Depression subtypes and obesity in adults: A systematic review and meta-analysis

Separating the effects of childhood and adult obesity on depression, subjective well-being, and suicide attempt: a Mendelian randomization study

Observational studies have linked obesity, both in childhood and adulthood, with higher risks of depression, reduced subjective well-being (SWB), and suicide attempts (SA). However, the causality remains unclear. This study aimed to investigate the causal effects of childhood and adult obesity on depression, SWB, and SA. A bidirectional two-sample Mendelian randomization (MR) was performed using genome-wide association study (GWAS) data to examine the causal effects of body mass index (BMI) on depression, SWB, and SA. The inverse variance weighted method was used for primary analysis. Univariable and multivariable MR were employed to assess the total and independent effects of early life and adult body size. Cochran's Q test and MR-Egger intercept were applied to evaluate heterogeneity and pleiotropy. Genetically predicted BMI was significantly associated with an increased risk of major depressive disorder (MDD: OR = 1.13, 95%CI = 1.06-1.22, p = 6.1 × 10⁻⁴), SA-ISGC (OR = 1.17, 95%CI = 1.08-1.27, p = 1.9 × 10⁻⁴), and SA-iPSYCH (OR = 1.31, 95%CI = 1.12-1.54, p = 6.2 × 10⁻⁴). No significant causal effects of MDD, SWB, or SA on BMI were found. Early-life body size showed no direct effect on MDD or SA. However, adult body size was directly linked to increased risks of MDD (OR = 1.32, 95%CI = 1.13-1.55, p = 4.7 × 10⁻⁴), SA-ISGC (OR = 1.24, 95%CI = 1.03-1.47, p = 0.022), and SA-iPSYCH (OR = 1.80, 95%CI = 1.29-2.50, p = 5.6 × 10⁻⁴). This study provides robust evidence supporting a causal link between obesity and an increased risk of both depression and SA, with adult body size exerting a more direct impact on these outcomes than early-life body size.

The association between metabolically healthy obesity and risk of depression: a systematic review and meta-analysis

This review aimed to explore the association between metabolically healthy obesity (MHO) and the risk of depression. Databases (EMBASE, PubMed, Web of Science, Cochrane Library) were searched up to 20 June 2024. Observational studies were included if they compared groups with MHO, metabolically unhealthy nonobesity, and metabolically unhealthy obesity to groups with metabolically healthy nonobesity for the risk of depression. The random-effect model was used to calculate the pooled odds ratios (ORs). Subgroup analyses and meta-regressions were conducted according to age, study design, definition of MHO, BMI cut-off value, depression assessment method, geographic location, ethnicity, development status, and gender to explore the sources of heterogeneity. Three cohorts and 9 cross-sectional studies (N = 1,277,267 participants) were included in this review. Individuals with MHO (OR 1.08 [95% CI 1.04, 1.12], I² = 88.3%), metabolically unhealthy nonobesity (OR 1.15 [95% CI 1.04, 1.28], I² = 99.6%), and metabolically unhealthy obesity (OR 1.30 [95% CI 1.12, 1.51], I² = 99.8%) had an increased risk of depression than individuals with metabolically healthy nonobesity. The association between MHO and risk of depression was stronger in women (OR = 1.14; 95% CI: 1.08-1.20) and populations from North America (OR = 1.26; 95% CI: 1.01-1.58) and Europe (OR = 1.23; 95% CI: 1.07-1.41). Inconsistencies in MHO definitions and BMI cutoff values across studies were important sources of heterogeneity (subgroup analysis: PQ = 29.87, p = 0.001; meta-regression: p = 0.015, R² = 100%). MHO was associated with an increased risk of depression, particularly among women and populations from North America and Europe. These high-risk groups need personalized interventions. Standardizing definition for MHO could enhance comparability across studies. Future prospective cohort studies are needed to validate our findings by including populations from developing nations and employing rigorous definitions.

A menu for microbes: unraveling appetite regulation and weight dynamics through the microbiota-brain connection across the lifespan

Appetite, as the internal drive for food intake, is often dysregulated in a broad spectrum of conditions associated with over- and under-nutrition across the lifespan. Appetite regulation is a complex, integrative process comprising psychological and behavioral events, peripheral and metabolic inputs, and central neurotransmitter and metabolic interactions. The microbiota-gut-brain axis has emerged as a critical mediator of multiple physiological processes, including energy metabolism, brain function, and behavior. Therefore, the role of the microbiota-gut-brain axis in appetite and obesity is receiving increased attention. Omics approaches such as genomics, epigenomics, transcriptomics, proteomics, and metabolomics in appetite and weight regulation offer new opportunities for featuring obesity phenotypes. Furthermore, gut-microbiota-targeted approaches such as pre-, pro-, post-, and synbiotic, personalized nutrition, and fecal microbiota transplantation are novel avenues for precision treatments. The aim of this narrative review is 1) to provide an overview of the role of the microbiota-gut-brain axis in appetite regulation across the lifespan and 2) to discuss the potential of omics and gut microbiota-targeted approaches to deepen understanding of appetite regulation and obesity.

Depression and Obesity

PURPOSE OF REVIEW

To summarize the recent literature regarding the interaction between the public health concerns of obesity and depression and provide preliminary recommendations for assessment and management of patients with co-occurring obesity and depression. RECENT FINDINGS : Recent studies have reinforced that while there is a bi-directional link between obesity and depression, there is stronger evidence that obesity contributes to the development of depression. Recent research has also elucidated potential mediating factors in the association between depression and obesity (e.g., demographical, biological, and psychological) as well as a moderating effect of treatment of depression on outcomes for treatment of obesity. There is evidence to suggest that in co-occurring depression and obesity, it is beneficial to treat depression first. Cognitive behavioral therapies have demonstrated effectiveness in treating co-occurring depression and obesity and there is preliminary evidence suggesting that increasing emotion regulation and reducing weight bias internalization may be important treatment targets.

The role of obesity and adipose tissue dysfunction in osteoarthritis pain

Obesity has a pivotal and multifaceted role in pain associated with osteoarthritis (OA), extending beyond the mechanistic influence of BMI. It exerts its effects both directly and indirectly through various modifiable risk factors associated with OA-related pain. Adipose tissue dysfunction is highly involved in OA-related pain through local and systemic inflammation, immune dysfunction, and the production of pro-inflammatory cytokines and adipokines. Adipose tissue dysfunction is intricately connected with metabolic syndrome, which independently exerts specific effects on OA-related pain, distinct from its association with BMI. The interplay among obesity, adipose tissue dysfunction and metabolic syndrome influences OA-related pain through diverse pain mechanisms, including nociceptive pain, peripheral sensitization and central sensitization. These complex interactions contribute to the heightened pain experience observed in individuals with OA and obesity. In addition, pain management strategies are less efficient in individuals with obesity. Importantly, therapeutic interventions targeting obesity and metabolic syndrome hold promise in managing OA-related pain. A deeper understanding of the intricate relationship between obesity, metabolic syndrome and OA-related pain is crucial and could have important implications for improving pain management and developing innovative therapeutic options in OA.

The relationship between depression and relative fat mass (RFM): A population-based study

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.

Depressive disorder subtypes, depressive symptom clusters, and risk of obesity and diabetes: A systematic review

BACKGROUND

Overlapping but divided literatures suggest certain depression facets may pose greater obesity and diabetes risk than others. Our objectives were to integrate the major depressive disorder (MDD) subtype and depressive symptom cluster literatures and to clarify which facets are associated with the greatest cardiometabolic disease risk.

METHODS

We conducted a systematic review of published studies examining associations of ≥2 MDD subtypes or symptom clusters with obesity or diabetes risk outcomes. We report which facets the literature is "in favor" of (i.e., having the strongest or most consistent results).

RESULTS

Forty-five articles were included. Of the MDD subtype-obesity risk studies, 14 were in favor of atypical MDD, and 8 showed similar or null associations across subtypes. Of the symptom cluster-obesity risk studies, 5 were in favor of the somatic cluster, 1 was in favor of other clusters, and 5 were similar or null. Of the MDD subtype-diabetes risk studies, 7 were in favor of atypical MDD, 3 were in favor of other subtypes, and 5 were similar or null. Of the symptom cluster-diabetes risk studies, 7 were in favor of the somatic cluster, and 5 were similar or null.

LIMITATIONS

Limitations in study design, sample selection, variable measurement, and analytic approach in these literatures apply to this review.

CONCLUSIONS

Atypical MDD and the somatic cluster are most consistently associated with obesity and diabetes risk. Future research is needed to establish directionality and causality. Identifying the depression facets conferring the greatest risk could improve cardiometabolic disease risk stratification and prevention programs.

Increased regional body fat is associated with depressive symptoms: a cross-sectional analysis of NHANES data obtained during 2011-2018

AIMS

The findings from previous epidemiological studies of the association between regional body fat and depressive symptoms have been unclear. We aimed to determine the association between the body fat in different regions and depressive symptoms based on data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

This study included 3393 participants aged ≥ 20 years from the NHANES performed during 2011-2018. Depressive symptoms were assessed using the Patient Health Questionnaire-9. The fat mass (FM) was measured in different regions using dual-energy X-ray absorptiometry to determine the total FM, trunk FM, arm FM, and leg FM. The FM index (FMI) was obtained by dividing the FM in kilograms by the square of the body height in meters. Weighted data were calculated in accordance with analytical guidelines. Linear logistic regression models were used to quantify the association between regional FMI and depressive symptoms. Univariate and stratified analyses were also performed.

RESULTS

The participants in this study comprised 2066 males and 1327 females. There were 404 (11.91%) participants with depressive symptoms, who were aged 40.89 ± 11.74 years and had a body mass index of 30.07 ± 7.82 kg/m². A significant association was found between total FMI and depressive symptoms. In the fully adjusted multivariate regression model, a higher total FMI (odds ratio = 2.18, 95% confidence interval [CI] = 1.08-4.39) was related to a higher risk of depressive symptoms, while increased total FMI (β = 1.55, 95% CI = 0.65-2.44, p = 0.001), trunk FMI (β = 0.57, 95% CI = 0.04-1.10, p = 0.036), and arm FMI (β = 0.96, 95% CI = 0.33-1.59, p = 0.004) were significantly associated with PHQ-9 (Patient Health Questionnaire-9) scores, whereas the leg FMI was not (p = 0.102). The weighted association between total FMI and depressive symptoms did not differ significantly between most of the subpopulations (all p values for interaction > 0.05). The risk of having depression was higher in individuals who were non-Hispanic Whites, smokers, drinkers, obese, and had diabetes and thyroid problems (p < 0.05).

CONCLUSION

These findings suggest that the population with a higher regional FMI is more likely to have depressive symptoms, especially in those who also have an increased total FMI. The association is more pronounced in individuals who are smokers, drinkers, obese, and have diabetes and thyroid problems.

The Relationship Between Obesity and Internet Addiction in University Students: A Cross-Sectional Study

PURPOSE

The purpose of this study was to investigate the relationship between obesity and internet addiction in first-year university students (aged 18-25 years).

DESIGN

The study was designed using a cross-sectional analytic model.

SETTING

Data collection took place at Dokuz Eylul University, involving a diverse group of first-year students from different faculties.

SUBJECTS

The study population comprised 12,365 students, with 2890 individuals selected using cluster sampling.

MEASURES

Internet addiction was evaluated using the Online Cognition Scale (OCS). Data on obesity-related variables and demographic details were collected through a questionnaire. Descriptive statistics, chi-square analysis, t test, and ANOVA were applied for statistical evaluation.

RESULTS

The study included 2105 participants, with 43.8% males and 56.2% females. A significant positive correlation was found between body mass index (BMI) and OCS scores (P = .000), indicating a higher prevalence of internet addiction among individuals with higher BMI. Males had higher mean OCS scores (91.19 ± 35.14) than females (80.21 ± 30.51) (P = .00). Overweight and obese individuals exhibited higher scores on OCS sub-dimensions (P < .005). Notably, individuals with a BMI over 25 were categorized as overweight, and those with a BMI over 30 were classified as obese.

CONCLUSIONS

The findings demonstrate a noteworthy relationship between internet addiction and obesity among university students. The study emphasizes the necessity of increased attention to this issue in Turkey for the implementation of effective interventions and preventive measures.

Understanding the subtypes of non-suicidal self-injury: A new conceptual framework based on a systematic review

Non-suicidal self-injury (NSSI) is a significant public health problem, but there is no consistent evidence of its risk factors. One possibility is that there are subtypes NSSI that have different risk factors and clinical symptoms. In this review we evaluated the evidence of subtypes to determine if there were consistent subtypes of NSSI that emerged across studies. Four databases (Medline; Embase; PsycINFO; Web of Science) were searched to identify studies that used data-driven approaches and were published before November 9, 2022. There were 21 studies with 23 unique samples for review. Most of the included studies used NSSI symptoms or personal characteristics as the subtyping indicators, revealing 2-5 subtypes of NSSI. Variations in subtyping indicators, sample characteristics, and statistical methods may have contributed to the inconsistent number and characteristics of subtypes across studies. A new conceptual framework is proposed to integrate these diverse findings, highlighting the important roles of NSSI function and psychological pain in differentiating NSSI subtypes. This framework sheds light on the differences among self-injurers and offers insights for future endeavors to address the complexities of NSSI.

Sex difference in the association between BMI and cognitive impairment in Chinese older adults

BACKGROUND

The association between body mass index (BMI) and cognitive impairment (CI) has been the subject of extensive research, yet the precise dose-response effects remain undefined.

METHODS

Older adults were selected from the 2011/2012 survey at baseline and the new recruits from the 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to evaluate the association between BMI categories and CI, and Restricted Cubic Spline (RCS) was used to explore the nonlinear relationship between BMI and CI.

RESULTS

The study included 29,380 older adults aged from 65 to 117 years, with an average age of 82 years. Of these, 13,465 were men, and 5359 exhibited cognitive impairment. The logistic model indicated that in female participants, being underweight was positively correlated with CI (OR:1.32; 95%CI 1.20-1.46), whereas being overweight was inversely correlated with CI (OR:0.86; 95%CI 0.75-0.99), and we didn't find any association between BMI category and CI in male participants. RCS modeling revealed a U-shaped relationship between BMI and CI. When stratified by sex, men exhibited a similar trend, with the lowest risk at a BMI of 22.774 kg/ m2, while women had the lowest risk of CI at a BMI of 24.817 kg/ m2.

LIMITATION

This was a cross-sectional study, it cannot provide information on causal relationships.

CONCLUSION

A U-shaped relationship was observed between BMI and CI in older adults, more pronounced in the male population, suggesting that male older adults may need to manage their BMI more rigorously.

Income or educational attainment: which is more effective in the fight against overweight? Evidence from Spain and Andalusia

Considered the epidemic of the 21st century by the WHO, obesity is a global problem that is on the rise and will continue to increase in the coming years. Spain and Andalusia, in particular, are no exception to this pathology, which has tripled since the 1970s, representing a public health challenge. The aim of this study is to analyse the socioeconomic determinants of this pathology, with special emphasis on answering the question of what has a greater influence on overweight, education level, or income. For this purpose, we have used the European Survey of Health in Spain (ESHS-2020), a microdata base, with a total of 22,072 valid individual observations (of which 2,820 belong to the Andalusian population). Results we obtain in our estimations of qualitative response models reveal that, although both income and educational attainment could be effective in the fight against overweight, the social gradient of this health problem is greater with respect to educational attainment. Additionally, there are many other variables and other factors related to the individual's overweight (mental health, subjective state of health, oral health, among others) which are much less explored and which must be considered in health policies to combat this disease.

The potential causal relationship between various lifestyles and depression: a univariable and multivariable Mendelian randomization study

Background

Previous studies have shown that lifestyle was associated with depression. Thus, the aim of this study was to examine the causality between multiple lifestyles and depression by Mendelian randomization (MR) analysis.

Methods

The single-nucleotide polymorphisms (SNPs) of depression, alcoholic drinks per week, sleeplessness or insomnia, body mass index (BMI), mood swings, weekly usage of mobile phone in the last 3 months, beef intake, cooked vegetable intake, and "smoking status: never" were acquired from the Integrative Epidemiology Unit Open genome-wide association study database. Causal effects of eight exposure factors and depression were investigated using MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode, and results were primarily referred to IVW. Subsequently, univariable MR (UVMR) analysis was performed on eight exposure factors and depression, separately. In addition, sensitivity analysis, including heterogeneity test, horizontal pleiotropy, and leave-one-out (LOO) methods, was conducted to evaluate the stability of MR results. Furthermore, multivariable MR (MVMR) analysis was carried out.

Results

UVMR analysis revealed that all eight exposure factors were causally associated with depression; alcoholic drinks per week, sleeplessness or insomnia, BMI, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake were risk factors, and beef intake and "smoking status: never" were protection factors. Heterogeneity tests revealed no heterogeneity for alcoholic drinks per week, sleeplessness or insomnia, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake. Meanwhile, there was no horizontal pleiotropy in UVMR, and LOO analysis verified that univariable analysis results were reliable. Moreover, MVMR analysis indicated that mood swings and weekly usage of mobile phone in the last 3 months were risk factors, and beef intake was a protection factor for depression when multiple factors occurred at the same time.

Conclusion

Alcoholic drinks per week, sleeplessness or insomnia, BMI, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake were risk factors, and beef intake and "smoking status: never" were protection factors. In addition, mood swings, weekly usage of mobile phone in the last 3 months, and beef intake had a direct effect on depression when multiple factors occurred simultaneously.

Subtypes of major depressive disorders and objectively measured physical activity and sedentary behaviors in the community

BACKGROUND

Lack of physical activity (PA) and high sedentary behavior (SB) may enhance mental health problems, including depression, and are associated with increased mortality. Aside from a large body of research on major depressive disorder (MDD) assessed as an entity and either PA or SB, few studies have examined associations among subtypes of MDD and both PA and SB simultaneously derived from wrist-worn accelerometers. Accordingly, our aim was to explore the associations among MDD subtypes (atypical, melancholic, combined atypical-melancholic and unspecified) and four actigraphy-derived behaviors combining the levels of PA and SB.

METHODS

The sample stemmed from CoLaus|PsyCoLaus, a population-based cohort study, consisting of 2375 participants (55.1% women; mean age: 62.4 years) who wore an accelorometer for 14 days after a physical exam and subsequently completed a semi-structured psychiatric interview. Activity behaviors were defined according to the combination of the levels of moderate-to-vigorous intensity PA and SB. Associations of remitted MDD subtypes, current MDD and physical inactivity behaviors were assessed using multinomial logistic regression, adjusted for socio-demographic characteristics, a history of anxiety, alcohol and drug use disorders and cardiovascular risk factors.

RESULTS

In the fully adjusted model, participants with the remitted combined atypical-melancholic subtype had a higher risk of being more physically inactive.

CONCLUSIONS

Our findings suggest that low PA and high SB are not restricted to the duration of depressive episodes in people with atypical and melancholic episodes. The lack of PA and high SB in this group of depressive patients exposes them to an additional long-term cardiovascular risk and measures to increase PA may be particularly fruitful in this MDD subgroup.

The relationship of within-individual and between-individual variation in mental health with bodyweight: An exploratory longitudinal study

BACKGROUND

Poor mental health is associated with obesity, but existing studies are either cross-sectional or have long time periods between measurements of mental health and weight. It is, therefore, unclear how small fluctuations in mental wellbeing within individuals predict bodyweight over short time periods, e.g. within the next month. Studying this could identify modifiable determinants of weight changes and highlight opportunities for early intervention.

METHODS

2,133 UK adults from a population-based cohort completed monthly mental health and weight measurements using a mobile app over a period of 6-9 months. We used random intercept regression models to examine longitudinal associations of depressive symptoms, anxiety symptoms and stress with subsequent weight. In sub-group analyses, we included interaction terms of mental health variables with baseline characteristics. Mental health variables were split into "between-individual" measurements (= the participant's median score across all timepoints) and "within-individual" measurements (at each timepoint, the difference between the participant's current score and their median).

RESULTS

Within-individual variation in depressive symptoms predicted subsequent weight (0.045kg per unit of depressive symptom severity, 95% CI 0.021-0.069). We found evidence of a moderation effect of baseline BMI on the association between within-individual fluctuation in depressive symptoms and subsequent weight: The association was only apparent in those with overweight/obesity, and it was stronger in those with obesity than those with overweight (BMI<25kg/m2: 0.011kg per unit of depressive symptom severity [95% CI -0.017 to 0.039]; BMI 25-29.9kg/m2: 0.052kg per unit of depressive symptom severity [95%CI 0.010-0.094kg]; BMI≥30kg/m2: 0.071kg per unit of depressive symptom severity [95%CI 0.013-0.129kg]). We found no evidence for other interactions, associations of stress and anxiety with weight, or for a reverse direction of association.

CONCLUSION

In this exploratory study, individuals with overweight or obesity were more vulnerable to weight gain following higher-than-usual (for that individual) depressive symptoms than individuals with a BMI<25kg/m2.

Individual mental health patterns and the role of lifestyle among ageing adults over 20 years - the Doetinchem Cohort Study

OBJECTIVE

We explored the prevalence of individual mental health patterns and the role of lifestyle factors over 20 years.

STUDY DESIGN

We used data from the Doetinchem Cohort Study (1995-2019), a population-based study amongst adults (26-90 years) examined every five years in the Netherlands. Participants were classified in five pre-defined mental health patterns (persistent good, persistent poor, worsening, improving, varying) over 20 years (five rounds) using the MHI-5 questionnaire. BMI, sleep, smoking, alcohol consumption, and physical activity were dichotomised as healthy/unhealthy based on guidelines. The role of lifestyle at baseline (t1), 20 years later (t5), and longitudinally over 20 years (using pre-defined patterns) was explored using logistic regression.

RESULTS

Most participants had good mental health at t1 (85 %) and t5 (88 %). Over 20 years, 67 % followed a persistent good mental health pattern, 30 % a changing pattern, and 3 % a persistent poor pattern. Persistent poor and changing patterns were associated with unhealthy sleep and smoking at t1, t5, and with the 20-year unhealthy patterns. Persistent poor mental health was associated with stable unhealthy and changing sleep (OR=5.58(2.48-12.54) and OR=2.07(1.14-3.74), respectively), and with stable unhealthy and changing smoking (OR=3.35(1.58-7.11) and OR=2.53(1.40-4.57), respectively). Changing mental health was associated with changing (OR=1.54(1.26-1.88) and OR=1.64(1.30-2.07), respectively) and stable unhealthy (OR=1.80(1.23-2.64) and OR=2.24(1.60-3.14), respectively) sleep and smoking, respectively.

CONCLUSIONS

Persistent good and changing mental health patterns were more common than poor mental health in adults and were associated with smoking and sleep. Clarifying the underlying mechanisms and directionality between mental health and lifestyle could improve interventions.

Antidepressant pharmacological mechanisms: focusing on the regulation of autophagy

The core symptoms of depression are anhedonia and persistent hopelessness. Selective serotonin reuptake inhibitors (SSRIs) and their related medications are commonly used for clinical treatment, despite their significant adverse effects. Traditional Chinese medicine with its multiple targets, channels, and compounds, exhibit immense potential in treating depression. Autophagy, a vital process in depression pathology, has emerged as a promising target for intervention. This review summarized the pharmacological mechanisms of antidepressants by regulating autophagy. We presented insights from recent studies, discussed current research limitations, and proposed new strategies for basic research and their clinical application in depression.

The relationship of food addiction with binge eating disorder and obesity: A network analysis study

Food addiction (FA) has been associated with binge eating disorder (BED) and obesity at varying levels of severity and treatment outcomes. Despite much debate and scientific interest in FA, the mechanisms that underlie its co-occurrence with both conditions are not yet well understood. In order to understand this relationship, this study explores FA in a clinical sample of individuals with BED and obesity using network analysis (NA). A total of 303 patients (151 with BED and 152 with obesity) completed a battery of tests that investigated eating psychopathology, eating behaviours, emotional dysregulation, depression and FA. Two different NAs were conducted to investigate the interaction between these variables and FA. The BED and obesity groups were comparable in age (38 ± 14 vs. 42 ± 13 years), body mass index (38.8 ± 8.5 vs 42.4 ± 7.8), sex and demographics. According to the expected influence values, binge eating severity and depression were identified as the central nodes in both networks. In the BED group, binge eating severity was the central node and showed strong connections to both FA and grazing. In contrast, in the obesity group, depression was the central node, but its connections were weak, with only marginal associations to FA. These results suggest that FA represents an important and distinct construct of the two populations. In patients with BED, FA is intimately connected to other loss-of-control-related eating behaviours, such as binge eating and grazing. Conversely, in those with obesity, depression explains the relationship of FA with pathological eating behaviours. The presence of FA seems to be a distinguishing characteristic in the psychopathology of patients suffering from obesity with and without BED, and this could have implications for the prevention, treatment and management of these disorders.

Obesity and psychological distress

The relationship between high body weight and mental health has been studied for several decades. Improvements in the quality of epidemiological, mechanistic and psychological research have brought greater consistency to our understanding of the links. Large-scale population-based epidemiological research has established that high body weight is associated with poorer mental health, particularly depression and subclinical depressive symptoms. There is some evidence for bidirectional relationships, but the most convincing findings are that greater body weight leads to psychological distress rather than the reverse. Particular symptoms of depression and distress may be specifically related to greater body weight. The psychological stress induced by weight stigma and discrimination contributes to psychological distress, and may in turn handicap efforts at weight control. Heightened systemic inflammation and dysregulation of the hypothalamic-pituitary-adrenal axis are biological mechanisms that mediate in part the relationship of greater body weight with poorer mental health. Changing negative societal attitudes to high body weights would improve the wellbeing of people living with obesity, and promote more effective weight-inclusive attitudes and behaviours in society at large, particularly in healthcare settings. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.

Lipids in major depressive disorder: new kids on the block or old friends revisited?

Major depressive disorder (MDD) is a psychiatric mood disorder that results in substantial functional impairment and is characterized by symptoms such as depressed mood, diminished interest, impaired cognitive function, and vegetative symptoms such as disturbed sleep. Although the exact etiology of MDD is unclear, several underlying mechanisms (disturbances in immune response and/or stress response) have been associated with its development, with no single mechanism able to account for all aspects of the disorder. Currently, about 1 in 3 patients are resistant to current antidepressant therapies. Providing an alternative perspective on MDD could therefore pave the way for new, unexplored diagnostic and therapeutic solutions. The central nervous system harbors an enormous pool of lipids and lipid intermediates that have been linked to a plethora of its physiological functions. The aim of this review is therefore to provide an overview of the implications of lipids in MDD and highlight certain MDD-related underlying mechanisms that involve lipids and/or their intermediates. Furthermore, we will also focus on the bidirectional relationship between MDD and the lipid-related disorders obesity and type 2 diabetes.

Body mass index and clinical outcomes in individuals with major depressive disorder: Findings from the GSRD European Multicenter Database

BACKGROUND

Individuals with major depressive disorder (MDD) are at higher risk for obesity. In turn, weight gain is a predisposing factor for depression. Although clinical data are sparse, suicide risk also appears to be elevated in obese patients. This study used data from the European Group for the Study of Resistant Depression (GSRD) to investigate clinical outcomes associated with body mass index (BMI) in MDD.

METHODS

Data were drawn from 892 participants with MDD over the age of 18 years (580 female, 50.5 ± 13.6 years). Response and resistance to antidepressant medication, depression rating scale scores, and further clinical and sociodemographic variables were compared using multiple logistic and linear regressions controlled for age, sex, and risk of weight gain due to psychopharmacotherapy.

RESULTS

Of the 892 participants, 323 were categorized as treatment-responsive and 569 as treatment-resistant. Within this cohort, 278 (31.1 %) were overweight (BMI = 25-29.9 kg/m2) and 151 (16.9 %) were obese (BMI > 30 kg/m2). Elevated BMI was significantly associated with higher suicidality, longer duration of psychiatric hospitalizations over their lifetimes, earlier age of onset of MDD, and comorbidities. There was a trend-wise association of BMI with treatment resistance.

LIMITATIONS

Data were analyzed in a retrospective, cross-sectional design. BMI was used as an exclusive measure of overweight and obesity.

CONCLUSIONS

Participants with comorbid MDD and overweight/obesity were at risk for worse clinical outcomes, suggesting that weight gain should be closely monitored in individuals with MDD in daily clinical practice. Further studies are needed to explore the neurobiological mechanisms linking elevated BMI to impaired brain health.

Objectively assessed sleep and physical activity in depression subtypes and its mediating role in their association with cardiovascular risk factors

The aims of this study were to investigate the associations of major depressive disorder (MDD) and its subtypes (atypical, melancholic, combined, unspecified) with actigraphy-derived measures of sleep, physical activity and circadian rhythms; and test the potentially mediating role of sleep, physical activity and circadian rhythms in the well-established associations of the atypical MDD subtype with Body Mass Index (BMI) and the metabolic syndrome (MeS). The sample consisted of 2317 participants recruited from an urban area, who underwent comprehensive somatic and psychiatric evaluations. MDD and its subtypes were assessed via semi-structured diagnostic interviews. Sleep, physical activity and circadian rhythms were measured using actigraphy. MDD and its subtypes were associated with several actigraphy-derived variables, including later sleep midpoint, low physical activity, low inter-daily stability and larger intra-individual variability of sleep duration and relative amplitude. Sleep midpoint and physical activity fulfilled criteria for partial mediation of the association between atypical MDD and BMI, and physical activity also for partial mediation of the association between atypical MDD and MeS. Our findings confirm associations of MDD and its atypical subtype with sleep and physical activity, which are likely to partially mediate the associations of atypical MDD with BMI and MeS, although most of these associations are not explained by sleep and activity variables. This highlights the need to consider atypical MDD, sleep and sedentary behavior as cardiovascular risk factors.

Women's lived experiences of sex hormones and life-related to bariatric surgery: an interpretative qualitative study

OBJECTIVES

The study aimed to explore the lived experiences of women with severe obesity before and after undergoing bariatric surgery with a special focus on possible effects of changed sex hormone levels.

DESIGN

A qualitative interview study with transcribed text analysis based on Gadamer's hermeneutics.

SETTING

Regional hospital and outpatient bariatric clinic in central Sweden.

PARTICIPANTS

Ten women (age 23-38 years) having undergone Roux-en-Y gastric bypass surgery between 2016 and 2019 were interviewed.

RESULTS

The transcribed interviews were analysed according to Gadamer's hermeneutics. Text horizons, interpreter horizons and fact horizons were derived and formed the fusions 'Recognition of unhealthy body weight', 'Dealing with other people's opinions and society's norms', 'Life has changed in a positive way' and 'Accepting inner self and bodily changes'.

CONCLUSION

Women highlighted weight and body size in their responses. The study provided a deeper understanding of the situation of women living with obesity and pros and cons of having undergone bariatric surgery. Experiences of changes in sex hormones and fertility were discussed but not central to the informants. Participants emphasised the need to be prepared and properly supported in dealing with changes in life after bariatric surgery and subsequent weight loss.

Obesity as pleiotropic risk state for metabolic and mental health throughout life

Obesity, a highly prevalent disorder and central diagnosis of the metabolic syndrome, is linked to mental health by clinical observations and biological pathways. Patients with a diagnosis of obesity may show long-lasting increases in risk for receiving psychiatric co-diagnoses. Austrian national registry data of inpatient services from 1997 to 2014 were analyzed to detect associations between a hospital diagnosis of obesity (ICD-10: E66) and disorders grouped by level-3 ICD-10 codes. Data were stratified by age decades and associations between each pair of diagnoses were computed with the Cochran-Mantel-Haenszel method, providing odds ratios (OR) and p values corrected for multiple testing. Further, directions of the associations were assessed by calculating time-order-ratios. Receiving a diagnosis of obesity significantly increased the odds for a large spectrum of psychiatric disorders across all age groups, including depression, psychosis-spectrum, anxiety, eating and personality disorders (all p_corr < 0.01, all OR > 1.5). For all co-diagnoses except for psychosis-spectrum, obesity was significantly more often the diagnosis received first. Further, significant sex differences were found for most disorders, with women showing increased risk for all disorders except schizophrenia and nicotine addiction. In addition to the well-recognized role in promoting disorders related to the metabolic syndrome and severe cardiometabolic sequalae, obesity commonly precedes severe mental health disorders. Risk is most pronounced in young age groups and particularly increased in female patients. Consequently, thorough screening for mental health problems in patients with obesity is urgently called for to allow prevention and facilitate adequate treatment.

Bangpungtongsung-san for patients with major depressive disorder: study protocol for a randomized controlled phase II clinical trial

BACKGROUND

Bangpungtongsung-san (BTS) is a representative herbal medicine that has been widely used for patients with obesity in east Asian countries. Various preclinical studies have demonstrated the anti-depressive effect of BTS granules in various animal models of depression. This phase II trial aimed to explore the efficacy and safety of BTS in human patients with depression.

METHODS

A total of 126 patients diagnosed with major depressive disorder and who are not underweight (body mass index ≥ 18.5 kg/m²) will be enrolled in this study. Eligible participants will be randomly allocated into three groups: the high-dose BTS, low-dose BTS, and placebo groups in a 1:1:1 ratio. BTS or placebo granules will be orally administered twice a day for 8 weeks. The BTS and placebo granules will be made to have identical color, scent, and shape, and participants and investigators will be blinded to the allocation. The primary efficacy endpoint is the change from baseline of the 17-item Hamilton Depression Rating Scale total score at 8 weeks. The superiority of the high- and low-dose BTS granules to the placebo granules will be tested.

DISCUSSION

The results of this clinical trial will provide evidence on the efficacy and safety of BTS for patients with major depressive disorder. This study will be conducted in accordance with ethical and regulatory guidelines, and the results will be submitted and published in international peer-reviewed journals.

TRIAL REGISTRATION

CRIS registration Number: KCT0007571; registered on 2022/07/26 ( https://cris.nih.go.kr/cris/search/detailSearch.do/23192 ).

Weight changes in adults with major depressive disorder: A systematic review and meta-analysis of prospective studies

BACKGROUND

Major Depressive Disorder (MDD) and obesity are bidirectionally related, but the amount of weight-gain secondary to MDD is unknown. We aimed to estimate the adjusted effect of MDD on weight-change in prospective studies compared to individuals without MDD.

METHODS

Scopus/MEDLINE, PsycInfo, Web of Science and Cochrane were systematically searched for prospective observational studies of participants with a diagnosis of MDD. We included studies that conducted regression analyses on weight-variables. We searched for weight-variables reported at baseline, follow-up, and regression analyses. A meta-analysis of the odds ratios reported in logistic regression models was performed using the generic inverse weight variance method.

RESULTS

Eight studies were included with a total of 60,443 subjects; 56.8 % with MDD. Weight-variables included weight, BMI, waist circumference, fat mass, and obesity incidence. In three follow-up reports, weight-variables increased more in participants with MDD and its subphenotypes than in control subjects, except for one MDD subphenotype. Meta-analysis of three eligible studies (n = 21,935) showed a significantly greater likelihood of incident obesity in participants with MDD (OR:1.48, 95%CI 1.03-2.13). MDD subphenotype reports might suggest a greater risk for atypical MDD.

LIMITATIONS

Heterogeneity in weight related variables, follow-ups, and regression models; scarcity of follow-up data; and limited studies eligible for meta-analysis.

CONCLUSIONS

Despite previous associations between MDD and obesity, current prospective evidence on MDD related weight-change is scarce and heterogeneous. Our findings suggest a need to standardize weight-change assessment in MDD trials. Moreover, careful weight tracking and management should be incorporated in clinical settings. PROSPERO registration CRD42020214427.

Association between adiposity and emergent depressive symptoms in a 10-years prospective cohort of older adults: The EpiFloripa Aging study

BACKGROUND

The association between obesity and depressive symptoms has been described in the literature, but there is a scarcity of longitudinal data. This study aimed to verify the association between body mass index (BMI) and waist circumference and the incidence of depressive symptoms over a 10-year follow-up in a cohort of older adults.

METHODS

Data from the first (2009-2010), second (2013-2014), and third (2017-2019) waves of the EpiFloripa Aging Cohort Study were used. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS-15) and classified in significant depressive symptoms for those with ≥6 points. The Generalized Estimating Equations model was used to estimate the longitudinal association between BMI and waist circumference and depressive symptoms across a 10-year follow-up.

RESULTS

The incidence of depressive symptoms (N = 580) was 9.9 %. The relationship between BMI and the incidence of depressive symptoms in older adults followed a U-shaped curve. Older adults with obesity had an incidence relative ratio of 76 % (IRR = 1.24, p = 0.035) for increasing the score of depressive symptoms after 10 years, compared to those with overweight. The higher category of waist circumference (Male: ≥102; Female: ≥88 cm) was associated with depressive symptoms (IRR = 1.09, p = 0.033), only in a non-adjusted analysis.

LIMITATIONS

Relatively high follow-up dropout rate; Few individuals in the underweight BMI category; BMI must be considered with caution because it does not measure only fat mass.

CONCLUSIONS

Obesity was associated with the incidence of depressive symptoms when compared with overweight in older adults.

Depression is a risk factor for metabolic syndrome: Results from the ELSA-Brasil cohort study

INTRODUCTION

Metabolic Syndrome (MetS) and depression comorbidity has been recognized, but its directionality is still uncertain. The aims of this study was to assess the association between depression (diagnosis and severity) and MetS (components, diagnosis and trajectory) in the baseline and over a 4-year follow-up period.

MATERIAL AND METHODS

Baseline and follow-up data from 13,883 participants of the Brazilian Longitudinal Study of Adult Health were analyzed. The Clinical Interview Schedule Revised assessed depressive episode and its severity. MetS components and diagnosis were assessed according to the National Cholesterol Education Program Adult Treatment Panel III. Participants were grouped according to MetS trajectory as recovered, incident and persistent MetS. Logistic regression analysis was conducted estimating odds ratios (OR) and 95% confidence intervals (95%CI).

RESULTS

Baseline depression was positively associated with recovered (OR = 1.59, 95%CI 1.18-2.14), incident (OR = 1.45, 95%CI 1.09-1.91) and persistent (OR = 1.70, 95%CI 1.39-2.07) MetS. Baseline depression was also associated with large waist circumference (OR = 1.47, 95%CI 1.23-1.75), high triglycerides (OR = 1.23, 95%CI 1.02-1.49), low high-density lipoprotein cholesterol (OR = 1.30, 95%CI 1.08-1.56), and hyperglycemia (OR = 1.38, 95%CI 1.15-1.66) at follow-up. Having three or more MetS components at follow-up was associated with baseline depression, with a positive dose-response effect (OR = 1.77, 95%CI 1.29-2.43; OR = 1.79, 95%CI 1.26-2.54; OR = 2.27, 95%CI 1.50-3.46, respectively). The magnitude of associations was greater in severe depression, when compared to moderate and mild.

DISCUSSION

These results support that depression is a risk factor for the development of MetS and highlights the need to follow metabolic and cardiovascular alterations in the presence of depression.

A prospective observational study for a Federated Artificial Intelligence solution for moniToring mental Health status after cancer treatment (FAITH): study protocol

BACKGROUND

Depression is a common condition among cancer patients, across several points in the disease trajectory. Although presenting higher prevalence rates than the general population, it is often not reported or remains unnoticed. Moreover, somatic symptoms of depression are common in the oncological context and should not be dismissed as a general symptom of cancer. It becomes even more challenging to track psychological distress in the period after the treatment, where connection with the healthcare system typically becomes sporadic. The main goal of the FAITH project is to remotely identify and predict depressive symptoms in cancer survivors, based on a federated machine learning (ML) approach, towards optimization of privacy.

METHODS

FAITH will remotely analyse depression markers, predicting their negative trends. These markers will be treated in distinct categories, namely nutrition, sleep, activity and voice, assessed in part through wearable technologies. The study will include 300 patients who have had a previous diagnosis of breast or lung cancer and will be recruited 1 to 5 years after the end of primary cancer. The study will be organized as a 12-month longitudinal prospective observational cohort study, with monthly assessments to evaluate depression symptoms and quality of life among cancer survivors. The primary endpoint is the severity of depressive symptoms as measured by the Hamilton Depression Rating Scale (Ham-D) at months 3, 6, 9 and 12. Secondary outcomes include self-reported anxiety and depression symptoms (HADS scale), and perceived quality of life (EORTC questionnaires), at baseline and monthly. Based on the predictive models gathered during the study, FAITH will also aim at further developing a conceptual federated learning framework, enabling to build machine learning models for the prediction and monitoring of depression without direct access to user's personal data.

DISCUSSION

Improvements in the objectivity of psychiatric assessment are necessary. Wearable technologies can provide potential indicators of depression and anxiety and be used for biofeedback. If the FAITH application is effective, it will provide healthcare systems with a novel and innovative method to screen depressive symptoms in oncological settings.

TRIAL REGISTRATION

Trial ID: ISRCTN10423782 . Date registered: 21/03/2022.

BMI Modifies the Association Between Depression Symptoms and Serum Copper Levels

Depression is one of the most common mental disorders which dramatically threatens public health and wellness. Copper has been known to be involved in many biological processes that could help explaining the occurrence of depression. However, studies focusing on its effect have yielded mixed results. The present study aims to evaluate the association between serum copper levels and depression symptoms. It also investigates the effect of modification of BMI (body mass index) on depression symptoms. A total of 5419 US adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 participated in the cross-sectional study. Logistic regression models were applied using depression levels as the outcome and serum cooper/selenium/zinc categories as the main predictor, with the adjustments of gender, age, marital status, race, education, family income level, alcohol drinking, cigarette smoking, diabetes, pressure, stroke, and BMI. The interaction terms for copper levels and other covariates were further incorporated into the model to assess their roles in predicting depression symptoms. The prevalence of depression symptoms was significantly higher in samples with a high copper level. Among the levels of serum copper, selenium, and zinc, only the association between depression symptoms and serum copper levels was observed to be significant in the unadjusted model (P = 0.002). Individuals with a high copper level (114-134 μg/dL) and a very high copper level (≥ 134 μg/dL) had 1.85 (95% CI 1.24, 2.77)- and 1.72 (95% CI 1.21, 2.44)-fold higher odds ratio of depression symptoms, respectively, compared to those with a normal serum copper level. Although the association was not significant in the adjusted models, in which confounders were added, the interaction of copper level, including high and very high copper levels, and obesity (BMI ≥ 30 kg/m²) exhibited significantly higher odds ratio (4.12 (95% CI 1.38, 12.27) and 4.53 (95% CI 1.87, 10.96)) of having depression symptoms. The concentration of serum copper was positively associated with the prevalence of depression symptoms. Obesity exacerbated the risk of having depression symptoms in people with high serum copper levels.

Shared genetics between classes of obesity and psychiatric disorders: A large-scale genome-wide cross-trait analysis

AIMS

Epidemiological studies demonstrate an association between classes of obesity and psychiatric disorders, although little is known about shared genetics and causality of association. Thus, we aimed to investigate shared genetics and causal link between different classes of obesity and psychiatric disorders.

METHODS

We used genome-wide association study (GWAS) summary data range from 9725 to 500,199 sample sizes of European descent, conducted a large-scale genome-wide cross-trait association study to investigate genetic overlap between the classes of obesity and anorexia nervosa, attention-deficit/hyperactivity disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, schizophrenia, anxiety disorders and Tourette syndrome. We conducted transcriptome-wide association study analysis (TWAS) to identified variants regulated gene expression in those related disorders. Finally, pathway enrichment analysis to identified major pathways.

RESULTS

In the combined analysis, we replicated 211 previously reported loci and discovered 58 novel independent loci that were associated with all three classes of obesity and related psychiatric disorders. Functional analysis revealed that the identified variants regulated gene expression in major tissues belonging to exocrine/endocrine, digestive, circulatory, adipose, digestive, respiratory, and nervous systems, such as DCC, NEGR1, INO80E. Mendelian randomization analyses suggested that there may be a two-way or one-way causal relationship between obesity and psychiatric disorders.

CONCLUSION

This large-scale genome-wide cross-trait analysis identified shared genetics and potential causal links between classes of obesity and psychiatric disorders (attention deficit hyperactivity disorder, autism spectrum disorder, anorexia nervosa, major depressive disorder, schizophrenia, and obsessive-compulsive disorder). Such shared genetics suggests potential new biological functions in common among them.

Overweight, obesity, and individual symptoms of depression: A multicohort study with replication in UK Biobank

OBJECTIVES

Obesity is associated with increased risk of depression, but the extent to which this association is symptom-specific is unknown. We examined the associations of overweight and obesity with individual depressive symptoms.

METHODS

We pooled data from 15 population-based cohorts comprising 57,532 individuals aged 18 to 100 years at study entry. Primary analyses were replicated in an independent cohort, the UK Biobank study (n = 122,341, age range 38 to 72). Height and weight were assessed at baseline and body mass index (BMI) was computed. Using validated self-report measures, 24 depressive symptoms were ascertained once in 16 cross-sectional, and twice in 7 prospective cohort studies (mean follow-up 3.2 years).

RESULTS

In the pooled analysis of the primary cohorts, 22,045 (38.3 %) participants were overweight (BMI between 25 and 29.9 kg/m2), 12,025 (20.9 %) class I obese (BMI between 30 and 34.9 kg/m2), 7,467 (13.0 %) class II-III obese (BMI ≥ 35 kg/m2); and 7,046 (12.3 %) were classified as depressed. After multivariable adjustment, obesity class I was cross-sectionally associated with 1.11-fold (95 % confidence interval 1.01-1.22), and obesity class II-III with 1.31-fold (1.16-1.49) higher odds of overall depression. In symptom-specific analyses, robust associations were apparent for 4 of the 24 depressive symptoms ('could not get going/lack of energy', 'little interest in doing things', 'feeling bad about yourself, and 'feeling depressed'), with confounder-adjusted odds ratios of having 3 or 4 of these symptoms being 1.32 (1.10-1.57) for individuals with obesity class I, and 1.70 (1.34-2.14) for those with obesity class II-III. Elevated C-reactive protein and 21 obesity-related diseases explained 23 %-31 % of these associations. Symptom-specific associations were confirmed in longitudinal analyses where obesity preceded symptom onset, were stronger in women compared with men, and were replicated in UK Biobank.

CONCLUSIONS

Obesity is associated with a distinct set of depressive symptoms. These associations are partially explained by systemic inflammation and obesity-related morbidity. Awareness of this obesity-related symptom profile and its underlying biological correlates may inform better targeted treatments for comorbid obesity and depression.

Interventions targeting comorbid depression and overweight/obesity: A systematic review

BACKGROUND

Overweight/obesity and depression are highly co-occurring conditions with shared pathophysiology as well as social and economic determinants. To our knowledge, this is the first systematic review aims to comprehensively synthesize extant literature with a focus on the effectiveness of interventions targeting obesity and depression comorbidity.

METHODS

We searched databases including MEDLINE, ProQuest Central, Web of Science, PsycINFO, Cochrane Library, from inception of the databases until Nov 12, 2021. Articles were included if they reported on the effects of pharmacological, psychological or dietary interventions on comorbid depression and overweight/obesity as their primary or secondary outcome.

RESULTS

Of the 5480 identified records, 19 eligible researches comprising 15 RCTs and 4 uncontrolled longitudinal studies for 3408 participants with comorbid depression and overweight/obesity. The available literature is not sufficient to inform evidence-based treatments targeting obesity and comorbid depression contemporaneously. Notwithstanding, the combination of CBT and lifestyle intervention show efficacy targeting obesity and comorbid depression as do some nutritional supplements, antidepressants and anti-diabetic agents.

LIMITATIONS

The high heterogeneity of various interventions in the included studies may cause a lack of comparability between different studies.

CONCLUSIONS

Concurrent management of depression and overweight/obesity is suggested by available data. There is a pressing need for studies that evaluate the effectiveness in real world samples of persons experiencing multiple co-occurring chronic diseases including but not limited to depression and overweight/obesity.

The molecular pathophysiology of depression and the new therapeutics

Major depressive disorder (MDD) is a highly prevalent and disabling disorder. Despite the many hypotheses proposed to understand the molecular pathophysiology of depression, it is still unclear. Current treatments for depression are inadequate for many individuals, because of limited effectiveness, delayed efficacy (usually two weeks), and side effects. Consequently, novel drugs with increased speed of action and effectiveness are required. Ketamine has shown to have rapid, reliable, and long-lasting antidepressant effects in treatment-resistant MDD patients and represent a breakthrough therapy for patients with MDD; however, concerns regarding its efficacy, potential misuse, and side effects remain. In this review, we aimed to summarize molecular mechanisms and pharmacological treatments for depression. We focused on the fast antidepressant treatment and clarified the safety, tolerability, and efficacy of ketamine and its metabolites for the MDD treatment, along with a review of the potential pharmacological mechanisms, research challenges, and future clinical prospects.

Astrocyte reactivation in medial prefrontal cortex contributes to obesity-promoted depressive-like behaviors

BACKGROUND

Little is known about how the obesogenic environment influences emotional states associated with glial responses and neuronal function. Here, we investigated glial reactivation and neuronal electrophysiological properties in emotion-related brain regions of high-fat diet (HFD) and ob/ob mice under chronic stress.

METHODS

The glial reactivation and neuronal activities in emotion-related brain regions were analyzed among normal diet mice (ND), HFD mice, wild-type mice, and ob/ob mice. To further activate or inhibit astrocytes in medial prefrontal cortex (mPFC), we injected astrocytes specific Gq-AAV or Gi-AAV into mPFC and ongoing treated mice with CNO.

RESULTS

The results showed that obesogenic factors per se had no significant effect on neuronal activities in emotion-related brain regions, or on behavioral performance. However, exposure to a chronic stressor profoundly reduced the frequency of spontaneous inhibitory postsynaptic currents (sIPSCs) and spontaneous excitatory postsynaptic currents (sEPSCs) in the mPFC; depressive-like behaviors were seen, accompanied by significant upregulation of astrocyte reactivation. We identified resilient and susceptible mice among chronic social defeat stress-exposed HFD mice. As expected, astrocyte reactivity was upregulated, while neuronal activity was depressed, in the mPFC of susceptible compared to resilient mice. Furthermore, activating astrocytes resulted in similar levels of neuronal activity and depressive-like behaviors between resilient and susceptible mice. Additionally, inhibiting astrocyte reactivation in the mPFC of HFD mice upregulated neuronal activities and inhibited depressive-like behaviors.

CONCLUSIONS

These observations indicate that obesogenic factors increase the risk of depression, and improve our understanding of the pathological relationship between obesity and depression.

Mental health problems and their related factors among seafarers: a scoping review

BACKGROUND

Seafarers are often reported to be engaged in a dangerous physical and psychosocial work environment. However, mental health status among seafarers has not been focused on compared with physical health issues. Systematic, comprehensive reviews of mental health problems and their relevant factors are lacking. This review aimed to clarify beneficial approaches to the mental health problems faced among seafarers using a scoping review to systematically map the evidence regarding mental health issues and their related factors.

METHODS

Studies were searched on MEDLINE/PubMed, Science Direct, Academic search complete using EBSCOhost databases, SCOPUS, EMBASE, and Web of science on 20, August 2020. This scoping review was conducted based on the framework of Arksey and O'Malley and Preferred Reporting items for Scoping Reviews flow diagram. The inclusion criteria were studies which determined the relationship between factors relevant to working conditions or working environment, and mental health in seafarers, and etc. Data were narratively summarized and reported.

RESULTS

Twenty-four were included in this review while two major findings were clarified. Firstly, the prevalence of stress, depressive symptoms, and burnout have been mentioned for decades. Secondly, factors related to mental health and psychological issues can be categorized as individual and work environmental factors. The individual factors include experience, age, health status (high BMI, poor sleep, and diabetics), and resilience. The work environmental factors consist of two parts. Job demands comprise pressure from contractors/customers/time, working hours, ship department, job title, voyage episodes, period of seafaring, noise, and vibration. The job resources included instrumental support, team cohesion, shipboard caring and effort-reward imbalance.

CONCLUSIONS

A beneficial approach to mental health problems faced among seafarers is necessary to understand comprehensively at individual and organization levels. Promoting health behaviors, training resilience, and managing obesity and chronic diseases comprise individual level strategies. Providing seafarers with adequate instrumental support, and practical support to communicate with customers, managing their distinct work-rest hours and adequate effort-reward balance comprise organization level methods.

Evaluation of inflammatory and metabolic impairments regarding depression dimensions: a case control study

Background

Patients with depression are at a higher risk of developing serious medical problems such as diabetes mellitus, hypertension, and cardiovascular diseases, increasing the burden of depression and worsening its outcome.

Recent studies revealed the presence of low-grade systemic inflammation and metabolic impairments which are playing an important role in the development of these medical problems among patients with depression.

It should be noted that not all patients with depressive disorder have these immune or metabolic impairments.

The study aims to evaluate inflammatory and metabolic impairments among patients with depression through categorizing patients with depression into four dimensional profilers which are (1) atypical energy-related symptom dimension, (2) melancholic dimension, (3) childhood trauma dimension, and (4) anxious distress dimension.

Also, the current study will evaluate inflammatory and metabolic impairments among patients with depression and a control group.

Results

This study highlights that of the patients with metabolic impairments (including hypertension, impaired glycemic control, low/high-density lipoprotein, elevated triglycerides, and central obesity), all of them had reported significantly higher scores in the atypical, energy-related symptom dimension.

Also, patients with impaired glycemic control had reported significantly (p < 0.001) high scores in the anxious distress symptom dimension.

While patients with inflammatory impairment (serum CRP > 3 mg/L) had significantly (p = 0.009) reported higher scores in the childhood trauma symptom dimension.

In addition, statistically significant metabolic and inflammatory impairments are detected among the depression cases group in comparison with the control group.

Conclusions

This study found that patients with depression presented by atypical, energy-related symptoms were at a higher risk of metabolic impairments than other depression profilers.

Also, patients of the Anxious distress symptom dimension reported significant impaired glycemic control.

In addition, patients with depression of the childhood trauma dimension were associated with high levels of inflammatory marker (C-reactive protein).

Potential implications

These results can be applied clinically to improve treatment and prognosis in patients with depression. For example, depressed patients with atypical, energy-related symptoms should increase their daily physical activities and exercise, and they should follow a special diet. Also, anti-inflammatory medications could be added to depressed patients of the childhood trauma dimension.

How Microbes Affect Depression: Underlying Mechanisms via the Gut-Brain Axis and the Modulating Role of Probiotics

Accumulating evidence suggests that the gut microbiome influences the brain functions and psychological state of its host via the gut-brain axis, and gut dysbiosis has been linked to several mental illnesses, including major depressive disorder (MDD). Animal experiments have shown that a depletion of the gut microbiota leads to behavioral changes, and is associated with pathological changes, including abnormal stress response and impaired adult neurogenesis. Short-chain fatty acids such as butyrate are known to contribute to the up-regulation of brain-derived neurotrophic factor (BDNF), and gut dysbiosis causes decreased levels of BDNF, which could affect neuronal development and synaptic plasticity. Increased gut permeability causes an influx of gut microbial components such as lipopolysaccharides, and the resultant systemic inflammation may lead to neuroinflammation in the central nervous system. In light of the fact that gut microbial factors contribute to the initiation and exacerbation of depressive symptoms, this review summarizes the current understanding of the molecular mechanisms involved in MDD onset, and discusses the therapeutic potential of probiotics, including butyrate-producing bacteria, which can mediate the microbiota-gut-brain axis.

Mechanisms affecting brain remodeling in depression: do all roads lead to impaired fibrinolysis?

Fibrinolysis occurs when plasminogen activators, such as tissue plasminogen activator (tPA), convert plasminogen to plasmin, which dissolves the fibrin clot. The proteolytic activity of tPA and plasmin is not restricted to fibrin degradation. In the extravascular space, these two proteases modify a variety of substrates other than fibrin, playing a crucial role in physiological and pathological tissue remodeling. In the brain, for example, tPA and plasmin mediate the conversion of brain-derived neurotrophic factor precursor (proBDNF) to mature brain-derived neurotrophic factor precursor (BDNF). Thus, the fibrinolytic system influences processes reported to be dysfunctional in depression, including neurogenesis, synaptic plasticity, and reward processing. The hypothesis that decreased fibrinolytic activity is an important element in the pathogenesis of depression is supported by the association between depression and increased levels of plasminogen activator inhibitor (PAI)-1, the main inhibitor of tPA. Also, various biochemical markers of depression induce PAI-1 synthesis, including hypercortisolism, hyperinsulinemia, hyperleptinemia, increased levels of cytokines, and hyperhomocysteinemia. Moreover, hypofibrinolysis provides a link between depression and emotional eating, binge eating, vegetarianism, and veganism. This paper discusses the role of reduced fibrinolytic activity in the bidirectional interplay between depression and its somatic manifestations and complications. It also reviews evidence that abnormal fibrinolysis links heterogeneous conditions associated with treatment-resistant depression. Understanding the role of hypofibrinolysis in depression may open new avenues for its treatment.

Development and validation using NHANES data of a predictive model for depression risk in myocardial infarction survivors

Background

Depression after myocardial infarction (MI) is associated with poor prognosis. This study aimed to develop and validate a nomogram to predict the risk of depression in patients with MI.

Methods

This retrospective study included 1615 survivors of MI aged >20 years who were selected from the 2005–2018 National Health and Nutrition Examination Survey database. The 899 subjects from the 2005–2012 survey comprised the development group, and the remaining 716 subjects comprised the validation group. Univariate and multivariate analyses identified variables significantly associated with depression. The least absolute shrinkage and selection operator (LASSO) binomial regression model was used to select the best predictive variables.

Results

A full predictive model and a simplified model were developed using multivariate analysis and LASSO binomial regression results, respectively, and validated using data from the validation group. The receiver operator characteristic curve and Hosmer–Lemeshow goodness of fit test were used to assess the nomogram's performance. The full nomogram model included 8 items: age, BMI, smoking, drinking, diabetes, exercise, insomnia, and PIR. The area under the curve for the development group was 0.799 and for the validation group was 0.731, indicating that our model has good stability and predictive accuracy. The goodness of fit test showed a good model calibration for both groups. The simplified model includes age, smoking, PIR, and insomnia. The AUC of the simplified model was 0.772 and 0.711 in the development and validation groups, respectively, indicating that the simplified model still possessed good predictive accuracy.

Conclusion

Our nomogram helped assess the individual probability of depression after MI and can be used as a complement to existing depression screening scales to help physicians make better treatment decisions.

L-Methylfolate in Antidepressant Non-responders: The Impact of Body Weight and Inflammation

This summary provides context for the role of L-methylfolate (LMF) in treating antidepressant non-responders. Bidirectional relationships have been observed between obesity and/or inflammation and depression. Studies have shown an increased prevalence of depression among patients with elevated body mass index and/or chronic inflammation and an increased risk of becoming obese and experiencing chronic inflammation in those with depression. These relationships can negatively affect the pathophysiology of depression. Elevated cytokine levels have been found to be among the factors that correlate with poor antidepressant treatment responsiveness. Low baseline neurotransmitter levels (e.g., serotonin) can also be associated with reduced effectiveness of commonly used antidepressants [e.g., selective serotonin reuptake inhibitors (SSRIs)]. LMF is an approved nutritional adjunctive antidepressant therapy that increases central neurotransmitter levels and thereby improves the effectiveness of antidepressant therapy. LMF can increase clinical response when used adjunctively in patients with major depressive disorder (MDD) and who are SSRI-resistant. In 2 randomized controlled trials, the pooled results showed increased response rates (32.3 vs. 14.6%; P = 0.04) as measured by a ≥50% reduction or final score ≤ 7 on the Hamilton Depression Rating Scale (HAM-D) and greater mean HAM-D reductions (-5.6 vs. -3.0; P = 0.05) when LMF was added to an SSRI compared with an SSRI plus placebo. Additionally, LMF has demonstrated effectiveness in real-world studies, with 67.9% of patients responding to therapy, using the 9-item Patient Health Questionnaire (P < 0.001). Post-hoc analyses found that patients with inflammation and/or obesity responded better to adjunctive LMF therapy compared with the overall sample (mean HAM-D reduction: -2.74 vs. +0.99).

Fasting Interventions for Stress, Anxiety and Depressive Symptoms: A Systematic Review and Meta-Analysis

Background. Fasting interventions have shown effectiveness in alleviating stress, anxiety and depressive symptoms. However, no quantitative analysis has been carried out thus far. The objective was to determine the effectiveness of fasting interventions on stress, anxiety and depression and if these interventions were associated with increased or decreased fatigue/energy. Methods. Overall, 11 studies and 1436 participants were included in the quantitative analyses. Results. After limiting analyses to randomized controlled trials with low risk of bias, we found that fasting groups had lower anxiety (b = −0.508, p = 0.038), depression levels (b= −0.281, p = 0.012) and body mass index compared to controls without increased fatigue. There was no publication bias and no heterogeneity for these results. These interventions were safe, even in patients with type 2 diabetes. Conclusions. These results should be taken with a caveat. These results are preliminary and encouraging and fasting appears to be a safe intervention. Data are not sufficient to recommend one fasting intervention more than the others. No study was carried out in psychiatric populations and further trials should be carried out in these populations that may be good candidates for fasting interventions.

[Atypical depression as a risk factor for obstructive sleep apnea syndrome in young adults]

OBJECTIVES

In the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥40 years) which means that this problem has been little studied in young adults (<30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation.

METHODS

Polysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n=215) and a patient group with OSAS (n=49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi² tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed.

RESULTS

The prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18-5.32), p-value=0.014], male gender [OR 4.53 (95% CI 2.20-9.34), P-value <0.001], presence of snoring [OR 2.51 (95% CI 1.33-4.75), P-value=0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19-4.28), P-value=0.012], body mass index>30 kg/m² [OR 4.55 (95% CI 2.07-10.03), P-value <0.001] and ferritin ≥150 μg/L [OR 3.28 (95% CI 1.69-6.36), P-value<0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26-7.54), P-value=0.019] was a risk factor for OSAS in young adults.

CONCLUSIONS

In our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.

The role of the FTO gene in the relationship between depression and obesity. A systematic review

Depression and obesity are major global health problems that frequently co-occur. The FTO gene has one of the strongest links with obesity and high body mass index (BMI) in humans. Besides, this gene is highly expressed in the brain, may play a role in the nervous system, and could confer risk for depression, although scarce literature is available in this respect. We perform a systematic review of the relationship between FTO and both conditions. We selected original articles with observational design or reviews, where depression was assessed with ICD-10, DSM-5 or previous versions, published from 2012 (when the first related paper was published) to November 2020, performed in adults, in English or Spanish and having an optimal methodological quality (evaluated with SIGN checklist). Five original studies were finally included. The results regarding the role of FTO in depression-obesity comorbidity were inconclusive. This leads us to endorse further research covering the role of this gene on both conditions, emphasising a more precise characterization of depression, in order to confirm this role.

Association between fractures and traditional risk factors for osteoporosis and low bone mineral density in patients with obesity

Objective

To evaluate the reasons for request of bone mineral density (BMD) evaluation and correlate the BMD results with previous fractures, risk factors for osteoporosis, and clinical characteristics in patients with obesity.

Methods

Cross-sectional, retrospective, single-site study including adult patients with body mass index (BMI) ≥ 30 kg/m² and BMD evaluation between January 2015 and May 2016 selected from a BMD database. Data on demographic characteristics, lifestyle habits, comorbidities, medications, risk factors, previous fractures, and indications for BMD evaluation were collected from the participants' medical records.

Results

The study included 619 patients (89.9% women, mean BMI 34.79 ± 4.05 kg/m²). In all, 382 (61.7%), 166 (26.8%), and 71 (11.5%) patients had class 1, 2, and 3 obesity, respectively. The most frequent (29.9%) reason for BMD evaluation was for osteoporosis monitoring. In all, 69.4% of the patients had low BMD. Multivariate analysis showed that age, calcium supplementation, and previous osteoporosis or osteopenia were associated with low BMD, while age, vitamin D supplementation, use of proton pump inhibitors (PPIs), and low BMD were associated with previous fractures (p < 0.05 for all).

Conclusion

Among patients with obesity identified from a tertiary hospital database, those with low bone mass and risk factors traditionally associated with fractures had an increased history of fractures. Patients with greater BMI had better bone mass and fewer fractures. These findings indicate that the association between reduced weight, risk factors for osteoporosis, and fractures remained despite the presence of obesity in our population.

Preference and detrimental effects of high fat, sugar, and salt diet in wild-caught Drosophila simulans are reversed by flight exercise

High saturated fat, sugar, and salt contents are a staple of a Western diet (WD), contributing to obesity, metabolic syndrome, and a plethora of other health risks. However, the combinatorial effects of these ingredients have not been fully evaluated. Here, using the wild-caught Drosophila simulans, we show that a diet enriched with saturated fat, sugar, and salt is more detrimental than each ingredient separately, resulting in a significantly decreased lifespan, locomotor activity, sleep, reproductive function, and mitochondrial function. These detrimental effects were more pronounced in female than in male flies. Adding regular flight exercise to flies on the WD markedly negated the adverse effects of a WD. At the molecular level, the WD significantly increased levels of triglycerides and caused mitochondrial dysfunction, while exercise counterbalanced these effects. Interestingly, fruit flies developed a preference for the WD after pre-exposure, which was averted by flight exercise. The results demonstrate that regular aerobic exercise can mitigate adverse dietary effects on fly mitochondrial function, physiology, and feeding behavior. Our data establish Drosophila simulans as a novel model of diet-exercise interaction that bears a strong similarity to the pathophysiology of obesity and eating disorders in humans.

Physical health in affective disorders: a narrative review of the literature

This article reviews the most common non-psychiatric comorbidities associated with affective disorders, examining the implications of their possible bidirectional link. A narrative review was conducted on the association among the three most common non-psychiatric diseases in major depressive disorder and bipolar disorder (obesity, metabolic syndrome, and cardiovascular diseases) in articles published from January 1994 to April 2020. The evidence suggests that obesity, metabolic syndrome, and cardiovascular diseases are highly prevalent in patients diagnosed with affective disorders. The presence of non-psychiatric comorbidities significantly worsens the therapeutic management and prognosis of affective disorders and vice versa. In many cases, these comorbidities may precede the onset of affective disorders, although in most cases they appear after it. The presence of these concurrent non-psychiatric diseases in an individual diagnosed with an affective disorder is associated with a more complex disease presentation and management. For professionals, the evidence unequivocally supports routine surveillance of comorbidities from a multidisciplinary approach.

The mediating role of depressive and anxiety symptoms in the association between obesity and problematic social media use in young adults

Background

Obesity has been associated with problematic internet use or internet use characterized by impulsivity, dependence, risk taking or impairment. Despite the unique affordances and growing popularity of social media, few studies have investigated obesity in relation to the problematic use of social media in contrast to general internet use.

Objective

The purpose of this study was to explore the relationship between obesity and problematic social media use and to test symptoms of anxiety and depression as potential mediators of this relationship.

Methods

A cross‐sectional online survey was administered to young adults between the ages of 18–25 using the Qualtrics platform. Two mediation models were tested using model 4 of the PROCESS Macro in SPSS.

Results

Participants (n = 4939) were between the ages of 18–25 (M = 21.74, SD = 2.3). Participants were 50.6% female (n = 2496) and 58.1% White (n = 2871). Reporting obesity was positively associated with reporting increased levels of problematic social media use, B = 1.15, SE B = .32, t(1, 4938) = 3.59, p < .001. The indirect effects in each model from obesity to problematic social media use, through both symptoms of anxiety and depression separately, were significant, B = .14, SE B = .05, confidence interval [0.055, .231] and B = .16, SE B = .07, confidence interval [0.018, .317], respectively.

Conclusions

Young adults who present both with obesity and with symptoms of depression or anxiety are more at risk for problematic social media use. These patients may benefit from education on health‐promoting social media use.