Higher levels of reported sun exposure, and not vitamin D status, are associated with less depressive symptoms and fatigue in multiple sclerosis

Dose-dependent increase in risk of bleeding and bleeding complications in relation to SSRI use at delivery

INTRODUCTION

Depression during pregnancy is a severe state that increases the risk of suicide, as well as adverse newborn outcomes. Selective serotonin re-uptake inhibitors (SSRIs) are effective for the treatment of depression, but increase the risk of bleeding complications at delivery. Knowledge on the dose dependency of this association is lacking.

METHODS

A hospital-based cohort study of all women who gave birth at Karolinska University Hospital in Stockholm over the 5-year period from 2007 to 2011, with or without SSRI use, was undertaken. In total, 334 women who delivered vaginally and were exposed to SSRIs at delivery were identified. All other women who delivered vaginally formed the control group (n = 31,929). The electronic maternal health records of the 334 SSRI users were scrutinized, and the women were categorized into two groups: moderate (n = 246) or high (n = 88) SSRI dose at delivery. The main outcome was bleeding complications at delivery in relation to SSRI dose.

RESULTS

A dose-dependent increase in the rate of postpartum haemorrhage (≥1000 ml) was found, affecting 8.4 %, 14.6 % and 23.9 % (p ≤ 0.001) of women in the control group, the moderate-dose group and the high-dose group, respectively. In addition, a dose-dependent increase in the rate of postpartum anaemia was found, affecting 7.0 %, 9.3 % and 15.9 % (p = 0.001) of women in the control group, the moderate-dose group and the high-dose group, respectively. Mean blood loss of 406 ml, 483 ml and 482 ml (p ≤ 0.001) was found in the control group, the moderate-dose group and the high-dose group, respectively. Women exposed to SSRIs delivered earlier, but did not have higher prevalence of pre-eclampsia compared with the control group.

CONCLUSIONS

The dose-dependent relationship between SSRIs and bleeding complications may be clinically useful in the management of this vulnerable group of women.

Vitamin D and Its Role on the Fatigue Mitigation: A Narrative Review

Vitamin D has historically been associated with bone metabolism. However, over the years, a growing body of evidence has emerged indicating its involvement in various physiological processes that may influence the onset of numerous pathologies (cardiovascular and neurodegenerative diseases, rheumatological diseases, fertility, cancer, diabetes, or a condition of fatigue). This narrative review investigates the current knowledge of the pathophysiological mechanisms underlying fatigue and the ways in which vitamin D is implicated in these processes. Scientific studies in the databases of PubMed, Scopus, and Web of Science were reviewed with a focus on factors that play a role in the genesis of fatigue, where the influence of vitamin D has been clearly demonstrated. The pathogenic factors of fatigue influenced by vitamin D are related to biochemical factors connected to oxidative stress and inflammatory cytokines. A role in the control of the neurotransmitters dopamine and serotonin has also been demonstrated: an imbalance in the relationship between these two neurotransmitters is linked to the genesis of fatigue. Furthermore, vitamin D is implicated in the control of voltage-gated calcium and chloride channels. Although it has been demonstrated that hypovitaminosis D is associated with numerous pathological conditions, current data on the outcomes of correcting hypovitaminosis D are conflicting. This suggests that, despite the significant involvement of vitamin D in regulating mechanisms governing fatigue, other factors could also play a role.

Effect of Vitamin D Supplementation on Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis

Vitamin D supplementation has been considered a possible treatment to reduce the risk of disease activity and progression in people with multiple sclerosis (MS). However, its effect on disease symptoms remains unclear. The aim of this meta-analysis was to conduct a systematic review to assess the effect of vitamin D on fatigue in this population. The systematic review was conducted using the MEDLINE, Cochrane Library, Embase and Web of Science databases from inception to May 2023. Randomized controlled trials (RCTs) reporting pre-post changes in fatigue after vitamin D supplementation were included. Pooled effect sizes and 95% confidence intervals (95% CIs) were calculated by applying a random effects model with Stata/SE (Version 16.0; StataCorp., College Station, TX, USA). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of five studies with 345 individuals (271 females; age range: 25.4-41.1 years) were included. A significant reduction in fatigue was perceived when vitamin D supplementation was compared with a control group: -0.18 (95% CI: -0.36 to -0.01; I² = 0%). Thus, our findings show that the therapeutic use of vitamin D on fatigue in people with MS could be considered. Nevertheless, due to the lack of agreement on the dose to be applied, it is recommended to use it under medical prescription.

Effects of eight weeks of aerobic exercise and vitamin D supplementation on psychiatric comorbidities in men with migraine and vitamin D insufficiency: A randomized controlled clinical trial

BACKGROUND

High prevalence of psychiatric comorbidities associated with migraine increases the risk of evolution from episodic migraine to chronic migraine. This study investigated the effects of eight weeks of aerobic exercise and vitamin D supplementation on psychiatric comorbidities in men with migraine and vitamin D insufficiency.

METHODS

Forty-eight participants took part in this randomized controlled clinical trial and were allocated into four groups: aerobic exercise and vitamin D (AE + VD), aerobic exercise and placebo (AE + Placebo), vitamin D (VD), and Placebo. AE + VD and AE + Placebo groups performed three aerobic exercise sessions per week for eight weeks and received a vitamin D supplement and placebo, respectively. The VD group received a vitamin D supplement, and the Placebo group received a placebo for eight weeks. The depression severity, quality of sleep, and physical self-concept were measured at baseline and after eight weeks.

RESULTS

The results showed that depression severity was significantly lower in AE + VD compared to AE + Placebo, VD, and Placebo at the post-test. Our results demonstrated that in the post-test, the mean score of sleep quality in AE + VD was significantly lower than AE + Placebo, VD, and Placebo. Finally, the results revealed that after eight weeks of intervention, the physical self-concept in AE + VD was significantly higher than in VD and Placebo groups.

LIMITATIONS

Not having complete control of sun exposure and the diet were the limitations.

CONCLUSION

The results indicated that the concomitant application of AE and VD supplementation could provoke synergistic effects leading to additional psycho-cognitive health benefits in men with migraine and vitamin D insufficiency.

Molecular biomarkers and cognitive impairment in multiple sclerosis: State of the field, limitations, and future direction - A systematic review and meta-analysis

OBJECTIVE

Multiple sclerosis (MS) is associated with cognitive impairment (CI) such as slowed information processing speed (IPS). Currently, no immunocellular or molecular markers have been established in cerebrospinal fluid and serum analysis as surrogate biomarkers with diagnostic or predictive value for the development of CI. This systematic review and meta-analysis aims to sum up the evidence regarding currently discussed markers for CI in MS.

METHODS

A literature search was conducted on molecular biomarkers of CI in MS, such as neurofilament light chain, chitinases, and vitamin D.

RESULTS

5543 publications were screened, of which 77 entered the systematic review. 13 studies were included in the meta-analysis. Neurofilament light chain (CSF: r_p = -0.294, p = 0.003; serum: r_p = -0.137, p = 0.001) and serum levels of vitamin D (r_p = 0.190, p = 0.014) were associated with IPS outcomes.

CONCLUSIONS

Neurofilament light chain and vitamin D are promising biomarkers to track impairments in IPS in MS. Further longitudinal research is needed to establish the use of molecular biomarkers to monitor cognitive decline.

The Association between Self-Rated Health Status, Psychosocial Stress, Eating Behaviors, and Food Intake According to the Level of Sunlight Exposure in Korean Adults

Sunlight exposure has been reported to have various beneficial effects on human health. This study investigated the relationship between self-rated health status, psychosocial stress, eating behaviors, and food intake according to sunlight exposure in 948 adults. Sunlight exposure was classified as less than one hour, less than three hours, and greater than three hours. Of the participants, 49.2% had fewer than three hours of daily exposure to sunlight. Regarding participants exposed to sunlight for less than one hour, the largest response was that they did not engage in outdoor activities on weekdays or weekends, and the rate of being outdoors in the shade on sunny days was the highest in this group at 42.7%. Furthermore, the participants exposed to sunlight for less than one hour had a lower health response than the other two groups, and there were significantly more participants classified in the stress risk group. Regarding eating habits, those with less than an hour of exposure to sunlight frequently ate fried foods, fatty foods, added salt, and snacks, and had significantly lower total dietary scores or three regular meals. Additionally, their frequency of consumption of cereals, milk and dairy products, orange juice, and pork was also significantly lower than the other groups. Thus, it is necessary to provide sufficient guidelines for adequate sunlight exposure and food intake because participants with low sunlight exposure may have low vitamin D synthesis and insufficient food intake.

Biological Role of Nutrients, Food and Dietary Patterns in the Prevention and Clinical Management of Major Depressive Disorder

Major Depressive Disorder (MDD) is a growing disabling condition affecting around 280 million people worldwide. This complex entity is the result of the interplay between biological, psychological, and sociocultural factors, and compelling evidence suggests that MDD can be considered a disease that occurs as a consequence of an evolutionary mismatch and unhealthy lifestyle habits. In this context, diet is one of the core pillars of health, influencing multiple biological processes in the brain and the entire body. It seems that there is a bidirectional relationship between MDD and malnutrition, and depressed individuals often lack certain critical nutrients along with an aberrant dietary pattern. Thus, dietary interventions are one of the most promising tools to explore in the field of MDD, as there are a specific group of nutrients (i.e., omega 3, vitamins, polyphenols, and caffeine), foods (fish, nuts, seeds fruits, vegetables, coffee/tea, and fermented products) or dietary supplements (such as S-adenosylmethionine, acetyl carnitine, creatine, amino acids, etc.), which are being currently studied. Likewise, the entire nutritional context and the dietary pattern seem to be another potential area of study, and some strategies such as the Mediterranean diet have demonstrated some relevant benefits in patients with MDD; although, further efforts are still needed. In the present work, we will explore the state-of-the-art diet in the prevention and clinical support of MDD, focusing on the biological properties of its main nutrients, foods, and dietary patterns and their possible implications for these patients.

Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce

OBJECTIVES

The therapeutic use of nutrient-based 'nutraceuticals' and plant-based 'phytoceuticals' for the treatment of mental disorders is common; however, despite recent research progress, there have not been any updated global clinical guidelines since 2015. To address this, the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Disorders (CANMAT) convened an international taskforce involving 31 leading academics and clinicians from 15 countries, between 2019 and 2021. These guidelines are aimed at providing a definitive evidence-informed approach to assist clinicians in making decisions around the use of such agents for major psychiatric disorders. We also provide detail on safety and tolerability, and clinical advice regarding prescription (e.g. indications, dosage), in addition to consideration for use in specialised populations.

METHODS

The methodology was based on the WFSBP guidelines development process. Evidence was assessed based on the WFSBP grading of evidence (and was modified to focus on Grade A level evidence - meta-analysis or two or more RCTs - due to the breadth of data available across all nutraceuticals and phytoceuticals across major psychiatric disorders). The taskforce assessed both the 'level of evidence' (LoE) (i.e. meta-analyses or RCTs) and the assessment of the direction of the evidence, to determine whether the intervention was 'Recommended' (+++), 'Provisionally Recommended' (++), 'Weakly Recommended' (+), 'Not Currently Recommended' (+/-), or 'Not Recommended' (-) for a particular condition. Due to the number of clinical trials now available in the field, we firstly examined the data from our two meta-reviews of meta-analyses (nutraceuticals conducted in 2019, and phytoceuticals in 2020). We then performed a search of additional relevant RCTs and reported on both these data as the primary drivers supporting our clinical recommendations. Lower levels of evidence, including isolated RCTs, open label studies, case studies, preclinical research, and interventions with only traditional or anecdotal use, were not assessed.

RESULTS

Amongst nutraceuticals with Grade A evidence, positive directionality and varying levels of support (recommended, provisionally recommended, or weakly recommended) was found for adjunctive omega-3 fatty acids (+++), vitamin D (+), adjunctive probiotics (++), adjunctive zinc (++), methylfolate (+), and adjunctive s-adenosyl methionine (SAMe) (+) in the treatment of unipolar depression. Monotherapy omega-3 (+/-), folic acid (-), vitamin C (-), tryptophan (+/-), creatine (+/-), inositol (-), magnesium (-), and n-acetyl cysteine (NAC) (+/-) and SAMe (+/-) were not supported for this use. In bipolar disorder, omega-3 had weak support for bipolar depression (+), while NAC was not currently recommended (+/-). NAC was weakly recommended (+) in the treatment of OCD-related disorders; however, no other nutraceutical had sufficient evidence in any anxiety-related disorder. Vitamin D (+), NAC (++), methylfolate (++) were recommended to varying degrees in the treatment of the negative symptoms in schizophrenia, while omega-3 fatty acids were not, although evidence suggests a role for prevention of transition to psychosis in high-risk youth, with potential pre-existing fatty acid deficiency. Micronutrients (+) and vitamin D (+) were weakly supported in the treatment of ADHD, while omega-3 (+/-) and omega-9 fatty acids (-), acetyl L carnitine (-), and zinc (+/-) were not supported. Phytoceuticals with supporting Grade A evidence and positive directionality included St John's wort (+++), saffron (++), curcumin (++), and lavender (+) in the treatment of unipolar depression, while rhodiola use was not supported for use in mood disorders. Ashwagandha (++), galphimia (+), and lavender (++) were modestly supported in the treatment of anxiety disorders, while kava (-) and chamomile (+/-) were not recommended for generalised anxiety disorder. Ginkgo was weakly supported in the adjunctive treatment of negative symptoms of schizophrenia (+), but not supported in the treatment of ADHD (+/-). With respect to safety and tolerability, all interventions were deemed to have varying acceptable levels of safety and tolerability for low-risk over-the-counter use in most circumstances. Quality and standardisation of phytoceuticals was also raised by the taskforce as a key limiting issue for firmer confidence in these agents. Finally, the taskforce noted that such use of nutraceuticals or phytoceuticals be primarily recommended (where supportive evidence exists) adjunctively within a standard medical/health professional care model, especially in cases of more severe mental illness. Some meta-analyses reviewed contained data from heterogenous studies involving poor methodology. Isolated RCTs and other data such as open label or case series were not included, and it is recognised that an absence of data does not imply lack of efficacy.

CONCLUSIONS

Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders. However several had only a weak endorsement for potential use; for a few it was not possible to reach a clear recommendation direction, largely due to mixed study findings; while some other agents showed no obvious therapeutic benefit and were clearly not recommended for use. It is the intention of these guidelines to inform psychiatric/medical, and health professional practice globally.

The Seasonal Fluctuation of Fatigue in Multiple Sclerosis

Background

Fatigue is a common symptom in patients with multiple sclerosis. Several studies suggest that outdoor temperature can impact fatigue severity, but a systematic study of seasonal variations is lacking.

Methods

Fatigue was assessed with the Fatigue Scale for Motor and Cognitive Functions (FSMC) in a temperate climatic zone with an average outdoor temperature of 8.8°C. This study included 258 patients with multiple sclerosis from 572 visits temporally distributed over the year. The data were adjusted for age, sex, cognition, depression, disease severity, and follow-up time. Linear regression models were performed to determine whether the temporal course of fatigue was time-independent, linearly time dependent, or non-linearly time dependent.

Results

Fatigue was lowest during January (mean FSMC: 49.84) and highest during August (mean FSMC: 53.88). The regression analysis showed the best fit with a model that included months + months2, which was a non-linear time dependency. Mean FSMC per month correlated significantly with the average monthly temperature (ρ = 0.972; p < 0.001).

Conclusion

In multiple sclerosis, fatigue showed a natural temporal fluctuation. Fatigue was higher during summer compared to winter, with a significant relationship of fatigue with outdoor temperature. This finding should be carefully taken into account when clinically monitoring patients over time to not interpret higher or lower scores independent of seasonal aspects.

Symptom Interconnectivity in Multiple Sclerosis: A Narrative Review of Potential Underlying Biological Disease Processes

Introduction

Fatigue, cognitive impairment, depression, and pain are highly prevalent symptoms in multiple sclerosis (MS). These often co-occur and may be explained by a common etiology. By reviewing existing literature, we aimed to identify potential underlying biological processes implicated in the interconnectivity between these symptoms.

Methods

A literature search was conducted to identify articles reporting research into the biological mechanisms responsible for the manifestation of fatigue, cognitive impairment, depression, and pain in MS. PubMed was used to search for articles published from July 2011 to July 2021. We reviewed and assessed findings from the literature to identify biological processes common to the symptoms of interest.

Results

Of 693 articles identified from the search, 252 were selected following screening of titles and abstracts and assessing reference lists of review articles. Four biological processes linked with two or more of the symptoms of interest were frequently identified from the literature: (1) direct neuroanatomical changes to brain regions linked with symptoms of interest (e.g., thalamic injury associated with cognitive impairment, fatigue, and depression), (2) pro-inflammatory cytokines associated with so-called ‘sickness behavior,’ including manifestation of fatigue, transient cognitive impairment, depression, and pain, (3) dysregulation of monoaminergic pathways leading to depressive symptoms and fatigue, and (4) hyperactivity of the hypothalamic–pituitary-adrenal (HPA) axis as a result of pro-inflammatory cytokines promoting the release of brain noradrenaline, serotonin, and tryptophan, which is associated with symptoms of depression and cognitive impairment.

Conclusion

The co-occurrence of fatigue, cognitive impairment, depression, and pain in MS appears to be associated with a common set of etiological factors, namely neuroanatomical changes, pro-inflammatory cytokines, dysregulation of monoaminergic pathways, and a hyperactive HPA axis. This association of symptoms and biological processes has important implications for disease management strategies and, eventually, could help find a common therapeutic pathway that will impact both inflammation and neuroprotection.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40120-022-00368-2.

Solar Radiation in Architectural Projects as a Key Design Factor for the Well-Being of Persons with Alzheimer’s Disease

The beneficial effects of solar radiation on human health are well documented. One necessary mechanism triggers the production of vitamin D, whose insufficiency has been linked to a variety of disorders such as diabetes; hypertension; and, more recently, amyloidosis and Alzheimer’s disease. However, there are few architectural designs capable of ensuring the adequate provision of solar radiation inside buildings. Conventional fenestration is not sufficient to provide for significant doses of sunlight, even to prevent seasonal affective disorder (SAD). In this paper, we discuss the effect of new design alternatives for skylights, especially in the refurbishment of obsolete facilities. Based on the authors’ previous studies, we defined a theoretical model that was subsequently adapted to a real building that was to be retrofitted in an area near Sevilla. After such complex refurbishment was executed, we analyzed the performance of buildings in warm and sunny climates, as is the case of southern Spain, where cloudiness is very scarce and available simulation models are not useful. The study of the factors that relate to sunlight; UV reception and energy; and, to a certain extent, other aspects such as ventilation and insulation has been considered a priority. Many architectural designs are presented as correct if the thermal requirements alone are met, even at the risk of later energy waste in lighting devices and visual or physical discomfort. On the other hand, large glazed areas allow for more daylight and UV radiation into a space if properly treated, but they may also produce excessive heat gains or losses, which increase the air-conditioning cooling or heating load, respectively. The uncontrolled increase in temperature can have negative effects on the well-being of a person with Alzheimer’s dementia. To avoid these problems, we have considered the combined effect of daylight and energy from the beginning of the skylight design-process. Daylighting software, based on configuration factors that we have applied in studies of the complex problem of there being direct sunlight over architectural structures, has been used. This question cannot be treated adequately with conventional programs for overcast skies. The skylights have already been constructed, with special UV increasing glazing and on-site measurements in the offices to complement the computer simulation data. The results show that it is possible to achieve energy saving and high radiation levels in winter without increasing heat loads during the summer. Ventilation is also improved through the aerodynamic design of the clerestories. All this is considered beneficial to improve the condition of users with cognitive diseases as Alzheimer’s disease, by virtue of adapted spaces.

Associations Between Consumption of Different Vegetable Types and Depressive Symptoms in Japanese Workers: A Cross-Sectional Study

Purpose

Vegetable intake is an important part of our everyday diet and is associated with many positive health outcomes. Although previous studies have investigated the association between vegetable consumption and depressive symptoms among various populations, no study has examined this association in the adult working population. The present study investigated whether the frequency of consumption of a specific type of vegetable is associated with the prevalence of depressive symptoms in Japanese adult workers.

Participants and Methods

The final participants consisted of 1724 Japanese adults, and a cross-sectional study was conducted to analyze the results. The frequency of vegetable consumption and depressive symptoms was evaluated using a brief-type self-administered diet history questionnaire and the Zung Self-Rating Depression Scale (SDS), respectively. The association between the variables was examined using Poisson regression analysis. Age-stratified analysis was performed, and SDS cut-off values of 45 and 50 were used to perform a sensitivity analysis.

Results

After adjustment for covariates, including age, body mass index, sociodemographic and lifestyle-related variables, health condition, C-reactive protein, and other dietary variables, an inverse association was found between tomato product consumption and the prevalence of depressive symptoms among men (P for trend <0.01); however, no significant association was found for other vegetable types. For women, there was no association between the frequency of consumption of any of the vegetable types and the prevalence of depressive symptoms. The results were confirmed by the age-stratified analysis for both genders.

Conclusion

Consumption of tomato products may help alleviate depressive symptoms, regardless of differences in dietary culture among men.

Vitamin D and Depressive Symptoms in Adults with Multiple Sclerosis: A Scoping Review

BACKGROUND

Vitamin D deficiency has been correlated with Multiple Sclerosis (MS) risk and disease activity. There is some controversy as to whether vitamin D could have an impact on depressive symptoms in people with MS (pwMS). The aim of this scoping review was to evaluate the association between vitamin D status and depressive symptoms in pwMS.

METHODS

We searched databases to include studies published up to March 2021 to provide an overview of the available evidence on the correlation between vitamin D status and depressive symptoms in pwMS. The eligibility criteria were as follows: studies evaluating the use of vitamin D measurement on depressive symptoms in patients suffering from MS, including randomized and non-randomized studies; studies written in English; and studies exploring an adult population over the age of 18.

RESULTS

Eleven studies met our inclusion criteria: two of them were abstracts only; the majority were cross-sectional studies; two were prospective longitudinal studies; one was a retrospective cohort study; and one was a randomized placebo-controlled trial (RCT). Of the eleven studies selected, seven showed a potential correlation between low vitamin D levels and depressive symptoms.

CONCLUSION

Future RCT studies should include patients with greater severity of depressive symptoms and should consider confounding factors such as sun exposure and seasonal variation of vitamin D.

The Role of Vitamin D in Early Knee Osteoarthritis and Its Relationship with Their Physical and Psychological Status

Osteoarthritis (OA) is a common joint condition and one of the greatest causes of disability worldwide. The role of vitamin D in the origin and development of the disease is not clear, although it could have important implications for diagnosis and treatment. For this proposal, a cross-sectional study with a non-probabilistic sample was performed. In total, 48 with early osteoarthritis (EOA) and 48 matched controls were selected, and serum 25(OH)D and parathyroid hormone (PTH) levels were analyzed. In addition, physical and psychological variables were measured to establish their relationship with vitamin D levels. Patients with EOA showed lower levels (22.3 ± 7.3 ng/mL) in comparison to matched controls (29.31 ± 9.2 ng/mL). A statistically significant higher number (Chi-squared = 8.525; p = 0.004) of patients with EOA had deficiency levels (<20 ng/mL) compared to the control group. Patients with lower vitamin D levels showed higher levels of pain intensity, disability, and anxiety, as well as poorer values for sit-to-stand, walking speed, and social participation. Correlation analysis showed a relationship between serum 25(OH)D, PTH and pain intensity, and social participation. These results highlight the relevance of vitamin D in the early diagnosis and prevention of EOA.

The relationship between sunlight exposure duration and depressive symptoms: A cross-sectional study on elderly Chinese women

Sunlight has been reported to have various beneficial effects on human health. Although research indicates an association between sunlight exposure and depressive symptoms, no study has examined it among the older adult population, especially among elderly Chinese women. This cross-sectional study addresses the aforesaid gap by investigating this association in 1,429 Chinese women aged 60 years and older. Information on their sunlight exposure was collected through a self-reported questionnaire. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SDS). The logistic regression models revealed that greater exposure to sunlight is associated with a lower prevalence of depressive symptoms. In the final adjusted model, when the short sunlight exposure category (reference) was compared with the medium and long ones, the odds ratios and 95% confidence intervals for the prevalence of depressive symptoms (SDS cutoff ≥ 45) were 0.84 (0.60, 1.19) and 0.62 (0.43, 0.91), respectively (p-value for trend = 0.01). This significant association did not change when the SDS cutoff points were altered to ≥ 40 and ≥ 50. Findings indicate that an increased sunlight exposure duration is associated with a lower prevalence of depressive symptoms in elderly women.

Physical Exercise Behaviors and Depressive Symptoms Among Elderly Chinese Women: Focus on Exercise Components

Purpose

Several studies have investigated the association between physical exercise and depressive symptoms in the elderly population. However, the relationship between components of physical exercise such as frequency, intensity, duration, and depressive symptoms remains unclear. This study was conducted on elderly Chinese women to investigate the association between each component of physical exercise and depressive symptoms and to examine the association between physical exercise patterns and depressive symptoms.

Patients and Methods

A total of 1429 Chinese women aged ≥60 years were enrolled in this cross-sectional study and provided information on their exercise behaviors through a self-reported questionnaire. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale. Multiple logistic regression analysis was used to estimate adjusted odds ratios (ORs) to measure the association between exercise behaviors and depression.

Results

High frequency, moderate intensity, long duration, and exercise habits were significantly associated with lower levels of depressive symptoms. Furthermore, participants with more than one optimal exercise behavior were more likely to have a lower risk of depressive symptoms. These associations were not changed after adjustment for confounding factors.

Conclusion

This study shows that exercise behaviors were significantly associated with the risk of developing depression. This finding suggests that keeping an optimal exercise behavior may be associated with a lower risk of depressive symptoms in elderly Chinese women.

Serum vitamin d inversely correlates with depression scores in people with multiple sclerosis

BACKGROUND

Vitamin D (Vit.D) deficiency is a risk factor for multiple sclerosis (MS) and correlates with its severity. Depression is also common in people with MS (PWMS). We aim to investigate Vit.D correlation with depression risk scores in PWMS.

METHODS

A cross-sectional cohort of PWMS were studied. Clinical and demographic data were collected. The Hospital Anxiety Depression Scale (HADS) and the Beck Depression Inventory-II (BDI-II) were used to evaluate the risk of depression. Expanded Disability Status Scale (EDSS) and Patient Determined Disease Steps (PDDS) were used to evaluate the disability. Serum concentrations of 25-hydroxyvitamin D were measured. Bivariate and partial correlations of Vit.D status and scores of depressive and disability scales were statistically analyzed. The IBM Statistical Package for Social Sciences software, version 25.0, was used for data processing.

RESULTS

A total of 88 PWMS were enrolled. More than half of them had potential depression, and 68% had below-normal serum Vit.D levels (normal ≥ 30 ng/ml, insufficient = 21-29 ng/ml, and deficient ≤ 20 ng/ml). Serum Vit.D levels significantly correlated with scores of depression scales in both males and females, which was more robust in males. This association was maintained with a partial correlation analysis controlling for age, sex, body mass index, disease duration, type of MS, and EDDS HADS: r=-0.513, p<0.001; BDI-II: r=-0.401, p<0.001). Serum Vit.D had significant inverse correlations with EDSS score (r=-0.353, p = 0.001) and PDDS score (r=-0.341, p = 0.001), with more robust correlations in females compared to the whole group.

CONCLUSION

Vit.D levels correlate with depression risk scores in PWMS with differential sex effects.

The effect of a plant cultivating program conducted at a community mental health center on the functional remission of individuals with schizophrenia: A randomized controlled study

PURPOSE

This study was conducted to determine the effect of a plant cultivating program carried out in a community mental health center (CMHC) on the functional remission levels of individuals with schizophrenia.

MATERIALS AND METHODS

The study was carried out as experimental research in pretest-posttest with control group design. Eighty individuals being followed up and treated at two CMHCs were randomly assigned to an intervention and a control group. The plant cultivating program, containing a theoretical and a practical sequence, was conducted for six weeks in the intervention group. The effectiveness of the program was assessed with the Functional Remission of General Schizophrenia (FROGS) scale.

RESULTS

The individuals participating in the program registered a significant increase in their FROGS scale overall scores as compared to the control group following the program. After the program, the intervention group's social, health, daily skills and professional functioning posttest scores were significantly higher than those of the control group.

CONCLUSION

The plant cultivating program applied to individuals with schizophrenia at the CMHCs positively resulted in an improvement in their functional remission. The nurse-led plant cultivating program conducted at the CMHCs was observed to be an effective and applicable program that would improve the social, health, daily skills and professional functioning of individuals with schizophrenia.

A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system which is associated with numerous comorbidities. These include cardiovascular disease, psychiatric and neurologic disturbances, restless leg syndrome, migraine, cancer, autoimmune diseases, and metabolic disorders. Comorbid disease is an important consideration for clinicians treating patients with MS; early presentation of comorbidities can obscure or delay MS diagnosis, as well as significantly impacting the disease course. Improved understanding of comorbidities and their emergence in MS populations is important for improving the quality of life and optimizing treatment for patients. Therefore, we evaluated published studies reporting epidemiologic data on comorbidities and their associated impact on disease progression in patients with MS (PwMS). The prevalence of neurologic, cardiovascular, metabolic, and autoimmune comorbidities was elevated in PwMS in general, and furthermore, this adversely affected a broad range of outcomes. Compared with PwMS, cancer rates in people without MS or the general population were lower, which should prompt further studies into the mechanisms of both diseases. Studies were under-represented in many regions owing to the latitudinal gradient of MS and possible underfunding of studies.

A Brief Review of the Effects of Vitamin D on Multiple Sclerosis

Multiple sclerosis (MS) is characterized as an autoimmune disease affecting the central nervous system. It is one of the most common neurological disorders in young adults. Over the past decades, increasing evidence suggested that hypovitaminosis D is a contributing factor to the risk of developing MS. From different risk factors contributing to the development of MS, vitamin D status is of particular interest since it is not only a modifiable risk factor but is also associated with MS disease activity. MS patients with lower serum vitamin D concentrations were shown to have higher disease activity. However, this finding does not demonstrate causality. In this regard, prospective vitamin D supplementation studies missed statistical significance in its primary endpoints but showed promising results in secondary outcome measures or post hoc analyses. An explanation for missed primary endpoints may be underpowered trials. Besides vitamin D supplementation as a potential add-on to long-term immunotherapeutic treatment, a recent laboratory study of our group pointed toward a beneficial effect of vitamin D to improve the efficacy of glucocorticoids in relapse therapy. In the following article, we will briefly review the effects of vitamin D on MS by outlining its effects on the immune and nervous system and by reviewing the association between vitamin D and MS risk as well as MS disease activity. We will also review the effects of vitamin D supplementation on MS risk and MS disease activity.

The Effect of Ultraviolet B Irradiation Compared with Oral Vitamin D Supplementation on the Well-being of Nursing Home Residents with Dementia: A Randomized Controlled Trial

There are indications that ultraviolet B (UVB) exposure has beneficial effects on well-being through mechanisms other than vitamin D synthesis alone. We conducted a randomized controlled multicenter trial to compare the effects of UVB light and vitamin D supplementation (VD) in terms of the well-being of nursing home residents with dementia. Participants were randomly assigned to the intervention group (UVB group, n = 41; half-body UVB irradiation, twice weekly over 6 months, with 1 standard erythema dose (SED)) or to the control group (VD group, n = 37; 5600 International units (IU) cholecalciferol supplementation once a week). The main outcome was well-being, measured by the Cohen-Mansfield Agitation Inventory (CMAI) and the Cornell scale for depression in dementia at 0, 3, and 6 months. Secondary outcomes were QUALIDEM quality of life domains and biochemical parameters of bone homeostasis. Intention-to-treat analysis with linear mixed modeling showed no significant between-group differences on agitation (p = 0.431) or depressive symptoms (p = 0.982). At six months, the UVB group showed less restless/tense behavior compared to the VD group (mean difference of the mean change scores 2.2, 95% CI 0.8 to 3.6; p = 0.003 for group x time interaction) and lower serum 25(OH)D3 concentration (estimated mean difference - 21.9, 95% CI −32.6 to −11.2; p = 0.003 for group difference). The exposure of nursing home residents with dementia to UVB light showed no positive benefits in terms of wellbeing. UVB treatment may have a positive effect on the restless/tense behavior characteristic of advanced dementia but more research is needed to confirm this finding.

Association between vitamin D and fatigue in patients with rheumatoid arthritis: a cross-sectional study

OBJECTIVES

In rheumatoid arthritis (RA), fatigue is an important complaint with a significant impact on quality of life. Vitamin D has modulatory effects on cells of the immune system and may potentially affect RA disease activity and thereby RA-related fatigue. The purpose of this study was to explore associations between fatigue and vitamin D status in patients with RA.

DESIGN

Hypothesis-generating cross-sectional study.

SETTING

Scheduled follow-up visits at a hospital-based general rheumatology clinic.

PARTICIPANTS

Patients (n=169) with established RA.

PRIMARY OUTCOME MEASURES AND ANLYSES

Fatigue, assessed by the Chalder fatigue questionnaire, and serum concentrations of 25-hydroxyvitamin D (25(OH)D), assessed by liquid chromatography-tandem mass spectrometry. Associations were analysed by correlation, and multivariate linear regression with adjustments for age, sex, body mass index, RA disease activity as measured by the Disease Activity Score 28-joint count C reactive protein (DAS28-CRP), psychological distress, pain and sleep. Fatigue was also compared across four groups based on the levels of serum 25(OH)D with cut points at 30, 50 and 75 nmol/L using one-way analysis of variance.

RESULTS

Two-thirds of the patients (116/169, 69%) were classified with low RA disease activity, that is, a DAS28-CRP score below 3.2. Their mean (SD) serum 25(OH)D concentration was 56.3 (21.2) nmol/L, with 77 (45.6%) having values below 50 nmol/L and 12 patients (7.1%) below 30 nmol/L. The correlation between fatigue and serum concentrations of 25(OH)D was weak and not statistically significant, r = -0.14 (95% CI: -0.29 to 0.03, p=0.08). In the multivariate model, fatigue was significantly associated with RA disease activity, psychological distress and pain, but not with serum 25(OH)D. Fatigue did not differ across groups with varying levels of serum 25(OH)D.

CONCLUSION

This cross-sectional study found no evidence of association between vitamin D and fatigue in patients with RA.

A new way of rapidly screening for depression in multiple sclerosis using Emotional Thermometers

OBJECTIVE

Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.

METHOD

Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale - Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.

RESULTS

In total, 190 patients were included. ET4 performed well as a 'rule-out' screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.

CONCLUSION

ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.

Investigating causality in the association between vitamin D status and self-reported tiredness

Self-reported tiredness or low energy, often referred to as fatigue, has been linked to low levels of circulating 25-hydroxyvitamin D (25OHD), a biomarker of vitamin D status. Although it is uncertain if the association is causal, fatigue is a common indication for testing, and correcting, low 25OHD-levels. We used two-sample Mendelian randomization to test for genetic evidence of a causal association between low 25OHD-levels and fatigue. Genetic-25OHD associations were estimated from the largest genome-wide association study of vitamin D to date, and genetic-fatigue associations were estimated in 327,478 individuals of European descent in UK Biobank, of whom 19,526 (5.96%) reported fatigue (tiredness or low energy nearly every day over the past two weeks). Using seven genome-wide significant 25OHD-reducing genetic variants, there was little evidence for a causal effect of 25OHD on fatigue (odds ratio for fatigue was 1.05 with 95% confidence interval of 0.87–1.27 per 1-SD decrease in log-transformed 25OHD). There was also little evidence of association between any individual 25OHD-reducing variant and fatigue. Our results suggest that a clinically relevant protective effect of 25OHD-levels on fatigue is unlikely. Therefore, vitamin D supplementation of the general population to raise 25OHD-levels is not likely to be useful in preventing fatigue.

Harnessing the Four Elements for Mental Health

Humans are intimately connected to nature, and our physical and mental health is influenced strongly by our environment. The "elements," classically described in humoral theory as Fire, Water, Earth, and Air, all may impact our mental health. In a contemporary sense, these elements reflect a range of modifiable factors: UV light or heat therapy (Fire); sauna, hydrotherapy, and balneotherapy (Water); nature-based exposure therapy and horticulture (Earth); oxygen-rich/clean air exposure; and breathing techniques (Air). This theoretical scoping review paper details the emerging evidence for a range of these elements, covering epidemiological and interventional data, and provides information on how we can engage in "biophilic" activities to harness their potential benefits. Interventional examples with emerging evidentiary support include "forest-bathing," heat therapy, sauna, light therapy, "greenspace" and "bluespace" exercise, horticulture, clay art therapy activities, and pranayamic yoga breathing exercises. Further robust research is however required to firmly validate many of these interventions, and to establish their therapeutic applications for the benefit of specific mental health disorders.

Exposure to Ultraviolet Radiation in the Modulation of Human Diseases

This review focuses primarily on the beneficial effects for human health of exposure to ultraviolet radiation (UVR). UVR stimulates anti-inflammatory and immunosuppressive pathways in skin that modulate psoriasis, atopic dermatitis, and vitiligo; suppresses cutaneous lesions of graft-versus-host disease; and regulates some infection and vaccination outcomes. While polymorphic light eruption and the cutaneous photosensitivity of systemic lupus erythematosus are triggered by UVR, polymorphic light eruption also frequently benefits from UVR-induced immunomodulation. For systemic diseases such as multiple sclerosis, type 1 diabetes, asthma, schizophrenia, autism, and cardiovascular disease, any positive consequences of UVR exposure are more speculative, but could occur through the actions of UVR-induced regulatory cells and mediators, including 1,25-dihydroxy vitamin D₃, interleukin-10, and nitric oxide. Reduced UVR exposure is a risk factor for the development of several inflammatory, allergic, and autoimmune conditions, including diseases initiated in early life. This suggests that UVR-induced molecules can regulate cell maturation in developing organs.

Are the protective benefits of vitamin D in neurodegenerative disease dependent on route of administration? A systematic review

Background: The clinical and preclinical exploration of the therapeutic properties of vitamin D have significantly increased in the past decade, owing to the growing associative evidence suggesting vitamin D is neuroprotective. However, whether depletion of vitamin D contributes to the onset of neurological disorders or is a symptom of neurological disease has yet to be defined. Much remains unclear about the causal role of vitamin D and the method of use and forms of vitamin D.Objectives: We sought to quantitatively assess if neuroprotective benefits from vitamin D in neurodegenerative diseases are dependent on route of administration: comparing the effect of endogenously sourced vitamin D from UV exposure to exogenously derived vitamin D through synthetic supplementation.Design: We systematically searched PubMed, Embase and PsycInfo databases which included both pre-clinical and clinical studies investigating vitamin D in neurodegenerative diseases. Articles were subject to strict inclusion criteria and objectively assessed for quality. Additionally, Medline data was analysed to identify trends in topic publications and linguistic characteristics of papers.Results: From a total of 231 screened articles, we identified 73 appropriate for review based on inclusion criteria: original studies that investigated vitamin D levels or levels of vitamin D supplementation in neurodegenerative diseases or investigated past/present sun exposure in disease cohorts. Results indicate there is insufficient evidence to comprehensively reflect on a potential neuroprotective role for vitamin D and if this was dependent on route of administration. The majority of current data supporting neuroprotective benefits from vitamin D are based on pre-clinical and observational studies. Solid evidence is lacking to support the current hypothesis that the beneficial effect of UV exposure results from the synthesis of vitamin D. Sun exposure, independent of vitamin D production, may be protective against multiple Sclerosis, Parkinson's disease and Alzheimer's disease. Yet, further research is required to elucidate the beneficial mechanism of actions of UV exposure. The literature of vitamin D and amyotrophic lateral sclerosis was limited, and no conclusions were drawn. Therefore, in cases where UV-derived vitamin D was hypothesized to be the beneficial mediator in the neuroprotective effects of sun exposure, we propose results are based only on associative evidence.Conclusion: On the basis of this systematic review, strong recommendations regarding therapeutic benefits of vitamin D in neurodegenerative disease cannot be made. It is unclear if vitamin D mediates a protective benefit in neurodegenerative disease or whether it is an associative marker of UV exposure, which may contribute to as of yet unidentified neuroprotective factors.

Effect of ultraviolet light on mood, depressive disorders and well-being

BACKGROUND

Human and animal studies have shown that exposure to ultraviolet light can incite a chain of endocrine, immunologic, and neurohumoral reactions that might affect mood. This review focuses on the evidence from clinical trials and observational studies on the effect of ultraviolet light on mood, depressive disorders, and well-being.

METHODS

A search was made in PubMed, Embase, Web of Science, Cochrane, Psychinfo, CINAHL, Academic Search Premier and Science Direct, and the references of key papers, for clinical trials and observational studies describing the effect of ultraviolet light applied to skin or eyes on mood, depressive disorders, and well-being.

RESULTS

Of the seven studies eligible for this review, the effect of ultraviolet light on mood, depressive symptoms and seasonal affective disorders was positive in six of them.

CONCLUSIONS

Of the seven studies, six demonstrated benefit of exposure to ultraviolet radiation and improvement in mood which supports a positive effect of ultraviolet light on mood. Because of the small number of the studies and their heterogeneity, more research is warranted to confirm and document this correlation.

Association between Serum Vitamin Levels and Depression in U.S. Adults 20 Years or Older Based on National Health and Nutrition Examination Survey 2005⁻2006

Depression is one of the leading causes of disability around the world. Although several studies have been conducted to analyze the association between vitamins and depression, the results have been inconsistent. Based on the database of National Health and Nutrition Examination Survey (NHANES) (2005–2006), a cross-sectional analysis was conducted to uncover the correlations between serum vitamin concentrations and depression in 2791 participants over 20 years of age. Vitamin concentrations in serum were measured by high performance liquid chromatography (HPLC), a standardized liquid chromatography-tandem mass spectrometry (LC-MS/MS) or radioassay kit method. A nine-item Patient Health Questionnaire (PHQ-9) was used to assess depression symptoms. The binary logistic regression model was applied to analyze the association between vitamins and depression. In the whole population, negative associations were discovered between folate concentrations (p for trend = 0.02), trans-β-carotene (p for trend = 0.01) and depression, while positive associations were found among vitamin B12 concentrations (p for trend = 0.008), vitamin A concentrations (p for trend = 0.01) and depression. In order to evaluate the influence of gender on the pathogenesis of depression of vitamins exposure, we performed gender-stratified analysis. In females, folate concentrations (p for trend = 0.03) and vitamin B12 concentrations (p for trend = 0.02) were correlated with depression. In males, no significant association was found between depression and serum vitamin concentrations. The correlation of vitamins with depression deserves further investigation in larger and diverse populations, especially in females.

A randomised, controlled clinical trial of narrowband UVB phototherapy for clinically isolated syndrome: The PhoCIS study

Background

The natural history of multiple sclerosis (MS) typically presents with the clinically isolated syndrome (CIS), an episode of neurological symptoms caused by central nervous system inflammation or demyelination that does not fulfil the diagnostic criteria for MS.

Objective

As preclinical studies have suggested that exposure to ultraviolet radiation (UVR) could regulate the development of MS, the Phototherapy for CIS (PhoCIS trial) was established to examine the effects of narrowband UVB phototherapy on patients with CIS, and their conversion to MS.

Methods

Of the 20 participants, half received 24 sessions of narrowband UVB exposure over eight weeks; participants in both arms were followed for 12 months. All participants were supplemented to 25-hydroxyvitamin D₃ levels of >80 nmol/l.

Results

By 12 months, 100% of those in the no phototherapy arm and 70% in the phototherapy arm had converted to MS, although this difference was not statistically significant.

Conclusion

This study provides a basis for further studies to determine if there are any benefits of the therapeutic effects of narrowband UVB radiation on MS progression.

Stress-Axis Regulation by Vitamin D3 in Multiple Sclerosis

Introduction

Multiple sclerosis (MS) has been associated with both a poor vitamin D status and hyperactivity of the hypothalamus–pituitary–adrenal (HPA) axis. Since nuclear receptor ligands may regulate each other, we explored the association of vitamin D₃ supplements with circadian cortisol levels in a double-blind and placebo-controlled supplementation study.

Methods

Female patients with relapsing-remitting MS received vitamin D₃ supplements (4,000 IU/day; n = 22) or placebo (n = 19) during 16 weeks. Salivary cortisol levels, repeatedly measured during the day, and serum 25(OH)D levels were assessed before (T0) and after (T1) this treatment period.

Results

Median 25(OH)D levels at T1 were 139.9 (interquartile range 123.5–161.2) and 74.5 nmol/L (58.6–88.1) in the vitamin D₃ and placebo group, respectively (p < 0.001). Comparisons within and between groups showed no differences in area under the curve (AUC) and slope of the cortisol day curve. Although the AUC of the cortisol awakening response (CAR, sampling each 15 min the first hour after awakening) showed a reduction over time in the vitamin D₃ group [39.16 nmol/L (27.41–42.07) at T0 to 33.37 nmol/L (26.75–38.08) at T1] compared to the placebo group [33.90 nmol/L (25.92–44.61) at T0 to 35.00 nmol/L (25.46–49.23) at T1; p = 0.044], there was no significant difference in AUC of CAR at T1 corrected for baseline AUC of CAR (p = 0.066).

Conclusion

Suppression of HPA-axis activity by vitamin D₃ supplements in non-depressed MS patients may be best reflected by CAR as primary outcome measure. Further studies should address this interaction and its potential implications for the disease course of MS.

Registration

This study was registered on ClinicalTrials.gov (NCT02096133) and EudraCT (2014-000728-97).

Green Care as Psychosocial Intervention for Depressive Symptoms: What Might Be the Key Ingredients?

BACKGROUND

Green care is an umbrella term for psychosocial interventions that integrate biotic and abiotic elements of nature to promote an individual's health and well-being. Green care decreases depressive symptoms but the parts of the interventions that lead to this effect are unknown.

OBJECTIVES

Review of literature to evaluate perceived social support, behavioral activation, and self-efficacy as key ingredients to decrease depressive symptoms in psychosocial interventions and extrapolate those mediators, or key ingredients, to green care.

DESIGN

A literature search of three databases was conducted to find relevant studies examining a psychosocial intervention for adults, the mediator of interest, and depressive symptoms.

RESULTS

Evidence supports behavioral activation, social support, and self-efficacy as mediators of psychosocial interventions to improve depressive symptoms.

CONCLUSIONS

Green care offers a portal for individuals with different depressive symptoms and severities to be treated alongside each other while receiving targeted interventions to meet the needs of each individual participant. Additionally, it offers the opportunity for psychiatric nurses to concurrently target all three active key ingredients.

Efficacy and Tolerability of Phytomedicines in Multiple Sclerosis Patients: A Review

Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disorder of the central nervous system (CNS) that can cause cognition, mobility, and sensory impairments. It is considered one of the most common non-traumatic causes of disability in the world. The aim of the present article was to review the clinical evidence related to medicinal plants in the management of MS symptoms. Electronic databases, including the Cochrane Library, Pubmed, and Scopus, were searched for entries from 1966 to February 2017. Only clinical studies were included in this review. Different medicinal plants have positive effects on MS, including Andrographis paniculata, Boswellia papyrifera, Ruta graveolens, Vaccinium spp., Camellia sinensis, Panax ginseng, Aloysia citrodora, Ginkgo biloba, Oenothera biennis, and Cannabis sativa. C. sativa had the highest level of clinical evidence, supporting its efficacy in MS symptoms. Proanthocyanidins, ginkgo flavone glycosides, ginsenosides, epigallocatechin-3-gallate, cannabinoids (including delta-9-tetrahydrocannabinol and cannabidiol), boswellic acid, and andrographolide were presented as the main bioactive components of medicinal plants with therapeutic benefits in MS. The main complications of MS in which natural drugs were effective include spasticity, fatigue, scotoma, incontinence, urinary urgency, nocturia, memory performance, functional performance, and tremor. Herbal medicines were mostly well tolerated, and the adverse effects were limited to mild to moderate. Further well-designed human studies with a large sample size and longer follow-up period are recommended to confirm the role of medicinal plants and their metabolites in the management of MS.

Light therapy for multiple sclerosis-associated fatigue: Study protocol for a randomized controlled trial

BACKGROUND

Fatigue is the most commonly reported symptom among multiple sclerosis (MS) patients, more than a quarter of whom consider fatigue to be their most disabling symptom. However, there are few effective treatment options for fatigue. We aim to investigate whether supplemental exposure to bright white light will reduce MS-associated fatigue.

METHODS

Eligible participants will have clinically confirmed multiple sclerosis based on the revised McDonald criteria (2010) and a score ≥36 on the Fatigue Severity Scale (FSS). Participants will be randomized 1:1 to bright white light (10,000 lux; active condition) or dim red light (<300 lux; control condition) self-administered for 1 hour twice daily. The study will include a 2-week baseline period, a 4-week treatment period, and a 4-week washout period. Participants will record their sleep duration, exercise, caffeine, and medication intake daily. Participants will record their fatigue using the Visual Analogue Fatigue Scale (VAFS) 4 times every third day, providing snapshots of their fatigue level at different times of day. Participants will self-report their fatigue severity using FSS on 3 separate visits: at baseline (week 0), following completion of the treatment phase (week 6), and at study completion (week 10). The primary outcome will be the change in the average FSS score after light therapy. We will perform an intention-to-treat analysis, comparing the active and control groups to assess the postintervention difference in fatigue levels reported on FSS. Secondary outcome measures include change in global VAFS scores during the light therapy and self-reported quality of life in the Multiple Sclerosis Quality of Life-54.

DISCUSSION

We present a study design and rationale for randomizing a nonpharmacological intervention for MS-associated fatigue, using bright light therapy. The study limitations relate to the logistical issues of a self-administered intervention requiring frequent participant self-report in a relapsing condition. Ultimately, light therapy for the treatment of MS-associated fatigue may provide a low-cost, noninvasive, self-administered treatment for one of the most prevalent and burdensome symptoms experienced by people with MS.

Regular sun exposure benefits health

Since it was discovered that UV radiation was the main environmental cause of skin cancer, primary prevention programs have been started. These programs advise to avoid exposure to sunlight. However, the question arises whether sun-shunning behaviour might have an effect on general health. During the last decades new favourable associations between sunlight and disease have been discovered. There is growing observational and experimental evidence that regular exposure to sunlight contributes to the prevention of colon-, breast-, prostate cancer, non-Hodgkin lymphoma, multiple sclerosis, hypertension and diabetes. Initially, these beneficial effects were ascribed to vitamin D. Recently it became evident that immunomodulation, the formation of nitric oxide, melatonin, serotonin, and the effect of (sun)light on circadian clocks, are involved as well. In Europe (above 50 degrees north latitude), the risk of skin cancer (particularly melanoma) is mainly caused by an intermittent pattern of exposure, while regular exposure confers a relatively low risk. The available data on the negative and positive effects of sun exposure are discussed. Considering these data we hypothesize that regular sun exposure benefits health.

The role of vitamin D in the prevention of late-life depression

BACKGROUND

In this article, we review current evidence regarding potential benefits of vitamin D for improving mood and reducing depression risk in older adults. We summarize gaps in knowledge and describe future efforts that may clarify the role of vitamin D in late-life depression prevention.

METHODS

MEDLINE and PsychINFO databases were searched for all articles on vitamin D and mood that had been published up to and including May 2015. Observational studies and randomized trials with 50 or more participants were included. We excluded studies that involved only younger adults and/or exclusively involved persons with current depression.

RESULTS

Twenty observational (cross-sectional and prospective) studies and 10 randomized trials (nine were randomized placebo-controlled trials [RCTs]; one was a randomized blinded comparison trial) were reviewed. Inverse associations of vitamin D blood level or vitamin D intake with depression were found in 13 observational studies; three identified prospective relations. Results from all but one of the RCTs showed no statistically significant differences in depression outcomes between vitamin D and placebo groups.

LIMITATIONS

Observational studies were mostly cross-sectional and frequently lacked adequate control of confounding. RCTs often featured low treatment doses, suboptimal post-intervention changes in biochemical levels of vitamin D, and/or short trial durations.

CONCLUSION

Vitamin D level-mood associations were observed in most, but not all, observational studies; results indicated that vitamin D deficiency may be a risk factor for late-life depression. However, additional data from well-designed RCTs are required to determine the impact of vitamin D in late-life depression prevention.

The risks and benefits of sun exposure 2016

Public health authorities in the United States are recommending that men, women and children reduce their exposure to sunlight, based on concerns that this exposure will promote skin cancer. On the other hand, data show that increasing numbers of Americans suffer from vitamin D deficiencies and serious health problems caused by insufficient sun exposure. The body of science concerning the benefits of moderate sun exposure is growing rapidly, and is causing a different perception of sun/UV as it relates to human health. Melanoma and its relationship to sun exposure and sunburn is not adequately addressed in most of the scientific literature. Reports of favorable health outcomes related to adequate serum 25(OH)D concentration or vitamin D supplementation have been inappropriately merged, so that benefits of sun exposure other than production of vitamin D are not adequately described. This review of recent studies and their analyses consider the risks and benefits of sun exposure which indicate that insufficient sun exposure is an emerging public health problem. This review considers the studies that have shown a wide range health benefits from sun/UV exposure. These benefits include among others various types of cancer, cardiovascular disease, Alzheimer disease/dementia, myopia and macular degeneration, diabetes and multiple sclerosis. The message of sun avoidance must be changed to acceptance of non-burning sun exposure sufficient to achieve serum 25(OH)D concentration of 30 ng/mL or higher in the sunny season and the general benefits of UV exposure beyond those of vitamin D.

The role of geographical ecological studies in identifying diseases linked to UVB exposure and/or vitamin D

Using a variety of approaches, researchers have studied the health effects of solar ultraviolet (UV) radiation exposure and vitamin D. This review compares the contributions from geographical ecological studies with those of observational studies and clinical trials. Health outcomes discussed were based on the author's knowledge and include anaphylaxis/food allergy, atopic dermatitis and eczema, attention deficit hyperactivity disorder, autism, back pain, cancer, dental caries, diabetes mellitus type 1, hypertension, inflammatory bowel disease, lupus, mononucleosis, multiple sclerosis, Parkinson disease, pneumonia, rheumatoid arthritis, and sepsis. Important interactions have taken place between study types; sometimes ecological studies were the first to report an inverse correlation between solar UVB doses and health outcomes such as for cancer, leading to both observational studies and clinical trials. In other cases, ecological studies added to the knowledge base. Many ecological studies include other important risk-modifying factors, thereby minimizing the chance of reporting the wrong link. Laboratory studies of mechanisms generally support the role of vitamin D in the outcomes discussed. Indications exist that for some outcomes, UVB effects may be independent of vitamin D. This paper discusses the concept of the ecological fallacy, noting that it applies to all epidemiological studies.

Ultraviolet radiation, vitamin D and multiple sclerosis

There is compelling epidemiological evidence that the risk of developing multiple sclerosis is increased in association with low levels of sun exposure, possibly because this is associated with low vitamin D status. Recent work highlights both vitamin D and non-vitamin D effects on cellular immunity that suggests that higher levels of sun exposure and/or vitamin D status are beneficial for both MS risk and in ameliorating disease progression. Here we review this recent evidence, focusing on regulatory cells, dendritic cells, and chemokines and cytokines released from the skin following exposure to ultraviolet radiation.

Ultraviolet radiation suppresses obesity and symptoms of metabolic syndrome independently of vitamin D in mice fed a high-fat diet

The role of vitamin D in curtailing the development of obesity and comorbidities such as the metabolic syndrome (MetS) and type 2 diabetes has received much attention recently. However, clinical trials have failed to conclusively demonstrate the benefits of vitamin D supplementation. In most studies, serum 25-hydroxyvitamin D [25(OH)D] decreases with increasing BMI above normal weight. These low 25(OH)D levels may also be a proxy for reduced exposure to sunlight-derived ultraviolet radiation (UVR). Here we investigate whether UVR and/or vitamin D supplementation modifies the development of obesity and type 2 diabetes in a murine model of obesity. Long-term suberythemal and erythemal UVR significantly suppressed weight gain, glucose intolerance, insulin resistance, nonalcoholic fatty liver disease measures; and serum levels of fasting insulin, glucose, and cholesterol in C57BL/6 male mice fed a high-fat diet. However, many of the benefits of UVR were not reproduced by vitamin D supplementation. In further mechanistic studies, skin induction of the UVR-induced mediator nitric oxide (NO) reproduced many of the effects of UVR. These studies suggest that UVR (sunlight exposure) may be an effective means of suppressing the development of obesity and MetS, through mechanisms that are independent of vitamin D but dependent on other UVR-induced mediators such as NO.

Serum 25-hydroxyvitamin D concentrations and depressive symptoms among young adult men and women

There has been an increased interest in the role of vitamin D in depression; however, there have been few studies conducted in younger population groups. Our aim was to investigate the association between vitamin D status and depressive symptoms in a non-clinical young adult sample living in Dunedin, New Zealand. A cross-sectional sample of 615 young adults completed a questionnaire including demographics and the Centre for Epidemiological Studies Depression Scale (CES-D). Height, weight and a blood sample for 25-hydroxyvitamin D [25(OH)D] was obtained. Serum 25(OH)D was used to predict depression scores, adjusting for potential confounders including time spent outdoors for 13 consecutive days, BMI, age, sex and ethnicity. Prevalence of low vitamin D was high even in this age group, and serum 25(OH)D was negatively associated with depression symptoms before and after adjustment. When investigating the relationship between the presence versus absence of depressive symptoms and quartiles of 25(OH)D, participants in the lowest quartile were more likely to report depressive symptoms compared with those in the highest quartile. Although our findings suggest that vitamin D is a predictor of depression symptomatology, even when controlling for time spent outdoors, a randomised controlled trial in this young adult target group is needed to confirm the association.

Lifestyle medicine for depression

The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. "Lifestyle Medicine" provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated, due to the complexity of human illness/wellbeing, the emerging evidence encourages a more integrative approach for depression, and an acknowledgment that lifestyle modification should be a routine part of treatment and preventative efforts.