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Zhu X, Yue Y, Li L, Zhu L, Cai Y, Shu Y. The relationship between depression and relative fat mass (RFM): A population-based study. J Affect Disord 2024; 356:323-328. [PMID: 38614443 DOI: 10.1016/j.jad.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Relative fat mass (RFM) is a novel indicator for measuring body fat. The relationship between RFM and depression was explored using National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018. METHODS A general statistical description of the population included in the study was performed, and logistic analyses were used to explore the association between body mass index (BMI), waist circumference (WC), RFM and depression. Sensitivity analyses and restricted cubic spline (RCS) were also conducted to investigate the association between RFM and depression. RESULTS A total of 28,836 participants were included in the study. In multivariate models, all obesity indices were associated with depression (P < 0.001). An increase of 1 SD in BMI, WC, and RFM was associated with a respective increased risk of depression of 2.3 %, 1.0 %, and 3.3 %. Excluding those taking antidepressants, the risk of depression was OR 1.88 (95 % CI: 1.26-2.79) for those with RFM in the highest quartile compared with those in the lowest quartile. After Inverse probability of weighting (IPW), the risk of depression in individuals with RFM in the highest quartile compared with individuals in the lowest quartile was 2.62 (95 % CI: 2.21-3.09). The RCS showed a possible nonlinear relationship between RFM and depression. CONCLUSIONS RFM is associated with depression, suggesting that attention to RFM may be helpful for depression research.
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Affiliation(s)
- Xianlin Zhu
- Department of Clinical Psychology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ya Yue
- Department of Psychiatry of Women and Children, The Second People's Hospital of Guizhou Province, Guiyang, China
| | - Lin Li
- Department of Clinical Psychology, Deyang City mental Health Center, Deyang, China
| | - Liying Zhu
- Medical Section, The Second People's Hospital of Huizhou, Huizhou, China
| | - Yuexi Cai
- Department of Psychiatry, Changzhou Dean Hospital, Changzhou, China
| | - Yanping Shu
- Department of Psychiatry of Women and Children, The Second People's Hospital of Guizhou Province, Guiyang, China.
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Miller NE, Steptoe A. Pericardial Fat, Socioeconomic Status, and Biological Responses to Acute Mental Stress. Psychosom Med 2023; 85:280-288. [PMID: 36705572 PMCID: PMC10082067 DOI: 10.1097/psy.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/14/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Central adiposity is associated with impaired biological responses to mental stress, and socioeconomic status (SES) might moderate this relationship. However, evidence for associations between pericardial fat, a fat depot implicated in the pathogenesis of cardiovascular disease (CVD), with cardiovascular and inflammatory responses to mental stress is lacking, and moderation by SES is unknown. METHODS The sample was 473 healthy men and women (mean age = 62.8 years) from the Whitehall II study. Cardiovascular and inflammatory responses to laboratory-induced mental stress, consisting of a 5-minute Stroop task and 5-minute mirror tracing task, were assessed. Pericardial fat volume was measured using electron bean computed tomography and adjusted for body surface area. SES was defined by grade of employment within the British civil service (higher/intermediate/lower). RESULTS Pericardial fat was associated with lower heart rate variability, raised heart rate, plasma interleukin-6, fibrinogen, and C-reactive protein at baseline. Furthermore, greater pericardial fat was associated with lower systolic blood pressure reactivity to mental stress, independent of sociodemographics, smoking status, waist-to-hip ratio, and baseline systolic blood pressure. There were no interactions between pericardial fat and SES for any outcome. CONCLUSIONS Greater pericardial fat was associated with numerous cardiovascular and inflammatory factors implicated in CVD. It was also related to reduced systolic blood pressure reactivity to acute mental stress, independent of central adiposity and baseline systolic blood pressure. This association did not vary by SES. Reduced systolic blood pressure reactivity to mental stress might contribute to the association between greater pericardial fat and CVD.
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Cardiovascular risk in bipolar disorder - A case for the hypothalamus-pituitary-adrenal axis? J Affect Disord 2023; 324:410-417. [PMID: 36587906 DOI: 10.1016/j.jad.2022.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Unipolar major depressive disorder (MDD) and bipolar disorder (BD) are associated with elevated mortality risk secondary to natural causes. Cardiovascular disease (CVD) constitutes the most prevalent underlying condition. Patients with BD display higher CVD-associated excess mortality than MDD patients. Epicardial adipose tissue (EAT) volume, a known predictor of premature CV morbidity and adrenal gland (AG) volume, an indicator for chronic hypothalamus-pituitary-adrenal (HPA) axis activation, were compared in BD and MDD patients. METHODS Magnetic resonance imaging was performed to assess EAT and AG volume in age-, gender-, and body mass index (BMI)-matched MDD (N = 27) and BD (N = 27) patients. Ten-year CV mortality risk and diabetes risk were assessed by PROCAM, ESC-SCORE, and FINDRISK, respectively; metabolic syndrome (MetS) was determined following NCEP/ATP III criteria. RESULTS Cardiometabolic risk scores and frequency of MetS were comparable, and scores of cardiometabolic risk indices did not significantly differ in both groups. After adjustment for age, BMI, and physical activity, EAT and AG volumes were significantly higher in BD compared to MDD. Partial correlation analyses showed a significant positive association of EAT and AG volumes in BD but not in the MDD. LIMITATIONS The modest sample size warrants confirmation in a larger cohort and the cross-sectional design does not allow for temporal or causal inferences. CONCLUSION Our study indicates increased EAT accumulation in BD patients. This was associated with HPA axis dysregulation. Therapeutic lifestyle interventions that reduce EAT volume should be considered in clinical BD management.
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Association between depressive symptoms and pericardial fat in healthy older men and women. Sci Rep 2022; 12:13959. [PMID: 35978037 PMCID: PMC9385858 DOI: 10.1038/s41598-022-17888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Depressive symptoms are associated with increased risk for cardiovascular disease (CVD), and inflammation may contribute to this relationship. Pericardial fat, a highly metabolically active fat depot, is implicated in the pathogenesis of CVD, but its association with depressive symptoms is unclear. This study examined the cross-sectional and longitudinal association between depressive symptoms and pericardial fat over a three-year period. Participants were 543 healthy men and women (mean age = 62.9 years) without history or objective signs of coronary heart disease from the Whitehall II cohort. In men, depressive symptoms were positively associated with pericardial fat at baseline after adjustment for sociodemographics, waist to hip ratio and conventional cardiovascular risk factors. Inflammation, indexed by plasma interleukin 6 concentration, accounted for 17% of this association. Longitudinally, depressive symptoms did not predict pericardial fat three years later in men once baseline levels of pericardial fat were accounted for. No significant associations between depressive symptoms and pericardial fat were found in women. Overall, our findings suggest that greater pericardial fat might be a mechanism by which depressive symptoms are associated with increased risk for CVD in men, and inflammation may also lie on this pathway.
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5
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Lee JI, Busler JN, Millett CE, Principe JL, Levin LL, Corrigan A, Burdick KE. Association between visceral adipose tissue and major depressive disorder across the lifespan: A scoping review. Bipolar Disord 2022; 24:375-391. [PMID: 34551182 DOI: 10.1111/bdi.13130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Increasing evidence supports a bidirectional relationship between major depressive disorder (MDD) and obesity, but the role of visceral adipose tissue (VAT) as a measure of obesity in relation to MDD is not well understood. Here we review literature investigating the link between MDD and VAT in terms of biomarkers, sex differences, and aging. METHODS PubMed, EMBASE, PsycINFO, and CINAHL searches were conducted on December 11, 2020. No date or language limits were imposed. Major concepts searched were Depressive Disorder linked with Adipose Tissue, White, Hypothalmo-Hypophyseal System, and Pituitary-Adrenal System in addition to keywords. A final set of 32 items meeting criteria for inclusion. RESULTS Converging biological evidence suggests a significant bidirectional relationship between VAT and MDD across the lifespan. In adulthood, greater VAT was associated with increased risk for depression, especially in vulnerable groups such as individuals who are overweight/obese, postmenopausal women, and individuals with comorbid medical or psychiatric illness. In older adults, sarcopenia had an impact on the relationship between abnormal VAT and risk of depression. Additionally, sex differences emerged as a potential factor affecting the strength of the association between VAT and depression. CONCLUSIONS Elucidating the pathophysiological mechanisms associated with increased rates of depression in obese individuals will be crucial for developing specific treatment strategies that seek to improve outcomes in individuals with comorbid depression and obesity. Moreover, identifying age- and sex-specific risk factors may contribute to a more personalized medicine approach, thereby improving the quality of clinical care.
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Affiliation(s)
- Jia-In Lee
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jessica N Busler
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Caitlin E Millett
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica L Principe
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonard L Levin
- Countway Library, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Alexandra Corrigan
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Stapel B, Jelinic M, Drummond GR, Hartung D, Kahl KG. Adipose Tissue Compartments, Inflammation, and Cardiovascular Risk in the Context of Depression. Front Psychiatry 2022; 13:831358. [PMID: 35444568 PMCID: PMC9013771 DOI: 10.3389/fpsyt.2022.831358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 12/20/2022] Open
Abstract
The neurobiological and behavioral underpinnings linking mental disorders, in particular, major depressive disorder (MDD), with cardiovascular disorders are a matter of debate. Recent research focuses on visceral (intra-abdominal and epicardial) adipose tissue and inflammation and their impact on the development of cardiometabolic disorders. Intra-abdominal adipose tissue is defined as an endocrine active fat compartment surrounding inner organs and is associated with type 2 diabetes mellitus, a risk factor for the later development of cardiovascular disorders. Epicardial (pericardial) adipose tissue is a fat compartment surrounding the heart with close proximity to the arteries supporting the heart. Visceral adipose tissue (VAT) is an important source of inflammatory mediators that, in concert with other risk factors, plays a leading role in cardiovascular diseases. In conjunction with the behavioral (physical inactivity, sedentary lifestyle), psychological (adherence problems), and hormonal (dysfunction of the hypothalamus-pituitary-adrenal axis with subsequent hypercortisolism) alterations frequently accompanying MDD, an enhanced risk for cardiovascular disorders results.
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Affiliation(s)
- Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Maria Jelinic
- Department of Physiology, Anatomy and Microbiology, Centre for Cardiovascular Biology and Disease Research, School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Grant R Drummond
- Department of Physiology, Anatomy and Microbiology, Centre for Cardiovascular Biology and Disease Research, School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Dagmar Hartung
- Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Hanover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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7
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Richter A, Stapel B, Heitland I, Westhoff-Bleck M, Ponimaskin E, Stubbs B, Lichtinghagen R, Hartung D, Kahl KG. Epicardial adipose tissue and adrenal gland volume in patients with borderline personality disorder. J Psychiatr Res 2021; 144:323-330. [PMID: 34715600 DOI: 10.1016/j.jpsychires.2021.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
Borderline personality disorder (BPD) is associated with an elevated mortality risk that is partially attributed to suicide, but few studies examined other possible causes of premature death. The present study compared epicardial adipose tissue (EAT) volume as a known early predictor of premature cardiovascular morbidity, cardiovascular risk indices, and adrenal gland volume (AGV) as an indicator for chronic hypothalamus-pituitary-adrenal (HPA) axis activation in females with borderline personality disorder (BPD), major depressive disorder (MDD) and in healthy individuals. Twenty-eight patients with BPD comorbid with MDD (BPD/MDD), 22 MDD patients and 26 healthy females (CTRL) of comparable age were included. EAT and AGV were assessed by magnetic resonance tomography; 10-year cardiovascular risk and diabetes risk were determined by PROCAM and FINDRISK score; metabolic syndrome was defined following National Cholesterol Education Adult Treatment Panel III R (NCEP/ATP III) criteria. MADRS was used to assess depression severity. After adjustment for age, body mass index (BMI), and physical activity, EAT and AGV were significantly increased in BPD/MDD compared to MDD and CTRL. EAT and AGV displayed a positive correlation. Finally, diabetes risk in BPD/MDD was elevated compared to CTRL and MDD. The present study highlights the increased cardiometabolic risk of BPD patients. We identify EAT accumulation as an early predictor and potential mediator of cardiovascular disease in BPD that appears to be driven at least in part by HPA axis dysregulation. Therefore, interventions that reduce EAT volume (i.e. exercise and diet) should be considered in the clinical management of BPD.
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Affiliation(s)
- A Richter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - B Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
| | - I Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - M Westhoff-Bleck
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - E Ponimaskin
- Institute of Cellular Neurophysiology, Hannover Medical School, Hannover, Germany
| | - B Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Maudsley NHS Foundation Trust, London, UK
| | - R Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - D Hartung
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - K G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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8
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Heart and brain interactions : Pathophysiology and management of cardio-psycho-neurological disorders. Herz 2021; 46:138-149. [PMID: 33544152 PMCID: PMC7966144 DOI: 10.1007/s00059-021-05022-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/22/2022]
Abstract
Cardiovascular diseases (CVD) and mental health disorders (MHD; e.g. depression, anxiety and cognitive dysfunction) are highly prevalent and are associated with significant morbidity and mortality and impaired quality of life. Currently, possible interactions between pathophysiological mechanisms in MHD and CVD are rarely considered during the diagnostic work-up, prognostic assessment and treatment planning in patients with CVD, and research addressing bidirectional disease mechanisms in a systematic fashion is scarce. Besides some overarching pathogenetic principles shared by CVD and MHD, there are specific syndromes in which pre-existing neurological or psychiatric illness predisposes and contributes to CVD development (as in Takotsubo syndrome), or in which the distorted interplay between innate immune and central nervous systems and/or pre-existing CVD leads to secondary MHD and brain damage (as in peripartum cardiomyopathy or atrial fibrillation). Clinical manifestations and phenotypes of cardio-psycho-neurological diseases depend on the individual somatic, psychosocial, and genetic risk profile as well as on personal resilience, and differ in many respects between men and women. In this article, we provide arguments on why, in such conditions, multidisciplinary collaborations should be established to allow for more comprehensive understanding of the pathophysiology as well as appropriate and targeted diagnosis and treatment. In addition, we summarize current knowledge on the complex interactions between the cardiovascular and central nervous systems in Takotsubo syndrome and peripartum cardiomyopathy, and on the neurological and psychiatric complications of atrial fibrillation.
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9
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Cosan AS, Schweiger JU, Kahl KG, Hamann B, Deuschle M, Schweiger U, Westermair AL. Fat compartments in patients with depression: A meta-analysis. Brain Behav 2021; 11:e01912. [PMID: 33150726 PMCID: PMC7821617 DOI: 10.1002/brb3.1912] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/18/2020] [Accepted: 09/26/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Depressive disorders are a common illness worldwide. Major depression is known as a significant predictor of the metabolic syndrome. However, the effects of depression on adipose tissue compartments are controversial. This meta-analysis aimed to evaluate the state of research on the relationship between patients with depression and adipose tissue compartments as compared to nondepressed individuals. METHODS The PubMed database was searched for human studies that measured adipose tissue compartments such as visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and/or organ-specific adipose tissue measurements using dual-energy X-ray absorptiometry, magnetic resonance imaging or computed tomography scan and reported the means and a measure of variance separately for depressed individuals and healthy controls. Twelve articles were identified, including a total of 1,141 depressed and 2,545 nondepressed individuals. RESULTS Major depressive disorder and self-reported depressive symptoms were associated with elevated visceral adipose tissue and elevated subcutaneous adipose tissue. Subanalyses for gender, age, method of adipose tissue measurement, and method of depression assessment showed elevated visceral adipose in depressed individuals. The results could be replicated when focussing on studies controlling for body mass index (BMI). Regarding other adipose tissue compartments, meta-analysis could not be carried out due to lack of studies. CONCLUSIONS Depression is associated with enlarged visceral and subcutaneous adipose tissue. Further, especially longitudinal, research is needed to identify the mechanism through which depressive disorders contribute to visceral adiposity.
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Affiliation(s)
- Alisa S Cosan
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lubeck, Germany
| | | | - Kai G Kahl
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Michael Deuschle
- Zentralinstitut für Seelische Gesundheit, Fakultät für Medizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Ulrich Schweiger
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lubeck, Germany
| | - Anna L Westermair
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lubeck, Germany
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Kahl KG, Fraccarollo D, Winter L, Bauersachs J, Westhoff-Bleck M. Increased epicardial adipose tissue in young adults with congenital heart disease comorbid with major depressive disorder. J Affect Disord 2019; 257:678-683. [PMID: 31377604 DOI: 10.1016/j.jad.2019.07.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/03/2019] [Accepted: 07/29/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Congenital heart disease is the most common congenital malformation. In adult congenital heart disease (ACHD), the prevalence of major depressive disorder (MDD) is increased. Beyond its immanent health risks, increased epi‑ and paracardial adipose tissue has been described in MDD. Epicardial adipose tissue (EAT) is a fat depot surrounding the heart, and it is hypothesized to be associated with coronary artery disease, left-ventricular dysfunction and atrial fibrillation, being frequent problems in ACHD long-term management. We here examined whether EAT is increased in depressed patients with ACHD. METHODS Two-hundred and ten ACHD outpatients (mean age 35.5y, 43% female) were included. MDD was diagnosed according to DSM-IV criteria using expert interviews. EAT was measured using echocardiography. Further assessments comprised NT-proBNP, left and right ventricular end-diastolic diameter, left-ventricular ejection fraction, smoking behavior and physical activity. RESULTS Of 210 patients, 53 (25.2%) were diagnosed with MDD. EAT was increased in depressed ACHD (F = 5.04; df = 1; p = 0.026). Depressed male patients were less physically active (p < 0.05) and smoked more cigarettes (p < 0.05). EAT was positively predicted by depression severity (p = 0.039), body mass index (p < 0.001), and negatively predicted by physical activity (p = 0.019). CONCLUSIONS The presence of MDD is associated with an increased amount of EAT in ACHD, and is dependent on depression severity. Further, the amount of EAT is at least in part mediated by a more sedentary lifestyle. Given the long-term health risks associated with increased EAT, interventions aiming at increased physical activity, smoking cessation and early identification of comorbid MDD may be recommended in ACHD.
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Affiliation(s)
- Kai G Kahl
- Dep. of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany.
| | - Daniela Fraccarollo
- Dep. of Cardiology and Angiology, Hannover Medical School, Adult Congenital Heart Centre, Germany
| | - Lotta Winter
- Dep. of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Johann Bauersachs
- Dep. of Cardiology and Angiology, Hannover Medical School, Adult Congenital Heart Centre, Germany
| | - Mechthild Westhoff-Bleck
- Dep. of Cardiology and Angiology, Hannover Medical School, Adult Congenital Heart Centre, Germany
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11
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Ruppert J, Hartung D, Westhoff-Bleck M, Herrmann J, Stubbs B, Cordes J, Krüger THC, Lichtinghagen R, Kahl KG. Increased pericardial adipose tissue and cardiometabolic risk in patients with schizophrenia versus healthy controls. Eur Arch Psychiatry Clin Neurosci 2018; 268:719-725. [PMID: 29170826 DOI: 10.1007/s00406-017-0858-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/14/2017] [Indexed: 02/07/2023]
Abstract
Patients with schizophrenia are at increased risk of diabetes, cardiovascular disease (CVD) and associated mortality versus the general population. Increased intra-abdominal and pericardial adipose tissue are associated with elevated CVD and mortality in the general population, but little is known about these in patients with schizophrenia. This study examined pericardial and intra-abdominal adipose tissue in schizophrenia and compared this to healthy controls. Thirty-one patients with schizophrenia (mean age 41.2 years, 76% males) and 30 healthy volunteers (CTRL) were examined in this study. The primary outcomes were the volumes of pericardial adipose tissue and intra-abdominal adipose tissue, measured using magnetic resonance imaging. Secondary outcomes included diabetes and cardiac event risk assessed by established instruments. Volumes of pericardial adipose tissue were increased in male and female patients with schizophrenia compared to healthy controls after the adjustment of age, sex and body mass index (P < 0.005). The 10-year risk of a cardiac event was significantly higher in patients with schizophrenia. Furthermore, the risk for developing type-2 diabetes mellitus was slightly increased in schizophrenia. Volumes of intra-abdominal adipose tissue were slightly increased in male and female patients with schizophrenia, albeit not statistically significant. This study demonstrates that patients with schizophrenia have increased pericardial adipose tissue versus controls. This increased fat deposit around the heart is highly relevant for understanding the comorbidity between heart disease and schizophrenia. Interventions aiming to reduce pericardial and intra-abdominal adipose tissue, such as exercise, may be essential to reduce the burden of heart disease in schizophrenia.
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Affiliation(s)
- J Ruppert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg. Str. 1, 30625, Hannover, Germany
| | - D Hartung
- Institute for Diagnostic and Interventional Radiology, MHH, Hannover, Germany
| | - M Westhoff-Bleck
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - J Herrmann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg. Str. 1, 30625, Hannover, Germany
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.,Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - J Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany
| | - T H C Krüger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg. Str. 1, 30625, Hannover, Germany
| | - R Lichtinghagen
- Institute for Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - K G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg. Str. 1, 30625, Hannover, Germany.
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12
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Kahl KG, Deuschle M, Stubbs B, Schweiger U. Visceral adipose tissue in patients with severe mental illness. Horm Mol Biol Clin Investig 2018; 33:hmbci-2018-0007. [PMID: 29547392 DOI: 10.1515/hmbci-2018-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
Abstract
Background Severe mental illnesses (SMIs), i.e. major depression, schizophrenia and bipolar disorder, are associated with an elevated risk for the development of type-2 diabetes mellitus and cardiovascular disorders. Several factors have been associated with increased cardiometabolic morbidity and mortality in SMI, including lifestyle factors (smoking, inactivity, unhealthy diet), endocrine and immunologic alterations; however, the underlying mechanisms remain to be fully uncovered. It is now well accepted that visceral adipose tissue (VAT) promotes the development of cardiometabolic disorders, at least in part by inflammatory and metabolic functions. Methods This paper reviews studies concerning VAT, with special focus on intra-abdominal and pericardial adipose tissue, in SMI. Results In patients with SMI, several studies have been performed concerning VAT. Most of these studies reported alterations of VAT particularly in patients with major depression and schizophrenia, independent of body weight and body mass index. Some of the studies also reported an increased cardiometabolic risk. Conclusion Patients with SMI are at increased risk of developing cardiometabolic disorders, and display increased amounts of VAT. As studies so far were mainly performed on patients before the onset of cardiometabolic disorders, VAT may serve as a biomarker for patients with SMI to assess cardiometabolic risks beyond established risk scores. Further, interventions aiming at reducing VAT in SMI are highly recommended in long-term multimodal treatment plans.
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Affiliation(s)
- Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany, Phone: +49 511-5322495, Fax: +49 511-5328573
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.,Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck Medical School, Lübeck, Germany
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Kerling A, Hartung D, Stubbs B, Kück M, Tegtbur U, Grams L, Weber-Spickschen TS, Kahl KG. Impact of aerobic exercise on muscle mass in patients with major depressive disorder: a randomized controlled trial. Neuropsychiatr Dis Treat 2018; 14:1969-1974. [PMID: 30122929 PMCID: PMC6086564 DOI: 10.2147/ndt.s167786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Sarcopenia leads to physical function impairment and at least to increasing all-cause mortality. There are notes on reduced muscle mass in patients with major depressive disorder (MDD). Whether an exercise intervention counteracts low muscle mass in patients with MDD has not been studied so far. Therefore, our study aimed at examining effects of regular aerobic exercise training on muscle mass in patients with MDD. PARTICIPANTS AND METHODS Thirty inpatients with MDD were included in the study, of which 20 received an additional supervised exercise program. Ten patients obtained treatment as usual. Muscle mass was measured using MRI before and 6 weeks after the training period (3 times per week for 45 minutes). RESULTS We found a significant effect of the exercise intervention on the amount of muscle mass depending on age, body mass index, and the physical activity score (P=0.042). CONCLUSION Among other positive effects, regular exercise increases muscle mass in patients with MDD and, therefore, should be recommended as an additional treatment tool.
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Affiliation(s)
- Arno Kerling
- Institute of Sport Medicine, Hannover Medical School, Hannover, Germany,
| | - Dagmar Hartung
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.,Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Momme Kück
- Institute of Sport Medicine, Hannover Medical School, Hannover, Germany,
| | - Uwe Tegtbur
- Institute of Sport Medicine, Hannover Medical School, Hannover, Germany,
| | - Lena Grams
- Institute of Sport Medicine, Hannover Medical School, Hannover, Germany,
| | | | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Kahl KG, Herrmann J, Stubbs B, Krüger THC, Cordes J, Deuschle M, Schweiger U, Hüper K, Helm S, Birkenstock A, Hartung D. Pericardial adipose tissue and the metabolic syndrome is increased in patients with chronic major depressive disorder compared to acute depression and controls. Prog Neuropsychopharmacol Biol Psychiatry 2017; 72:30-35. [PMID: 27528109 DOI: 10.1016/j.pnpbp.2016.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/18/2016] [Accepted: 08/08/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is associated with an estimated fourfold risk for premature death, largely attributed to cardiovascular disorders. Pericardial adipose tissue (PAT), a fat compartment surrounding the heart, has been implicated in the development of coronary artery disease. An unanswered question is whether people with chronic MDD are more likely to have elevated PAT volumes versus acute MDD and controls (CTRL). METHODS The study group consists of sixteen patients with chronic MDD, thirty-four patients with acute MDD, and twenty-five CTRL. PAT and adrenal gland volume were measured by magnetic resonance tomography. Additional measures comprised factors of the metabolic syndrome, cortisol, relative insulin resistance, and pro-inflammatory cytokines (interleukin-6; IL-6 and tumor necrosis factor-α, TNF-α). RESULTS PAT volumes were significantly increased in patients with chronic MDD>patients with acute MDD>CTRL. Adrenal gland volume was slightly enlarged in patients with chronic MDD>acute MDD>CTRL, although this difference failed to reach significance. The PAT volume was correlated with adrenal gland volume, and cortisol concentrations were correlated with depression severity, measured by BDI-2 and MADRS. Group differences were found concerning the rate of the metabolic syndrome, being most frequent in chronic MDD>acute MDD>CTRL. Further findings comprised increased fasting cortisol, increased TNF-α concentration, and decreased physical activity level in MDD compared to CTRL. CONCLUSION Our results extend the existing literature in demonstrating that patients with chronic MDD have the highest risk for developing cardiovascular disorders, indicated by the highest PAT volume and prevalence of metabolic syndrome. The correlation of PAT with adrenal gland volume underscores the role of the hypothalamus-pituitary-adrenal system as mediator for body-composition changes. Metabolic monitoring, health advices and motivation for the improvement of physical fitness may be recommended in depressed patients, in particular in chronic depression.
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Affiliation(s)
- K G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany.
| | - J Herrmann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - T H C Krüger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany
| | - J Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany
| | - M Deuschle
- Central Institute of Mental Health, Mannheim, Germany
| | - U Schweiger
- Dep. of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - K Hüper
- Institute for Diagnostic and Interventional Radiology, MHH, Hannover, Germany
| | - S Helm
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany
| | - A Birkenstock
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Hannover, Germany
| | - D Hartung
- Institute for Diagnostic and Interventional Radiology, MHH, Hannover, Germany
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Kerling A, von Bohlen A, Kück M, Tegtbur U, Grams L, Haufe S, Gützlaff E, Kahl KG. Exercise therapy improves aerobic capacity of inpatients with major depressive disorder. Brain Behav 2016; 6:e00469. [PMID: 27134769 PMCID: PMC4842901 DOI: 10.1002/brb3.469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/15/2016] [Accepted: 03/07/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Unipolar depression is one of the most common diseases worldwide and is associated with a higher cardiovascular risk partly due to reduced aerobic capacity. OBJECTIVES Therefore, the aim of our study was to examine whether a structured aerobic training program can improve aerobic capacity in inpatients with MDD (major depressive disorder). METHODS Overall, 25 patients (13 women, 12 men) diagnosed with MDD were included in the study. Parameters of aerobic capacity, such as maximum performance, maximum oxygen consumption, and VAT (ventilatory anaerobic threshold), were assessed on a bicycle ergometer before and 6 weeks after a training period (three times per week for 45 min on two endurance machines). In addition, a constant load test was carried out at 50% of the maximum performance prior to and after the training period. The performance data were compared with 25 healthy controls matched for sex, age, and body mass index before and after the training period. RESULTS Compared to controls, patients with MDD had significantly lower aerobic capacity. After training, there was a significant improvement in their performance data. A significant difference remained only for VAT between patients with MDD and healthy controls. CONCLUSION With regard to the coincidence of MDD with cardiovascular and cardiometabolic disorders, a structured supervised exercise program carried out during hospitalization is a useful supplement for patients with MDD.
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Affiliation(s)
- Arno Kerling
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Anne von Bohlen
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Momme Kück
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Uwe Tegtbur
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Lena Grams
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Sven Haufe
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 HannoverGermany; Institute of Clinical Pharmacology Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Elke Gützlaff
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
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16
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Nyboe L, Vestergaard CH, Lund H, Møller MK, Videbech P. Metabolic syndrome in first-time hospitalized patients with depression: a 1-year follow-up study. Acta Psychiatr Scand 2016; 133:241-8. [PMID: 26251964 DOI: 10.1111/acps.12470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Studies on metabolic syndrome (MetS) in younger patients with depression are few. We examined the prevalence and progression of MetS in first-time hospitalized patients with depression during 1 year of follow-up. Furthermore, we explored putative risk factors of MetS. METHOD We evaluated MetS and its components in first-time hospitalized patients with depression (N = 52) and healthy controls (N = 50) (18-45 years). Physical activity, aerobic fitness, sleeping disturbances, smoking and dietary habits, and psychopharmacological treatment were recorded at baseline for all participants and after 1 year for the patients. RESULTS Patients had significantly higher waist circumference (WC) and lower high-density lipoproteins compared with healthy controls (P < 0.05). Patients had higher prevalence of MetS, but this was not significant when adjusted for age. Patients had significant increase in WC and triglycerides and a non-significant increase in the prevalence of MetS. Antipsychotic medication (OR 10.5, 95% CI 1.18-94.14) and low aerobic fitness (OR 0.79, 95% CI 0.68-0.93) were significantly correlated with MetS (P < 0.05). CONCLUSION Metabolic syndrome is highly prevalent in younger, severely depressed patients and the incidence increases during 1 year of follow-up. Low aerobic fitness and use of atypical antipsychotics are strongly correlated with MetS.
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Affiliation(s)
- L Nyboe
- The Research Unit, Department of Affective Disorders Q, Aarhus University Hospital Risskov, Risskov, Denmark
| | - C H Vestergaard
- The Research Unit, Department of Affective Disorders Q, Aarhus University Hospital Risskov, Risskov, Denmark
| | - H Lund
- SEARCH - Research Group for Synthesis of Evidence and Research, Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Centre for Evidence-based Practice, Bergen University College, Bergen, Norway
| | - M K Møller
- Department of Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - P Videbech
- The Research Unit, Department of Affective Disorders Q, Aarhus University Hospital Risskov, Risskov, Denmark
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Kahl KG, Kerling A, Tegtbur U, Gützlaff E, Herrmann J, Borchert L, Ates Z, Westhoff-Bleck M, Hueper K, Hartung D. Effects of additional exercise training on epicardial, intra-abdominal and subcutaneous adipose tissue in major depressive disorder: A randomized pilot study. J Affect Disord 2016; 192:91-7. [PMID: 26707353 DOI: 10.1016/j.jad.2015.12.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/23/2015] [Accepted: 12/11/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is associated with increased amounts of intra-abdominal and epicardial adipose tissue, risk factors for the development of cardio-metabolic disorders. Exercise has been shown to reduce intra-abdominal fat in different conditions such as obesity and diabetes mellitus, thereby reducing cardio-metabolic risks. Therefore we examined the effects of exercise on adipose tissue compartments in patients with MDD. METHODS Of thirty depressed patients included, twenty received supervised exercise training, and ten received no specific training. Volumes of subcutaneous, intra-abdominal and epicardial adipose tissue were measured using magnetic resonance imaging, and factors constituting the metabolic syndrome were determined. RESULTS Significant effects of the training condition were observed on the amount of epicardial adipose tissue (P=0.017), subcutaneous adipose tissue (P=0.023), weight (P=0.047), body-mass index (P=0.04), high density lipoproteins (P=0.021) and the number of metabolic syndrome factors (P=0.018). The amount of intra-abdominal adipose tissue decreased slightly, although not significantly, in the exercise group. CONCLUSION Exercise training reduces the amount of visceral, in particular epicardial adipose tissue, in patients with MDD, and ameliorates factors constituting the metabolic syndrome. Given the high prevalence of cardio-metabolic disorders in major depression, exercise training may be recommended as an additional treatment component.
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Affiliation(s)
- K G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg. Street 1, Hannover, Germany; Department of Neurology, MHH, Hannover, Germany.
| | - A Kerling
- Department of Neurology, MHH, Hannover, Germany; Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - U Tegtbur
- Department of Neurology, MHH, Hannover, Germany; Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - E Gützlaff
- Department of Neurology, MHH, Hannover, Germany; Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - J Herrmann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg. Street 1, Hannover, Germany; Department of Neurology, MHH, Hannover, Germany
| | - L Borchert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg. Street 1, Hannover, Germany; Department of Neurology, MHH, Hannover, Germany
| | - Zeynep Ates
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg. Street 1, Hannover, Germany; Department of Neurology, MHH, Hannover, Germany
| | - M Westhoff-Bleck
- Department of Neurology, MHH, Hannover, Germany; Dep. of Cardiology and Angiology, MHH, Hannover, Germany
| | - K Hueper
- Institute for Diagnostic and Interventional Radiology, MHH, Hannover, Germany; Department of Neurology, MHH, Hannover, Germany
| | - D Hartung
- Institute for Diagnostic and Interventional Radiology, MHH, Hannover, Germany; Department of Neurology, MHH, Hannover, Germany
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Deuschle M, Gilles M. Hypercortisolemic Depressed Women: Lean but Viscerally Obese? Neuroendocrinology 2016; 103:263-8. [PMID: 26138707 DOI: 10.1159/000437168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Activation of the hypothalamic-pituitary-adrenal (HPA) system in depressed patients has been related to visceral adiposity. In contrast, low HPA system activity is associated with increased body fat in the general population. Our study intended to clarify whether HPA system activity is related to body weight and composition in depressed inpatients. METHODS In a cohort of 51 female and 20 male depressed inpatients, we measured saliva cortisol (HPA system activity), body mass index (BMI), waist circumference as well as body composition as reflected by bioimpedance. RESULTS In female patients, cortisol in saliva was negatively associated with fat-to-muscle ratio and BMI. CONCLUSION In depressed inpatients, especially women, there is evidence that activation of the HPA system is related to relatively low body weight and low body fat content.
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Affiliation(s)
- Michael Deuschle
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Adrenal gland volume, intra-abdominal and pericardial adipose tissue in major depressive disorder. Psychoneuroendocrinology 2015; 58:1-8. [PMID: 25935636 DOI: 10.1016/j.psyneuen.2015.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/20/2022]
Abstract
Major depressive disorder (MDD) is associated with an increased risk for the development of cardio-metabolic diseases. Increased intra-abdominal (IAT) and pericardial adipose tissue (PAT) have been found in depression, and are discussed as potential mediating factors. IAT and PAT are thought to be the result of a dysregulation of the hypothalamus-pituitary-adrenal axis (HPAA) with subsequent hypercortisolism. Therefore we examined adrenal gland volume as proxy marker for HPAA activation, and IAT and PAT in depressed patients. Twenty-seven depressed patients and 19 comparison subjects were included in this case-control study. Adrenal gland volume, pericardial, intraabdominal and subcutaneous adipose tissue were measured by magnetic resonance imaging. Further parameters included factors of the metabolic syndrome, fasting cortisol, fasting insulin, and proinflammatory cytokines. Adrenal gland and pericardial adipose tissue volumes, serum concentrations of cortisol and insulin, and serum concentrations tumor-necrosis factor-α were increased in depressed patients. Adrenal gland volume was positively correlated with intra-abdominal and pericardial adipose tissue, but not with subcutaneous adipose tissue. Our findings point to the role of HPAA dysregulation and hypercortisolism as potential mediators of IAT and PAT enlargement. Further studies are warranted to examine whether certain subtypes of depression are more prone to cardio-metabolic diseases.
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Kerling A, Tegtbur U, Gützlaff E, Kück M, Borchert L, Ates Z, von Bohlen A, Frieling H, Hüper K, Hartung D, Schweiger U, Kahl KG. Effects of adjunctive exercise on physiological and psychological parameters in depression: a randomized pilot trial. J Affect Disord 2015; 177:1-6. [PMID: 25743367 DOI: 10.1016/j.jad.2015.01.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Major depressive disorder (MDD) is associated with decreased physical activity and increased rates of the metabolic syndrome (MetS), a risk factor for the development of type 2 diabetes and cardiovascular disorders. Exercise training has been shown to improve cardiorespiratory fitness and metabolic syndrome factors. Therefore, our study aimed at examining whether patients receiving an exercise program as an adjunct to inpatient treatment will benefit in terms of physiological and psychological factors. METHOD Fourty-two inpatients with moderate to severe depression were included. Twenty-two patients were randomized to additional 3x weekly exercise training (EXERCISE) and compared to treatment as usual (TAU). Exercise capacity was assessed as peak oxygen uptake (VO2peak), ventilatory anaerobic threshold (VAT) and workload expressed as Watts (W). Metabolic syndrome was defined according to NCEP ATPIII panel criteria. RESULTS After 6 weeks of treatment, cardiorespiratory fitness (VO2peak, VAT, Watt), waist circumference and HDL cholesterol were significantly improved in EXERCISE participants. Treatment response expressed as ≥50% MADRS reduction was more frequent in the EXERCISE group. CONCLUSIONS Adjunctive exercise training in depressed inpatients improves physical fitness, MetS factors, and psychological outcome. Given the association of depression with cardiometablic disorders, exercise training is recommended as an adjunct to standard antidepressant treatment.
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Affiliation(s)
- Arno Kerling
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Uwe Tegtbur
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Elke Gützlaff
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Momme Kück
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Luise Borchert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Zeynep Ates
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Anne von Bohlen
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Katja Hüper
- Institute for Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Dagmar Hartung
- Institute for Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Increased left ventricular mass in hypercortisolemic depressed patients: A hypothesis based on a case series. Med Hypotheses 2014; 83:730-2. [DOI: 10.1016/j.mehy.2014.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/28/2014] [Indexed: 11/18/2022]
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