.

Identification of an Immune-Neuroendocrine Biomarker Panel for Detection of Depression: A Joint Effects Statistical Approach

BACKGROUND/AIMS

Less than half of depression patients are correctly diagnosed within the primary care setting. Previous proteomic studies have identified numerous immune and neuroendocrine changes in patients. However, few studies have considered the joint effects of biological molecules and their diagnostic potential. Our aim was to develop and validate a diagnostic serum biomarker panel identified through joint effects analysis of multiplex immunoassay profiling data from 1,007 clinical samples.

METHODS

In stage 1, we conducted a meta-analysis of two independent cohorts of 78 first-/recent-onset drug-naive/drug-free depression patients and 156 controls and applied the 10-fold cross-validation with least absolute shrinkage and selection operator regression to identify an optimal diagnostic prediction model (biomarker panel). In stage 2, we tested the discriminatory performance of this biomarker panel using the naturalistic Netherlands Study of Depression and Anxiety (NESDA) cohort of 468 depression patients and 305 controls.

RESULTS

An optimal panel of 33 immune-neuroendocrine biomarkers and gender was selected in the meta-analysis. Testing this biomarker-gender panel using the NESDA cohort resulted in a moderate to good performance to differentiate patients from controls (0.69 < AUC < 0.86), particularly the first-episode patients free of chronic non-psychiatric diseases or medications and following incorporation of sociodemographic covariates (0.76 < AUC < 0.92).

CONCLUSION

Despite the need for additional validation studies, we demonstrated that a blood-based biomarker-sociodemographic panel can detect depression in naturalistic healthcare settings with good discriminatory power. Further refinements of blood biomarker panels aiding in the diagnosis of depression may provide a cost-effective means to increase accuracy of clinical diagnosis within the primary care setting.

Albumin and depression in elderly stroke survivors: An observational cohort study

BACKGROUND/OBJECTIVES

Post-stroke depression affects approximately one third of stroke survivors. In non-stroke affected populations, depressive symptomatology is associated with hypoalbuminemia. This is also common among stroke survivors and associated with poor outcome and increased mortality. The role of stroke-associated hypoalbuminemia in post-stroke depression is not clear. We aimed to explore the relationship between serum albumin and post-stroke depression, as measured 20 months post-stroke.

SUBJECTS/METHODS

Observational cohort study of elderly Swedish patients drawn from the 'Gothenburg 70+ Stroke Study' (n=149) and assessed at 20 months after stroke onset. Serum albumin was drawn from venous blood and analysed with gas chromatography/mass spectrometry. Depressive symptomatology was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) and functional impairment was assessed using the Barthel Index.

RESULTS

Analysis of covariance analysis showed that serum albumin levels were associated with depressive symptoms at 20 months after stroke. Multivariate analysis of covariance showed that disability scores at 3 days were associated with depressive symptoms at 20 months after stroke and after accounting for the age covariate. Stroke survivors were not clinically deficient in serum albumin.

CONCLUSIONS

Low serum albumin appears to be associated with depressive symptoms in elderly individuals long term post-stroke.

Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating: a cross-sectional study

BACKGROUND

Poor appetite could be indicative of protein energy wasting (PEW) and experts recommend assessing appetite in dialysis patients. Our study aims to determine the relationship between PEW and appetite in haemodialysis (HD) patients.

METHODS

HD patients (n=205) self-rated their appetite on a scale of 1 to 5 as very good (1), good (2), fair (3), poor (4) or very poor (5). Nutritional markers were compared against appetite ratings. Using logistic regression analysis associations between dichotomized appetite with PEW diagnosis were determined as per the International Society of Renal Nutrition and Metabolism (ISRNM) criteria and alternate objective measures. Data was adjusted for socioeconomic and demographic characteristics.

RESULTS

Poorer appetite ratings were significantly associated with lower income (P = 0.021), lower measurements (P < 0.05) for mid-arm muscle circumference, mid-arm muscle area and lean tissue mass (LTM), serum urea (P = 0.007) and creatinine (P = 0.005). The highest hsCRP (P = 0.016) levels occurred in patients reporting the poorest appetite. Serum albumin did not differ significantly across appetite ratings. Poor oral intake represented by underreporting (EI/BMR < 1.2) was evident for all appetite ratings. PEW was prevalent irrespective of appetite ratings (very good: 17.6 %, good: 40.2 %, fair: 42.3 % and poor: 83.3 %). After dichotomizing appetite ratings into normal and diminished categories, there was a marginal positive association between diminished appetite and overall PEW diagnosis (OR adj: 1.71; 95 % CI: 0.94-3.10, P = 0.079). Amongst individual ISRNM criteria, only BMI < 23 kg/m2 was positively associated with diminished appetite (OR adj: 2.17; 95 % CI: 1.18-3.99). However, patients reporting diminished appetite were more likely to have lower LTM (OR adj: 2.86; 95 % CI: 1.31-6.24) and fat mass (OR adj: 1.91; 95 % CI: 1.03-3.53), lower levels of serum urea (OR adj: 2.74; 95 % CI: 1.49-5.06) and creatinine (OR adj: 1.99; 95 % CI: 1.01-3.92), higher Dialysis Malnutrition Score (OR adj: 2.75; 95 % CI: 1.50-5.03), Malnutrition Inflammation Score (OR adj: 2.15; 95 % CI: 1.17-3.94), and poorer physical (OR adj: 3.49; 95 % CI: 1.89-6.47) and mental (OR adj: 5.75; 95 % CI: 3.02-10.95) scores.

CONCLUSIONS

A graded but non-significant increase in the proportion of PEW patients occurred as appetite became poorer. However, after dichotomization, a positive but marginally significant association was observed between diminished appetite and PEW diagnosis.

Advances in biomarkers of major depressive disorder

Major depressive disorder (MDD) is characterized by mood, vegetative, cognitive, and even psychotic symptoms and signs that can cause substantial impairments in quality of life and functioning. Biomarkers are measurable indicators that could help diagnosing MDD or predicting treatment response. In this chapter, lipid profiles, immune/inflammation, and neurotrophic factor pathways that have long been implicated in the pathogenesis of MDD are discussed. Then, pharmacogenetics and epigenetics of serotonin transport and its metabolism pathway, brain-derived neurotrophic factor, and abnormality of hypothalamo-pituitary-adrenocortical axis also revealed new biomarkers. Lastly, new techniques, such as proteomics and metabolomics, which allow researchers to approach the studying of MDD with new directions and make new discoveries are addressed. In the future, more data are needed regarding pathophysiology of MDD, including protein levels, single nucleotide polymorphism, epigenetic regulation, and clinical data in order to better identify reliable and consistent biomarkers for diagnosis, treatment choice, and outcome prediction.

Proteomic changes in serum of first onset, antidepressant drug-naïve major depression patients

Major depressive disorder (MDD) is a complex and multi-factorial disorder. Although genetic factors and other molecular aspects of MDD have been widely studied, the underlying pathological mechanisms are still mostly unknown. We sought to investigate the pathophysiology of MDD by identifying and characterising serum molecular differences and their correlation to symptom severity in first onset, antidepressant drug-naïve MDD patients. We performed an exploratory molecular profiling study on serum samples of MDD patients and controls using multiplex immunoassay and label-free liquid chromatography mass spectrometry in data independent mode (LC-MSE). We included two independent cohorts of first onset, antidepressant drug-naïve MDD patients (n = 23 and 15) and matched controls (n = 42 and 21) in our study in order to validate the results. The main outcome included the following list of circulatory molecules changing and/or correlating to symptom severity: angiotensin-converting enzyme, acute phase proteins (e.g. ferritin and serotransferrin), brain-derived neurotrophic factor, complement component C4-B, cortisol, cytokines (e.g. macrophage migration inhibitory factor and interleukin-16), extracellular newly identified receptor for advanced glycosylation end products-binding protein, growth hormone and superoxide dismutase-1. This study provides evidence of an increased pro-inflammatory and oxidative stress response, followed by a hyperactivation of the HPA-axis in the acute stages of first onset MDD, as well as a dysregulation in growth factor pathways. These findings help to elucidate MDD related pathways in more detail and further studies may lead to identification of novel drug targets, including components of the inflammatory and oxidative stress response.

Serum albumin correlates with affective prosody in adult males with attention-deficit hyperactivity disorder

The aim of this study was to determine the relationship between serum albumin, affective prosody, and symptoms of attention-deficit hyperactivity disorder (ADHD) found coincidentally in a recently published study. Here, serum albumin levels were assessed as a covariate. Twenty healthy male adults (controls) and 20 adult male patients with ADHD participated in the study on two study days. Serum albumin levels and performance in an affective prosody task were assessed, and correlations were determined. Serum albumin had a significant correlation with performance on an affective prosody task on both of the 2 study days. The same correlations were not significant in the healthy control group. There was no difference in the serum albumin level between patients with ADHD and healthy controls. The association between serum albumin and affective prosody in adults with ADHD is a novel finding. However, to date, there is no clear theory that explains this association. Future research should analyze whether serum albumin influences causes changes in performance in affective prosody using experimental designs.

Essential elements in depression and anxiety. Part I

Essential elements are very important for the proper functioning of the human body. They are required for fundamental life processes such as cell division and differentiation and protein synthesis. Thus a deficiency of these essential elements is associated with an enormous health risk that can ultimately lead to death. In recent years, studies have provided valuable information on the involvement of essential elements in psychiatric disorders, in particular depression and anxiety. There is strong evidence indicating that deficiency of essential elements can lead to the development of depressive and/or anxiogenic behaviour and supplementation can enhance therapeutic effect of antidepressants and anxiolytics. This review presents the most important results from preclinical and clinical studies showing involvement of essential elements such as zinc, magnesium, lithium, iron, calcium and chromium in depression and anxiety. From these studies it is evident that different types of depression and anxiety respond to treatment at different receptors indicating that the underlying mechanisms are slightly different. Furthermore, administration of low dose antidepressants supplemented with an element is effective and can reduce unwanted side effects in different types of depression/anxiety.

Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies

Prevalence estimates of depression in chronic kidney disease (CKD) vary widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with CKD. We searched MEDLINE and Embase (through January 2012). Random-effects meta-analysis was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. We included 249 populations (55,982 participants). Estimated prevalence of depression varied by stage of CKD and the tools used for diagnosis. Prevalence of interview-based depression in CKD stage 5D was 22.8% (confidence interval (CI), 18.6-27.6), but estimates were somewhat less precise for CKD stages 1-5 (21.4% (CI, 11.1-37.2)) and for kidney transplant recipients (25.7% (12.8-44.9)). Using self- or clinician-administered rating scales, the prevalence of depressive symptoms for CKD stage 5D was higher (39.3% (CI, 36.8-42.0)) relative to CKD stages 1-5 (26.5% (CI, 18.5-36.5)) and transplant recipients (26.6% (CI, 20.9-33.1)) and suggested that self-report scales may overestimate the presence of depression, particularly in the dialysis setting. Thus, interview-defined depression affects approximately one-quarter of adults with CKD. Given the potential prevalence of depression in the setting of CKD, randomized trials to evaluate effects of interventions for depression on patient-centered outcomes are needed.

The relationship between psychological factors, inflammation, and nutrition in patients with chronic renal failure undergoing hemodialysis

OBJECTIVE

Hemodialysis has an adverse impact on the immunological, nutritional, and emotional status of patients. The biochemical markers of inflammation and nutrition were studied as well as the relationship of these factors to emotional symptoms.

METHOD

One hundred and ninety-five patients undergoing hemodialysis were enrolled. The mean age was 58.5 years. Emotional symptoms were assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale, Chalder Fatigue Scale, and Short-form Health-related Quality of Life. Venus blood was collected for laboratory assessment of serum hemoglobin, albumin, ferritin, C-reactive protein, interleukin (IL) 1beta), IL-6, and tumor necrosis factor alpha.

RESULTS

Among the 195 subjects (92 men and 103 women), 47 (24.1%) fulfilled the criteria for a major depressive disorder (MDD). The IL-6 level in patients with a MDD was significantly higher than in the patients without a MDD. Significant correlation was observed among the following factors: IL-6, fatigue, and quality of life for both physical and mental components. The albumin levels showed a significant correlation with the IL-6 and depression scores.

CONCLUSIONS

These results show that the serum levels of albumin and IL-6 might be laboratory markers associated with the expression of emotional symptoms in patients undergoing hemodialysis. Prospective studies are needed to determine the causal relationships among these variables.

The impact of intra- and postoperative albumin levels as a biomarker of delirium after cardiopulmonary bypass: results of an exploratory study

In this prospective study the frequency of delirium after cardiac surgery with cardiopulmonary bypass (CPB) was determined. Furthermore, we investigated the impact of intra- and postoperative levels of albumin as a biomarker of delirium. Thirty-four patients who underwent elective CPB at the Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Germany, were enroled in this prospective study. During the intensive care unit (ICU) stay and shortly after discharge from the ICU, delirious state was evaluated daily using the Delirium-Rating-Scale. Albumin was assayed pre-anaesthesia, immediately after induction of anaesthesia, at the beginning of the heart-lung-apparatus period, immediately before the opening and 5min after the opening of the aortic clamp, 24h and 48h postoperatively and on the day before discharge. After CPB, a clinical significant delirious state was observed in 11 patients (32.4%). The albumin level decreased during the surgical intervention and increased postoperatively with a maximum level at the time of discharge. CPB patients with delirious state showed a significantly lower albumin level 24h and 48h postoperatively than those without delirium. A low level of postoperative albumin seems to be a useful biomarker to identify patients with high risk of delirious state after CPB.

Survey of depression by Beck Depression Inventory in uremic patients undergoing hemodialysis and hemodiafiltration

High prevalence of depression has been reported in patients with end stage kidney disease and depression is associated with increased morbidity and mortality. We aimed to investigate the prevalence of depression in patients receiving standard hemodialysis (SHD) and hemodiafiltration (HDF) and compare the associated factors between these treatment modalities. The Beck Depression Inventory (BDI) was used to survey for major depressive symptoms. Demographic and biochemical data were reviewed and collected. Point prevalence of depression in HDF patients was significantly lower than SHD patients (23.9% vs. 43.1%, P < 0.05). The BDI score was also higher in SHD than HDF group (13.2 ± 11.6 vs. 8.7 ± 11.2, P < 0.05). SHD patients with major depressive symptoms had significantly lower levels of hemoglobin, albumin, creatinine, sodium and hand grip strength but had higher prevalence of diabetes and high sensitivity C-reactive protein (hs-CRP) levels. In HDF patients, phosphorus level was significantly lower in patients with major depressive symptoms. Logistic regression analysis revealed that hs-CRP, serum sodium and hand grip strength were significantly associated with major depressive symptoms in patients treated with SHD; while serum phosphorus was identified in HDF groups. We concluded that prevalence of depression was high in dialysis patients. Patients receiving HDF had a lower mean BDI score and a nearly 50% lower prevalence rate of major depressive symptoms than that of SHD. Factors associated with depression were different between two modalities.

Association between serum ferritin concentrations and depressive symptoms in Japanese municipal employees

It remains unclear whether levels of body iron store are related to milder forms of depression, which are more common among apparently healthy people. We examined the association between serum ferritin concentrations and depressive symptoms among 312 men and 216 women working in two municipal offices in Japan. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression (CES-D) scale. In men, increased prevalence of depressive symptoms (defined by using a cutoff value of ≥ 19) was significantly associated with decreased levels of serum ferritin. In age- and study-site-adjusted models, ORs (95% CIs) for depressive symptoms for men in first, second, third, and fourth quartiles of serum ferritin concentrations were 2.83 (1.01-7.94), 1.74 (0.87-3.49), 1.33 (0.71-2.47), and 1.00 (reference), respectively (p for trend=0.02). In multivariate-adjusted model, ORs (95% CIs) in first, second, third, and fourth quartiles of serum ferritin concentrations were 2.88 (0.93-8.91), 1.91 (0.90-4.05), 1.28 (0.66-2.49), and 1.00 (reference), respectively (p for trend=0.03). No significant association was detected in women. Our finding that men with lower levels of serum ferritin concentrations had a higher prevalence of depressive symptoms suggests that adverse psychological effects may be implicated in iron deficiency among middle-age Japanese workers.

Risk factors for depressive symptoms in a large population on chronic hemodialysis

Despite their significant influence on the quality of life, depressive symptoms are not usually included as a clinical parameter in the evaluation of hemodialysis patients. We aimed to identify depressive symptoms and associated risk factors in a large group of individuals with end-stage renal disease (ESRD) on chronic hemodialysis. This was a cross-sectional study of 400 consecutive patients. Cases were analyzed according to the presence/absence of depressive symptoms. All individuals were investigated by interview, and all variables were measured concurrently. Depressive symptoms were evaluated by the Beck Depression Inventory (BDI-II ≥16) and sleep quality by the Pittsburgh Sleep Quality Index (PSQI > 5). Among the 400 patients (59% male), depressive symptoms were present in 77 (19.3%). Depressive symptoms were more common in women and were independently associated with poor sleep quality (P = <0.005), unemployment (P = 0.001), diabetes (P = 0.02), hypoalbuminemia (P = 0.01), low education (P = 0.03), and pruritus (P = 0.04). Women with ESRD on chronic hemodialysis are at increased risk of depression. Furthermore, unemployment and the presence of diabetes, hypoalbuminemia, low education, and pruritus are significantly associated with depressive symptoms. Depressive symptoms are also independently associated with poor quality sleep and studies about the effects of sleep hygiene therapy on depressive symptoms are warranted.