Long-term glucocorticoid levels measured in hair in patients with depressive and anxiety disorders

Prospective exploration of the role of combined internalizing symptoms in self-reported memory among older adults during the COVID-19 pandemic

OBJECTIVES

A growing literature suggests depression and anxiety increase risk of cognitive decline. However, few studies have examined their combined effects on cognition, among older adults, especially during periods of high stress.

METHOD

Based on a sample of community dwelling older adults (N = 576), we evaluated the effects of pre-pandemic anxiety and depressive symptoms, obtained in September 2018, to changes in self-reported memory (SRM) assessed 3 months into the COVID-19 pandemic.

RESULTS

In separate models, we found participants with depression scores at least 1-SD above the mean and participants with anxiety scores at least 2-SD above the mean to report a significant decline in SRM. Moderation analyses revealed those with high depressive symptoms (at or above the mean) showed a decrease in SRM regardless of anxiety. The extent to which high pre-pandemic anxiety symptoms influenced SRM is dependent on whether pre-pandemic depression was at or above the mean.

CONCLUSIONS

Pre-pandemic depression predicted a decline in SRM regardless of anxiety. Moderation analyses revealed that the extent to which anxiety symptoms influenced SRM was dependent on depression being at or above the mean. Those with high anxiety and depression are at highest risk of experiencing cognitive consequences related to stressful exposures like COVID-19.

Reviewing the neurobiology of electroconvulsive therapy on a micro- meso- and macro-level

BACKGROUND

Electroconvulsive therapy (ECT) remains the one of the most effective of biological antidepressant interventions. However, the exact neurobiological mechanisms underlying the efficacy of ECT remain unclear. A gap in the literature is the lack of multimodal research that attempts to integrate findings at different biological levels of analysis METHODS: We searched the PubMed database for relevant studies. We review biological studies of ECT in depression on a micro- (molecular), meso- (structural) and macro- (network) level.

RESULTS

ECT impacts both peripheral and central inflammatory processes, triggers neuroplastic mechanisms and modulates large scale neural network connectivity.

CONCLUSIONS

Integrating this vast body of existing evidence, we are tempted to speculate that ECT may have neuroplastic effects resulting in the modulation of connectivity between and among specific large-scale networks that are altered in depression. These effects could be mediated by the immunomodulatory properties of the treatment. A better understanding of the complex interactions between the micro-, meso- and macro- level might further specify the mechanisms of action of ECT.

Validation of an ELISA kit to measure allopregnanolone in human and equine hair

In humans, allopregnanolone plays important roles in a number of different neurodegenerative disorders, and it has been proposed for use in some therapies. Horses are commonly used as animal models for human neurodegenerative diseases, mental and behavioral disorders, and neuropsychiatric disorders, and there is interest in using hair as a biological sample to study hormones in these conditions. We validated the use of a commercial ELISA kit (DetectX allopregnanolone kit; Arbor Assays), which was designed for serum, plasma, feces, urine, and tissue samples, to assess allopregnanolone in hair samples from 30 humans and 63 horses. The ELISA kit had good precision (intra- and inter-assay CVs: 6.4% and 11.0% for equine hair; 7.3% and 11.0% for human hair, respectively), sensitivity (50.4 pg/mL for both equine and human hair), and accuracy (parallelism and recovery tests) in determining allopregnanolone concentrations in hair from both species. The allopregnanolone concentrations in human hair were 7.3-79.1 pg/mg; the concentrations were 286 ± 141 pg/mg (x̄ ± SD) in mares on the day of parturition and 16.9 ± 5.5 pg/mg in nonpregnant mares. The DetectX ELISA kit offered a simple and accessible analysis of allopregnanolone in human and equine hair samples.

Depressive symptoms are negatively associated with hair N-arachidonoylethanolamine (anandamide) levels: A cross-lagged panel analysis of four annual assessment waves examining hair endocannabinoids and cortisol

BACKGROUND

The endocannabinoid system (ECS) is increasingly being recognized as key regulatory system coupled with the glucocorticoid system implicated in the pathophysiology of major depressive disorder (MDD). However, prior studies examining the ECS in MDD have been inconclusive, of small sample size or of cross-sectional nature limiting interpretation of causal inferences or time-dependent effects.

METHODS

In a prospective community-based cohort study including 128 individuals (women: 108), depressive symptoms (PHQ-9) as well as hair cortisol and endocannabinoids were measured annually over four years (T1-T4). Cortisol, N-arachidonoylethanolamine (AEA), and 2-arachidonoyl-sn-glycerol/1-arachidonoyl-sn-glycerol (2-AG/1-AG) were extracted from 3 cm hair segments reflecting cumulative concentrations of the last three months prior sampling.

RESULTS

Cross-sectional group comparisons at baseline revealed reduced AEA and cortisol levels in the group with a positive MDD screening compared to individuals with low depressive symptomatology (both p < .05). Cross-lagged panel models showed that AEA levels at T2 were negatively associated with depressive symptoms at T3 (p < .05). Also, depressive symptoms at T3 were negatively associated with AEA levels at T4 (p < .01). The direction of association was reversed for 2-AG/1-AG, as 2-AG/1-AG levels at T1 were positively associated with depressive symptoms at T2 (p < .01).

CONCLUSIONS

While cross-sectional analyses suggest higher depressive symptomatology to be associated with reduced AEA and cortisol release, longitudinal analyses reveal that primarily AEA levels are negatively associated with depressive symptoms. These longitudinal associations elucidate time-dependent relationships between depressive symptomatology and the ECS and further highlight AEA as potential treatment target in MDD.

The use of biochemical indexes in hair for clinical studies of psychiatric diseases: What can we learn about mental disease from hair?

Analysis of hair samples provides unique advantages, including non-invasive sampling, sample stability, and the possibility of additional optimization of high sensitivity detection methods. Hair sample analysis is often used in psychiatric disease research to evaluate previous periods of stress encountered by patients. Glucocorticoid analysis is the most frequently tested indicator of stress. Furthermore, the hypothalamus-pituitary-gonad axis and endocannabinoid system also are involved in the occurrence and development of mental disorders. The endocannabinoid and sex hormone levels in patients experiencing mental illness are considerably different from levels observed in healthy individuals. Nevertheless, due to the different methods used to assess the degree of disease and the range of analytical methods involved in clinical research, the trends in changes for these biomarkers are not uniform. The correlations between changes in biomarker concentrations and illness severity also are not clear. The observed alterations suggest these biochemical substances in hair have potential as biomarkers for diagnosis or predictive treatment. However, the variable results obtained thus far could hamper further development of hair samples for clinical assessment in psychiatric disorders. This article summarizes the published reports documenting the changes in the content of relevant substances in hair in individuals experiencing mental illness and the degree of correlation. In the discussion section, we proposed several issues that should be considered in future studies of hair samples obtained from patients with mental disorders to promote the use of hair sample assessment as an aid in diagnosis or predictive treatment.

Intergenerational impact of childhood trauma on hair cortisol concentrations in mothers and their young infants

Background

Alterations in stress regulation and function of the hypothalamic-pituitary-adrenal (HPA) axis during infancy may be a risk factor for the development of psychopathology later in life. Maternal childhood trauma, depression, anxiety and stressful life events are individually associated with HPA axis dysregulation. Less is known about their interdependent influence on maternal and infant stress regulation in at risk populations. In a sample of mothers with a history of depressive-, and/or anxiety disorders and their infants we explored if a history of maternal childhood trauma, current depressive and anxiety symptomatology, and recent life events were associated with maternal and infant long-term cortisol levels three months postpartum.

Methods

Data were available of 89 mothers and 49 infants. All mothers fulfilled criteria for a lifetime depressive or anxiety disorder. Diagnosis was established with a diagnostic interview. Current depressive symptomatology was assessed with the Edinburgh Postnatal Depression Scale (EPDS), current anxiety with the State-Trait Anxiety Inventory (STAI), maternal childhood trauma with the Childhood Trauma Questionnaire (CTQ) and recent life events with the Everyday Problem Checklist (EPC). Maternal and infant hair cortisol concentrations (HCC) were quantified with liquid chromatography with tandem mass spectrometry (LC-MS/MS) three months after birth. Total scores of the CTQ and subscales, EPDS, STAI, and EPC were regressed on maternal and infant HCC using regression analyses. Differences in HCC regarding trauma history were tested with t-tests. Potential confounders were identified and adjusted for.

Results

In regression analyses, a positive curvilinear relationship was found between CTQ total score and maternal HCC (n = 83, B = 0.076, SE 0.033, p = .021), but not for current depression (n = 88, B = -0.001, SE 0.011, p = .931), current anxiety (n = 88, B = 0.002, SE 0.004, p = .650) or recent life events (n = 89, B = 0.018, SE 0.032, p = .568). Analyses were adjusted for confounders. A negative linear relationship was found between maternal CTQ score and infant HCC (n = 49, β = -0.264, B = -0.006, SE 0.003, p = .052), but not for current maternal depression (n = 45, β = -0.182, B = -0.011, SE 0.008, p = .164), current maternal anxiety (n = 45, β = -0.209, B = -0.005, SE 0.003, p = .113) or recent life events (n = 46, β = -0.128, B = -0.022, SE 0.023, p = .325). Analyses were adjusted for relevant infant hair characteristics. Specifically, maternal emotional and physical neglect were related to HCC in both mothers and infants.

Conclusions

Results suggest that maternal childhood trauma is more prominent in altering maternal and infant long-term cortisol levels than perinatal depressive and anxiety symptomatology or recent life stressors in mothers with a history of depressive and/or anxiety disorders, and their infants. As infants of mothers with psychopathology are at increased risk for later psychiatric disease, future studies should investigate the interplay of possible risk factors for transgenerational transmission, intra-uterine programming of the HPA axis, including (epi-)genetic phenomena, of the HPA axis, and the influence of parenting impairment.

Joint modelling of mental health markers through pregnancy: a Bayesian semi-parametric approach

Maternal depression and anxiety through pregnancy have lasting societal impacts. It is thus crucial to understand the trajectories of its progression from preconception to postnatal period, and the risk factors associated with it. Within the Bayesian framework, we propose to jointly model seven outcomes, of which two are physiological and five non-physiological indicators of maternal depression and anxiety over time. We model the former two by a Gaussian process and the latter by an autoregressive model, while imposing a multidimensional Dirichlet process prior on the subject-specific random effects to account for subject heterogeneity and induce clustering. The model allows for the inclusion of covariates through a regression term. Our findings reveal four distinct clusters of trajectories of the seven health outcomes, characterising women's mental health progression from before to after pregnancy. Importantly, our results caution against the loose use of hair corticosteroids as a biomarker, or even a causal factor, for pregnancy mental health progression. Additionally, the regression analysis reveals a range of preconception determinants and risk factors for depressive and anxiety symptoms during pregnancy.

Hair Cortisol Concentration as a Biomarker of Symptoms of Depression in the Perinatal Period

Pregnancy is a sensitive period when women experience major hormonal and psychological changes. A high prevalence of the symptoms of depression and manifested major depression rates have been reported during this period, leading to negative outcomes both for mothers and the offspring. Despite its prevalence, the aetiology of depression is not yet fully understood. Nonetheless, alterations in cortisol levels have been proposed as a reliable biomarker to identify pregnant women at risk of perinatal depression. Hair cortisol has recently been extensively used in bio-psychological studies as a suitable non-invasive biomarker for several neuropsychiatric disorders. Various studies have published evidence regarding the relationship between cortisol fluctuations during the perinatal period, measured both in hair and in other substrates, and the onset of perinatal symptoms of depression. This current review provides an overview of cortisol level changes measured in women's hair during pregnancy or the postpartum period and its association with perinatal symptoms of depression. Further studies, including repetitive measurement of both hair cortisol and depression throughout the prenatal period, must be performed to clarify the relationship between cortisol levels and perinatal symptoms of depression.

Fast and Noninvasive Hair Test for Preliminary Diagnosis of Mood Disorders

The main objective of this study was to develop a test for the fast and noninvasive prediagnosis of mood disorders based on the noninvasive analysis of hair samples. The database included 75 control subjects (who were not diagnosed with depression) and 40 patients diagnosed with mood disorders such as depression or bipolar disorder. Both women and men, aged 18-65 years, participated in the research. After taking the hair samples, they were washed (methanol-water-methanol by shaking in a centrifuge for two min) and air-dried in a fume hood. Each hair collection was analyzed using Fourier transform infrared spectroscopy attenuated total reflection (ATR-FTIR) spectroscopy. Subsequently, the results obtained were analyzed based on chemometric methods: hierarchical cluster analysis (HCA) and principal component analysis (PCA). As a results of the research conducted, potential differences were noticed. There was a visible change in the spectra intensity at around 2800-3100 cm^-1 and smaller differences around 1460 cm^-1; the bands can be assigned to protein vibrations. However, these are preliminary studies that provide a good basis for the development of a test for the initial diagnosis of mood disorders.

Hair cortisol change at COVID-19 pandemic onset predicts burnout among health personnel

BACKGROUND

The COVID-19 pandemic has put chronic pressure on worldwide healthcare systems. While the literature regarding the prevalence of psychological distress and associated risk factors among healthcare workers facing COVID-19 has exploded, biological variables have been mostly overlooked.

METHODS

467 healthcare workers from Quebec, Canada, answered an electronic survey covering various risk factors and mental health outcomes three months after the onset of the COVID-19 pandemic. Of them, 372 (80%) provided a hair sample, providing a history of cortisol secretion for the three months preceding and following the pandemic's start. We used multivariable regression models and a receiver operating characteristic curve to study hair cortisol as a predictor of burnout and psychological health, together with individual, occupational, social, and organizational factors.

RESULTS

As expected, hair cortisol levels increased after the start of the pandemic, with a median relative change of 29% (IQR = 3-59%, p < 0.0001). There was a significant association between burnout status and change in cortisol, with participants in the second quarter of change having lower odds of burnout. No association was found between cortisol change and post-traumatic stress disorder, anxiety, and depression symptoms. Adding cortisol to individual-occupational-socio-organizational factors noticeably enhanced our burnout logistic regression model's predictability.

CONCLUSION

Change in hair cortisol levels predicted burnout at three months in health personnel at the onset of the COVID-19 pandemic. This non-invasive biological marker of the stress response could be used in further clinical or research initiatives to screen high-risk individuals to prevent and control burnout in health personnel facing an important stressor.

Healthy Ageing and Intellectual Disability study: summary of findings and the protocol for the 10-year follow-up study

INTRODUCTION

The Healthy Ageing and Intellectual Disability (HA-ID) study is a prospective multicentre cohort study in the Netherlands that started in 2008, including 1050 older adults (aged ≥50) with intellectual disabilities (ID). The study is designed to learn more about the health and health risks of this group as they age. Compared with the amount of research in the general population, epidemiological research into the health of older adults with ID is still in its infancy. Longitudinal data about the health of this vulnerable and relatively unhealthy group are needed so that policy and care can be prioritised and for guiding clinical decision making about screening, prevention and treatment to improve healthy ageing.

METHODS AND ANALYSIS

This article presents a summary of the previous findings of the HA-ID study and describes the design of the 10-year follow-up in which a wide range of health data will be collected within five research themes: (1) cardiovascular disease; (2) physical activity, fitness and musculoskeletal disorders; (3) psychological problems and psychiatric disorders; (4) nutrition and nutritional state; and (5) frailty.

ETHICS AND DISSEMINATION

Ethical approval for the 10-year follow-up measurements of the HA-ID study has been obtained from the Medical Ethics Review Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2019-0562).

TRIAL REGISTRATION NUMBER

This cohort study is registered in the Dutch Trial Register (NTR number NL8564) and has been conducted according to the principles of the Declaration of Helsinki.

The Association of Childhood Maltreatment, Sex, and Hair Cortisol Concentrations With Trajectories of Depressive and Anxious Symptoms Among Adult Psychiatric Inpatients

OBJECTIVE

Depression and anxiety symptoms are commonly observed among clinical populations, especially among women and maltreated individuals. Few investigations have, however, assessed the existence of distinct symptoms trajectories among clinical populations and how these relate to childhood maltreatment, sex differences, and stress physiology indexed by hair cortisol concentrations (HCCs). The current study a) identified distinct depression and anxious trajectories in a sample of psychiatric inpatients followed up prospectively from their admission to a psychiatric emergency service, and b) examined whether HCC, childhood maltreatment, and sex independently and jointly predict these trajectories.

METHODS

Adult inpatients (n = 402; 55% women) were recruited upon admission to psychiatric emergency service (T1) during which HCC (reflecting cortisol secretion for the last 3 months), childhood maltreatment, and depression and anxiety symptoms were assessed. Symptoms were reevaluated when patients were discharged from the hospital (T2), admitted to outpatient clinics (T3), and 12 months later or at the end of outpatient treatment (T4).

RESULTS

Three trajectories were identified for depression and anxiety symptoms. Among men, higher HCC predicted higher odds of evincing chronic depressive symptoms compared with a low stable trajectory (odds ratio [OR] = 3.46, 95% confidence interval [CI] = 1.43-8.40). Greater childhood maltreatment among men predicted higher chances of exhibiting chronic anxious symptoms than the low stable (OR = 1.47, 95% CI = 1.07-2.02) and the high decreasing trajectories (OR = 0.70, 95% CI = 0.51-0.95). Opposite findings were noted for women.

CONCLUSIONS

Childhood maltreatment and HCC should be further investigated as predictors of anxious and depressive trajectories, during which sex-specific associations ought to be considered.

Examining the Relationship Between Hair Cortisol With Stress-Related and Transdiagnostic Subclinical Measures

Background: Hair cortisol concentrations (HCC) provide a retrospective examination of long-term cortisol production as a measure of the hypothalamic-pituitary-adrenal (HPA) axis functioning, one of the major neural systems implicated in mediating the effects of stress on mental illness. However, evidence about the relationship between HCC with stressors and symptoms is scattered. In the present study, we aimed to examine the association between HCC and a wide range of stress-related and transdiagnostic subclinical measures in a sample of non-clinical young adults with a wide distribution of schizotypy. Methods: A total sample of 132 non-clinical young adults recruited at college and technical schools oversampled for schizotypy scores were assessed on distal and proximal stressful experiences, appraisals of stress, traits and symptoms of the affective, psychosis and dissociation spectrums, as well as stress-buffering measures, and provided 3 cm-hair samples. Results: No significant associations were found between HCC and any of the stress-related and subclinical measures. Only suspiciousness and disorganization showed a trend for a positive association with HCC but the magnitude was small. Conclusions: The present findings support previous studies indicating an overall lack of concordance between a broad range of stress-related and (sub)clinical phenotypic measures with hair cortisol. This study examined for the first time the relationship of HCC with the non-clinical expression of the psychosis spectrum, that is, schizotypy, which complements previous studies on clinical high risk and established psychosis and offers a promising strategy for studying possible HPA dysfunctions characterizing the subclinical psychosis continuum without the confounds associated to clinical psychosis.

Daidzein Alleviates Hypothalamic-Pituitary-Adrenal Axis Hyperactivity, Ameliorates Depression-Like Behavior, and Partly Rectifies Circulating Cytokine Imbalance in Two Rodent Models of Depression

Depression is one very common mental health disorder which can cause morbidity and mortality if not addressed. Recent studies have provided strong evidence that depression may be accompanied by immune activation, secondary inflammatory reaction, and hyperactivity of the Hypothalamic Pituitary Adrenal (HPA) axis. It is well-known that it takes at least 2 weeks for conventional antidepressants, especially SSRIs (Selective serotonin reuptake inhibitors) to produce effects. To better understand the mechanism of antidepressant effects on depression and subsequently further elucidate the pathogenesis of depression, we selected phytestrogen daidzein (DD) to observe its effects on the depression-like and anxiety-like behavior in two different rodent models of depression which were induced by learned helplessness and chronic mild stress (CMS) and then simultaneous evaluation of the depression-like behavior, the activity of HPA axis, and circulatory cytokines. Our results showed that daidzein attenuated depression-like behaviors through alleviating HPA axis hyperactivity, decreasing the levels of stress-related hormones, and partly rectifying some inflammatory cytokines imbalance in both the rodent models of depression.

Alterations of Stress-Related Glucocorticoids and Endocannabinoids in Hair of Chronic Cocaine Users

BACKGROUND

Previous research in animals and humans has demonstrated a potential role of stress regulatory systems, such as the hypothalamic-pituitary-adrenal (HPA) axis and the endocannabinoid (eCB) system, in the development of substance use disorders. We thus investigated alterations of HPA and eCB markers in individuals with chronic cocaine use disorder by using an advanced hair analysis technique.

METHODS

We compared hair concentrations of glucocorticoids (cortisone, cortisol) and the eCBs 2-arachidonylglycerol, anandamide (AEA), oleoylethanolamide (OEA), and palmitoylethanolamide (PEA) between 48 recreational cocaine users (RCU), 25 dependent cocaine users (DCU), and 67 stimulant-naïve controls. Self-reported substance use and hair concentrations of substances were also assessed.

RESULTS

Significantly higher concentrations of hair cortisone were found in RCU and DCU compared with controls. Hair concentrations of OEA and PEA were significantly lower in DCU compared with RCU and controls. Additionally, within cocaine users, elevated cocaine hair concentration was a significant predictor for increased glucocorticoid and decreased OEA hair levels. Moreover, higher 3,4-methyl​enedioxymethamphetamine hair concentration was correlated with elevated cortisone and AEA, OEA, and PEA levels in hair within cocaine users, whereas more self-reported cannabis use was associated with lower eCBs levels in hair across the total sample.

CONCLUSION

Our findings support the hypothesis that the HPA axis and eCB system might be important regulators for substance use disorders. The mechanistic understanding of changes in glucocorticoid and eCB levels in future research might be a promising pharmacological target to reduce stress-induced craving and relapse specifically in cocaine use disorder.

Hair cortisol, obesity and the immune system: Results from a 3 year longitudinal study

OBJECTIVES

Higher long-term glucocorticoid levels, measured in scalp hair (HairGC), are associated with obesity. This may represent the state of obesity (perhaps interrelated with chronic immune activation), but could also promote further weight gain. We studied whether hair cortisol (HairF) and hair cortisone (HairE) predict changes in body mass index (BMI) and waist circumference (WC) over time, and assessed the association between HairGC and common immune parameters.

METHODS

We measured HairGC in 1604 participants of the Netherlands Study of Depression and Anxiety (NESDA), and investigated their associations to BMI, WC, and immune parameters (interleukin-6 (IL-6), C-reactive protein (CRP), and leukocyte subsets). Also, we assessed whether baseline HairGC predict changes in BMI and WC at follow-up (three years later).

RESULTS

In cross-sectional analyses, HairF and HairE were positively associated to BMI (β = 2.06 kg/m2, 95% confidence interval (CI)= 1.22-2.90 kg/m2) and β = 2.84 kg/m2 (95%CI 1.75-3.93 kg/m2) respectively) and WC (β = 5.36 cm (95%CI 3.09-7.62 cm) and β = 8.54 cm (95%CI 5.60-11.48 cm) respectively, all p < 0.001). HairF was also positively associated to IL-6 (β = 0.15 (95%CI 0.003-0.292) p < 0.05) and leukocyte count (β = 0.57 (95%CI 0.234-0.909), p < 0.01), and HairE to IL-6 (β = 0.21 (95%CI 0.016-0.399), p < 0.05). In the longitudinal analyses, higher HairF was associated with yearly increases in BMI (β = 0.58% BMI change per year (95%CI 0.14-1.01%), p = 0.009) and higher HairE with increases in WC (β = 0.84% WC change per year (95%CI 0.02-1.69%), p = 0.049). Adjusting for baseline IL-6 or leukocytes did not change the found associations between HairGC and WC or BMI change.

CONCLUSIONS

HairGC levels are positively associated to BMI, WC, IL-6 and leukocyte numbers in cross-sectional analyses, and to increases in BMI and WC in longitudinal analyses. Although causality is yet to be proven, higher long-term glucocorticoid levels could represent a relevant risk factor for the development of obesity.

Hair-based biomarkers in women with major depressive disorder: Glucocorticoids, endocannabinoids, N-acylethanolamines, and testosterone

Background

Stress-related alterations in the regulation of several endocrine systems, including the hypothalamus-pituitary-adrenal (HPA) and -gonadal (HPG) axes and the endocannabinoid system are proposed to be involved in the etiology of major depressive disorder (MDD). Therefore, this study examines whether altered concentrations of glucocorticoids, testosterone, endocannabinoids, and related N-acylethanolamines accumulated in hair are present in MDD.

Methods

Female participants (range: 19–59, Mdn = 30.5 years) were recruited, including n = 21 with a current MDD episode and n = 27 nondepressed controls without any current mental disorder. Weight-standardized samples of 3 cm hair segments were analyzed which equals to three months of retrospectively assessed biomarkers in hair. Concentrations of cortisol, cortisone, testosterone, endocannabinoids (i.e., anandamide [AEA], 2-arachidonylglycerol [2-AG]), and selected N-acylethanolamines (i.e., stearoylethanolamide [SEA], oleoylethanolamide [OEA], palmitoylethanolamide [PEA]) were measured using mass spectrometry.

Results

Female MDD patients exhibited lower cortisol and cortisone levels in hair than nondepressed controls, whereas the hair concentrations of endocannabinoids, N-acylethanolamines, and testosterone did not differ between the groups.

Conclusions

Our results add to the heterogeneous body of findings on alterations in hair-stored glucocorticoids and endocannabinoids in MDD. As in previous studies, there was no evidence of altered testosterone concentrations in the hair of MDD patients. Larger and longitudinal studies are needed to comprehensively explore the overall picture of endocrine alterations in MDD.

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Analysis of hair-based markers of endocrine alterations in female MDD outpatients.

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Lower hair cortisol and cortisone concentrations in mild to moderately severe MDD.

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No differences in endocannabinoid, N-acylethanolamine, and testosterone hair levels.

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Testosterone and cortisone levels were linked to higher stress/trauma exposure.

Hair growth predicts a depression-like phenotype in rats as a mirror of stress traceability

As a subjective mood-related disorder with an unclear mechanism, depression has many problems in its diagnosis, which offers great space and value for research. At present, the methods commonly used to judge whether an animal model of depression has been established are mainly by biochemical index detection and behavioral tests, both of which inevitably cause stress in animals. Stress-induced hair growth inhibition has been widely reported in humans and animals. The simplicity of collecting hair samples and the observable state of hair growth has significant advantages; we tried to explore whether the parameters related to hair growth could be used as auxiliary indicators to evaluate a depression model in animals. The length and weight of the hair were calculated. Correlation analysis was conducted between the depressive behavioral results and the glucocorticoid levels in hair and serum. Learned helplessness combined with chronic restraint stress, and chronic unpredictable stress in the animal were detectable by superficial observation, weight ratio, and length of hair, and follicular development scores were significantly reduced compared to the control. The hair growth parameters of rats with depression, the rise in corticosterone, and the corresponding changes in behavioral parameters were significantly correlated. The neurotrophic factors, glucocorticoid-receptor (GR), brain-derived neurotrophic factor (BDNF), fibroblast growth factor 2 (FGF2), and fibroblast growth factor 5 (FGF5), are associated with depression and hair growth. Significant differences were detected between the stress and control groups, suggesting that the mechanism underlying the stress-phenomenon inhibition of hair growth may be related to growth factor mediation.

Coping with stress before and after mild traumatic brain injury: a pilot hair cortisol study

Background: Cortisol is a crucial hormone for adaptation to challenging and stressful situations. Hair cortisol measurement is used to determine chronic stress; the growth rate of hair allows to determine averaged cortisol levels for a longer period. Objective: Pre- and post-injury measures of hair cortisol were compared in patients with mild traumatic brain injury (mTBI), and related to their coping styles.Methods: For 46 patients with mTBI, 3 cm scalp hair samples were collected 4-6 weeks post-injury, resulting in two 1 cm segments, pre- and post-injury. Hair samples were also collected for 11 healthy controls. Hair cortisol was quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Complaints, anxiety, depression and coping style were measured two weeks post-injury and long term (six-twelve months), added with measures for post-traumatic stress and functional outcome.Results: There were no differences between patients' pre- and post-injury cortisol levels, nor between cortisol levels of patients and controls. However, pre- and post-injury cortisol levels of patients were negatively correlated with both passive and an avoidant coping style.Conclusions: Our findings suggest that mTBI has no separate impact on chronic long-term cortisol levels, possibility indicating that variability in cortisol levels reflects individuals' premorbid characteristics determining coping with stress in general.

The effects of Pythagorean Self-Awareness Intervention on patients with major depressive disorder: A pilot randomized controlled trial

Stress plays an important role in major depressive disorder (MDD). Thus, a variety of stress management programs have been developed for people with this diagnosis. This is a pilot randomized clinical trial which implemented a holistic stress management program, Pythagorean Self-Awareness Intervention (PSAI) in adults with MDD, aiming to evaluate the effectiveness of PSAI compared to standard care for reduction of depressive symptoms (primary aim), improving mental health and quality of life (secondary aims). A total of 69 participants were randomized to an intervention group (N = 34), who received the usual care provided for patients with major depression and attended the PSAI program, and a control group (N = 35), who received the usual care only. Measurements were taken in both groups before and after the intervention and included: 1. Self-report questionnaires for measuring depressive symptoms, healthy lifestyle, perceived stress, anxiety, positive and negative affect and sleep quality, 2 Cognitive function assessment tools, 3. Hair and salivary cortisol. The intervention group demonstrated significantly greater reductions in depressive symptoms, negative affect, perceived stress, sleep quality and significantly greater increase in visual memory and healthy lifestyle compared to the control group. In addition, the intervention group demonstrated a significant reduction in first morning salivary cortisol, indicating a reduction in diurnal stress levels, while no significant change of salivary cortisol was observed in the control group. Finally, none of the study's groups demonstrated a significant change in hair cortisol concentration. In conclusion, PSAI can be applied to adults suffering from MDD with significant benefits for their mental health and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04536714.

Hair glucocorticoids in adults with intellectual disabilities and depressive symptoms pre- and post-bright light therapy: First explorations

BACKGROUND

Depressive symptoms and stress are common in adults with intellectual disabilities. Our aim was to explore long-term biological stress levels, assessed by hair cortisol (HairF) and cortisone (HairE) concentrations, in adults with intellectual disabilities and depressive symptoms and to investigate the effects of bright light therapy (BLT) on hair glucocorticoids.

METHOD

Scalp hair samples (n = 14) were retrospectively examined at baseline and post-BLT (10.000 and 300 lux). Liquid chromatography-tandem mass spectrometry was used to measure hair glucocorticoids.

RESULTS

A significant correlation was found between baseline HairF and depression scores (r = .605, p = .028). Post-intervention HairE levels were significantly increased ([95% CI: 11.2-17.4 pg/mg], p = .003), in particular after dim light (300 lux) ([95% CI: 10.0-18.3 pg/mg], p = .020).

CONCLUSIONS

This study showed that retrospectively examining biological levels of stress in adults with intellectual disabilities seems a potentially promising and objective method to gain insight in the stress level of adults with intellectual disabilities.

Cohort profile of the longitudinal Netherlands Study of Depression and Anxiety (NESDA) on etiology, course and consequences of depressive and anxiety disorders

INTRODUCTION

The Netherlands Study of Depression and Anxiety (NESDA, www.nesda.nl) is a longitudinal, multi-site, naturalistic, case-control cohort study set up to examine the etiology, course and consequences of depressive and anxiety disorders. This paper presents a cohort profile of NESDA.

METHODS AND RESULTS

The NESDA sample recruited initially 2329 persons with a remitted or current DSM-IV based depressive (major depressive disorder, dysthymia) and/or anxiety disorder (panic disorder, social phobia, agoraphobia, generalized anxiety disorder), 367 of their siblings and 652 healthy controls, yielding a total of 3348 participants. Half-day face-to-face assessments of participants started in 2004 and since then have been repeated six times over a period of 9 years. A 13-year follow-up assessment is ongoing, at what time we also recruit offspring of participants. Retention rates are generally high, ranging from 87.1% (after 2 years) to 69.4% (after 9 years). Psychiatric diagnostic interviews have been administered at all face-to-face assessments, as was monitoring of clinical characteristics, psychosocial functioning and somatic health. Assessed etiological factors include e.g. early and current environmental risk factors, psychological vulnerability and resilience factors as well as (neuro)biology through hypothesis-driven biomarker assessments, genome-wide and large-scale '-omics' assessments, and neuroimaging assessments.

LIMITATIONS

The naturalistic design allows research into course and consequences of affective disorders but is limited in treatment response interpretation.

CONCLUSIONS

NESDA provides a strong research infrastructure for research into depressive and/or anxiety disorders. Its data have been used for many scientific papers describing either NESDA-based analyses or joint collaborative consortia-projects, and are in principle available to researchers outside the NESDA consortium.

Long-lasting effects of prenatal stress on HPA axis and inflammation: A systematic review and multilevel meta-analysis in rodent studies

Exposure to prenatal stress (PNS) can lead to long-lasting neurobiological and behavioral consequences for the offspring, which may enhance the susceptibility for mental disorders. The hypothalamus-pituitary-adrenal (HPA) axis and the immune system are two major factors involved in the stress response. Here, we performed a systematic review and meta-analysis of rodent studies that investigated the effects of PNS exposure on the HPA axis and inflammatory cytokines in adult offspring. Our analysis shows that animals exposed to PNS display a consistent increase in peripheral corticosterone (CORT) levels and central corticotrophin-releasing hormone (CRH), while decreased levels of its receptor 2 (CRHR2). Meta-regression revealed that sex and duration of PNS protocol are covariates that moderate these results. There was no significant effect of PNS in glucocorticoid receptor (GR), CRH receptor 1 (CRHR1), pro- and anti-inflammatory cytokines. Our findings suggest that PNS exposure elicits long-lasting effects on the HPA axis function, providing an important tool to investigate in preclinical settings key pathological aspects related to early-life stress exposure. Furthermore, researchers should be aware of the mixed outcomes of PNS on inflammatory markers in the adult brain.

How childhood trauma and recent adverse events are related to hair cortisol levels in a large adult cohort

BACKGROUND

Exposure to adversity is a risk factor for many mental and somatic health problems. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is a potential mechanism linking adversity exposure and negative health outcomes. However, associations between adversity exposure and HPA-axis activity have been inconsistent. To understand the impact of adversity on the HPA-axis, we examined associations between early-life and recent adversity with hair cortisol concentration, an indicator of long-term systemic cortisol levels.

METHODS

We included 1166 adult participants of the Netherlands Study of Depression and Anxiety (NESDA). Hair cortisol was measured in 3 cm of proximal hair, representing cortisol exposure during the previous 3 months. Childhood maltreatment, childhood negative life events, and recent negative life events were retrospectively assessed using interview and self-report questionnaires. Linear regression analyses were performed to assess the associations between childhood maltreatment, childhood life events and recent life events with hair cortisol. Associations with cumulative adversity exposure and with subtypes of childhood maltreatment, childhood and recent negative life events were also investigated, as were interaction effects between adversity and sex, age and psychopathology.

RESULTS

Childhood maltreatment (β = 0.034, p = 0.243), childhood life events (β = - 0.017, p = 0.544), and recent life events (β = - 0.021, p = 0.456) were not significantly associated with hair cortisol levels. Subtypes of childhood maltreatment and specific childhood and recent life events were not significantly associated with hair cortisol (p_FDR>0.05). There were no significant interaction effects between adversity exposure and sex, age or depression/anxiety diagnostic status on hair cortisol.

CONCLUSIONS

There were no significant associations between childhood and recent adversity with systemic cortisol levels in adults. Effects of early-life and adult adversity are complex and may not directly impact on long-term systemic cortisol levels as measured in hair.

Depressive and anxiety disorders in concert-A synthesis of findings on comorbidity in the NESDA study

BACKGROUND

Comorbidity of depressive and anxiety disorders is common and remains incompletely comprehended. This paper summarizes findings from the Netherlands Study of Depression and Anxiety (NESDA) regarding prevalence, temporal sequence, course and longitudinal patterns; sociodemographic, vulnerability and neurobiological indicators; and functional, somatic and mental health indicators of comorbidity.

METHODS

Narrative synthesis of earlier NESDA based papers on comorbidity (n=76).

RESULTS

Comorbidity was the rule in over three-quarter of subjects with depressive and/or anxiety disorders, most often preceded by an anxiety disorder. Higher severity and chronicity characterized a poorer comorbidity course. Over time, transitions between depressive and anxiety disorders were common. Consistent comorbidity risk indicators in subjects with depressive and anxiety disorders were childhood trauma, neuroticism and early age of onset. Psychological vulnerabilities, such as trait avoidance tendencies, were more pronounced in comorbid than in single disorders. In general, there were few differences in biological markers and neuroimaging findings between persons with comorbid versus single disorders. Most functional, somatic, and other mental health indicators, ranging from disability to cardiovascular and psychiatric multimorbidity, were highest in comorbid disorders.

LIMITATIONS

The observational design of NESDA limits causal inference. Attrition was higher in comorbid relative to single disorders.

CONCLUSIONS

As compared to single disorders, persons with comorbid depressive and anxiety disorders were characterized by more psychosocial risk determinants, more somatic and other psychiatric morbidities, more functional impairments, and poorer outcome. These results justify specific attention for comorbidity of depressive and anxiety disorders, particularly in treatment settings.

Clinical features of the patients with major depressive disorder co-occurring insomnia and hypersomnia symptoms: a report of NSSD study

BACKGROUND

The co-occurrence of insomnia and hypersomnia symptoms in patients with major depressive disorder (MDD) is associated with suicidal ideation and functional impairment. The relationship between sleep disturbances and clinical features and outcomes may not be adequately studied. In this study, we measured the functional impairments and clinical features of co-occurring insomnia and hypersomnia symptoms in Chinese patients with MDD.

METHODS

A post-hoc analysis was performed on data from the National Survey on Symptomatology of Depression (NSSD), which assessed the MDD patients in 32 hospitals by a clinician-rating questionnaire. The clinical features and outcomes were compared among the following four groups: insomnia symptom only, hypersomnia symptom only, both insomnia and hypersomnia symptoms, no sleep disturbance, respectively.

RESULTS

Totally, 234 (7.15%) of 3275 participants with MDD co-occurred insomnia and hypersomnia symptoms. They had more depressive symptoms (27.41 ± 9.123), higher rate of suicide ideation (39.7%), more severe impairment in physical (58.1%), economic (32.9%), work (55.1%), and relationship with families (29.5%). Patients with both sleep disturbances were more likely to excessive worry about sleep, have suicidal ideation, the distress of social disharmony, more somatic symptoms, lack of energy, hyperphagia, loss of mood reactivity, and diurnal change, whereas less likely to have anxious mood.

LIMITATIONS

Sleep disorders were not diagnosed by current standard diagnostic criteria.

CONCLUSIONS

Patients co-occurring with both sleep disturbances are associated with a higher rate of suicide risk and poorer social function. Our study could provide implications for suicidal risk evaluation and the development of therapeutic strategies for depression.

Perceived stress, depressive symptoms, and cortisol-to-cortisone ratio in spot urine in 6878 older adults

BACKGROUND

Late life depression and perceived stress could influence disease pathways via reduced 11β-HSD2 activity, particularly given suggestions that reduced 11β-HSD2 activity, which is reflected in the cortisol-to-cortisone ratio, is a risk factor of disease. To date, however, examination of the relationship between the cortisol-to-cortisone ratio and perceived stress or depressive symptoms is insufficient.

METHODS

We examined the cross-sectional association of the cortisol-to-cortisone ratio with perceived stress and depressive symptoms, and analyzed whether cortisol levels modify this association, in 6878 participants aged 45-74 years. Cortisol and cortisone in spot urine were measured using liquid chromatography-mass spectrometry. Perceived stress during the past year was measured using a self-reported questionnaire. Depressive symptoms were evaluated using the Zung Self-Rating Depression Scale. Analyses were performed with adjustment for age, sex, lifestyle factors (smoking habit, alcohol consumption, physical activity, and sleeping hours), and physical health factors (body mass index [kg/m²] and medical history [diabetes, hypertension, and medication for hyperlipidemia or corticosteroids]).

RESULTS

Cortisol-to-cortisone ratio and cortisol were positively associated with perceived stress (% change: 2.33, P_trend = 0.003; and 4.74, P_trend = 0.001, respectively), but were not significantly associated with depressive symptoms. Further, the relationship between cortisol-to-cortisone ratio and perceived stress was modified by cortisol level and sex: the positive association between perceived stress and the cortisol-to-cortisone ratio was more evident in subjects with lower cortisol levels (P_interaction = 0.009) and in men (P_interaction = 0.026).

CONCLUSIONS

These findings suggest that the cortisol-to-cortisone ratio in spot urine may be a useful marker for non-acute perceived stress in daily life against a possible background of reduced 11β-HSD2 in older adults.

Is there a relation between major depression and hair cortisol? A systematic review and meta-analysis

Literature supports a causal role of stress in major depressive disorder (MDD). Hair cortisol concentration (HCC) has been widely used as a measure of long-term stress. Although elevated HCC has been observed in healthy people experiencing chronic stress, findings regarding individuals with mental disorders have been complicated. This review attempts to systematically present all the published research on major depression and HCC. An extensive search of databases was performed to identify articles that investigated this question. The initial search retrieved 142 studies, of which, 16 original articles were included in this review. Results were contradictory; most of the studies showed no significant HCC differences between MDD patients and controls, while others indicated either higher or lower HCC in MDD patients than controls. Higher HCC was reported in first depressive episode compared to recurrent MDD and controls; patients with comorbid MDD and anxiety disorder had higher HCC than controls. No significant HCC difference was found between patients with melancholic or atypical depression and controls. Findings concerning HCC in postpartum depression were inconsistent. A meta-analysis of the data extracted from seven studies of the sample was performed to quantify the degree of cortisol change in MDD patients vs. controls. A random effects model revealed no significant hair cortisol concentrations difference between depressed patients and healthy controls (SMD: -0.02, 95% CI: -0.36 to 0.32). Significant heterogeneity was identified across included studies (P = 0.002, I² = 71%). The disagreement among studies' results indicates that there is room for improvement in this research field. Confounding factors independent of depression should be taken into consideration.

Relationship of Hair Cortisol with History of Psychosis, Neuropsychological Performance and Functioning in Remitted Later-Life Major Depression

INTRODUCTION

Major depressive disorder (MDD) is associated with hypothalamic-pituitary-adrenal axis dysfunction that may persist into remission. Preliminary evidence suggests that this dysfunction may be associated with impaired neuropsychological performance in remitted MDD. MDD with psychotic features ("psychotic depression") is associated with greater neuropsychological and functional impairment than nonpsychotic depression, including in remission. Therefore, the aim of this exploratory study was to examine the relationships among hair cortisol concentration (HCC) - a marker of longer term endogenous cortisol exposure - and history of psychotic features, neuropsychological performance, and functioning in remitted MDD.

METHODS

This cross-sectional study compared the relationship between HCC and (i) history of psychosis, (ii) neuropsychological performance, and (iii) everyday functioning in a group of 60 participants with remitted later-life MDD using Pearson's correlation coefficients. This study also measured HCC in a group of 36 nonpsychiatric volunteers to examine the clinical significance of HCC in the patient group.

RESULTS

There were no statistically significant correlations between HCC and history of psychotic features, neuropsychological performance, or functioning. Furthermore, there was no clinically meaningful difference in HCC between patients and nonpsychiatric volunteers.

CONCLUSION

This study is the first to examine HCC in psychotic depression. The results do not support the hypothesis that impaired neuropsychological performance, and everyday function in remitted psychotic depression is due to a sustained elevation of cortisol.

Evaluation of the HPA Axis' Response to Pharmacological Challenges in Experimental and Clinical Early-Life Stress-Associated Depression

Early-life stress (ELS) is associated with a higher risk of psychopathologies in adulthood, such as depression, which may be related to persistent changes in the hypothalamic-pituitary-adrenal (HPA) axis. This study aimed to evaluate the effects of ELS on the functioning of the HPA axis in clinical and experimental situations. Clinically, patients with current depressive episodes, with and without ELS, and healthy controls, composed the sample. Subjects took a capsule containing placebo, fludrocortisone, prednisolone, dexamethasone or spironolactone followed by an assessment of plasma cortisol the morning after. Experimentally, male Wistar rats were submitted to ELS protocol based on variable, unpredictable stressors from postnatal day (PND)1 to PND21. On PND65 animals were behaviorally evaluated through the forced-swimming test (FST). At PND68, pharmacological challenges started, using mifepristone, dexamethasone, spironolactone, or fludrocortisone, and corticosterone levels were determined 3 h after injections. Cortisol response of the patients did not differ significantly from healthy subjects, regardless of their ELS history, and it was lower after fludrocortisone, prednisolone, and dexamethasone compared with placebo, indicating the suppression of plasma cortisol by all these treatments. Animals exposed to ELS presented altered phenotype as indicated by an increased immobility time in the FST when compared with control, but no significant long-lasting effects of ELS were observed on the HPA axis response. Limitations on the way the volunteers were sampled may have contributed to the lack of ELS effects on the HPA axis, pointing out the need for further research to understand these complex phenomena.

Effects of adipokinetic hormone/red pigment-concentrating hormone family of peptides in olfactory bulbectomy model and posttraumatic stress disorder model of rats

One of the major neuropeptide groups in insects is adipokinetic hormone/red pigment-concentrating hormone (AKH/RPCH) family of peptides. AKH had improving effects on depression and anxiety in animal models and it may be a new treatment choice in these disorders. Aim of this study was to investigate effects of Anax imperator AKH (Ani-AKH), Libellula auripennis AKH (Lia-AKH) and Phormia-Terra hypertrehalosemic hormone (Pht-HrTH) on animal behavior in olfactory bulbectomy (OBX) model and in posttraumatic stress disorder (PTSD) model of Wistar-albino rats. Lia-AKH and Pht-HrTH significantly increased time spent in escape platform's quadrant compared to sham control while Lia-AKH significantly increased time spent in escape platform's quadrant compared to OBX controls in probe trial of Morris water maze (MWM). Ani-AKH, Lia-AKH and Pht-HrTH significantly decreased immobility time compared to OBX controls in forced swimming test (FST). Pht-HrTH significantly increased %open arm time compared to OBX controls in elevated plus maze (EPM) test. Ani-AKH significantly increased %open arm entry compared to sham control while Ani-AKH and Pht-HrTH significantly increased %open arm entry compared to OBX controls in EPM. In PTSD study Ani-AKH and Lia-AKH significantly decreased immobility time compared to traumatized controls in FST. In acoustic startle reflex test, Ani-AKH, Lia-AKH and Pht-HrTH significantly decreased average startle amplitude compared to non-traumatized controls in PTSD study. Metabolomic studies showed that AKH may affect glutamatergic and dopaminergic system and neurochemistry. In conclusion, AKH peptides had wide ranging effects on behavior and improved performance in OBX and PTSD models in rats.

Hair cortisol in patients with a depressive episode treated with electroconvulsive therapy

BACKGROUND

There is substantial evidence showing changes in hypothalamic pituitary adrenal (HPA)-axis activity in patients with major depressive disorder (MDD). Also, there seem to be differences in HPA-axis functioning between MDD subgroups. It is however unclear whether hair cortisol concentrations (HCC), which are a stable marker of long-term cortisol levels, are suitable as a biomarker for identifying subgroups in MDD.

METHODS

We were able to attain valid HCC from a scalp hair sample of sixty-two patients with a major depressive episode right before electroconvulsive therapy (ECT). HCC were our main biological outcome measure. We created subgroups using depression severity as defined by the Hamilton Depression Rating Scale, the presence/absence of psychotic symptoms, the presence of melancholia as defined by the CORE and catatonia as defined by the Bush-Francis Catatonia Rating Scale.

RESULTS

Our analyses of the total group showed a median HCC of 4.4 pg/mg. We found patients with catatonia (N = 10) to have substantially higher median HCC (8.3 pg/mg) than patients without catatonia (3.8 pg/mg). Although presence of melancholia and depression severity were not significantly associated with HCC, more severe psychomotor agitation was associated with higher HCC. Pre-treatment HCC was not associated with ECT outcome.

STRENGTHS AND LIMITATIONS

A complicating factor in interpretation of our results was the large variability in HCC. This could be related to potential confounders such as cardiometabolic and other comorbidities, that were however addressed to the extent possible.

CONCLUSIONS

HCC is a potential biomarker for MDD patients with severe agitation and/or catatonia. CLINICALTRIALS.GOV: Identifier: NCT02562846.