Relationships between urinary catecholamine metabolites, particularly MHPG, and selected personality and physical fitness characteristics in normal subjects

Exercise as a therapeutic modality for the prevention and treatment of depression

While maintaining an active lifestyle and engaging in regular exercise are known to promote cardiovascular (CV) health, increasing evidence has emerged to indicate that these lifestyle behaviors also can promote psychological health and well-being. This has led to research to determine if exercise can serve as a potential therapeutic modality for major depressive disorder (MDD), which is a leading cause of mental-health impairment and overall disability worldwide. The strongest evidence to support this use comes from an increasing number of randomized clinical trials (RCTs) that have compared exercise to usual care, placebo controls, or established therapies in healthy adults and in various clinical populations. The relatively large number of RCTs has led to numerous reviews and meta-analyses, which generally have been concordant in indicating that exercise ameliorates depressive symptoms, improves self-esteem, and enhances various aspects of quality of life. Together, these data indicate that exercise should be considered as a therapeutic modality for improving CV health and psychological well-being. The emerging evidence also has led to a new proposed subspecialty of "lifestyle psychiatry", which promotes the use of exercise as an adjunctive treatment for patients with MDD. Indeed, some medical organizations have now endorsed lifestyle-based approaches as foundational aspects of depression management, with adoption of exercise as a treatment option for MDD. This review summarizes research in the area and provides practical suggestions for the use of exercise in clinical practice.

Psychological distress and metabolomic markers: A systematic review of posttraumatic stress disorder, anxiety, and subclinical distress

Psychological distress can be conceptualized as an umbrella term encompassing symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), or stress more generally. A systematic review of metabolomic markers associated with distress has the potential to reveal underlying molecular mechanisms linking distress to adverse health outcomes. The current systematic review extends prior reviews of clinical depressive disorders by synthesizing 39 existing studies that examined metabolomic markers for PTSD, anxiety disorders, and subclinical psychological distress in biological specimens. Most studies were based on small sets of pre-selected candidate metabolites, with few metabolites overlapping between studies. Vast heterogeneity was observed in study design and inconsistent patterns of association emerged between distress and metabolites. To gain a more robust understanding of distress and its metabolomic signatures, future research should include 1) large, population-based samples and longitudinal assessments, 2) replication and validation in diverse populations, 3) and agnostic metabolomic strategies profiling hundreds of targeted and nontargeted metabolites. Addressing these research priorities will improve the scope and reproducibility of future metabolomic studies of psychological distress.

What is the role of alternative treatments in late-life depression?

Late-life depression remains challenging to treat. One major limitation to treatment is the concern over medication-related side effects to which the elderly are especially vulnerable. Also, because many elderly people are already taking multiple medications for medical conditions, there is the concern over drug-drug interactions. This article reviews various complementary and alternative medicine interventions for late-life depression, including natural remedies, exercise, yoga, tai chi, massage therapy, music therapy, and religion and spirituality.

Exercise and pharmacotherapy in the treatment of major depressive disorder

OBJECTIVE

To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls.

METHODS

Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50-200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D).

RESULTS

After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23).

CONCLUSIONS

The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors.

Treatment of minor depression in older adults: a pilot study comparing sertraline and exercise

The purpose of this study was to conduct a pilot clinical trial to test the feasibility and efficacy of an exercise program and anti-depressant treatment compared with usual care in improving the emotional and physical functioning of older adults with minor depression. Participants were 37 older adults with minor depression who were randomized to exercise, sertraline, or usual care; 32 participants completed the 16-week study. Outcomes included measures of both emotional (clinician and self-report) and physical (observed and self-report) functioning. There were trends for the superiority of the exercise and sertraline conditions over usual care in improving SF-36 mental health scores and clinician-rated depression scores. Individuals in the exercise condition showed greater improvements in physical functioning than individuals in the usual care condition. Both sertraline and exercise show promise as treatments for late-life minor depression. However, exercise has the added benefit of improving physical functioning as well.

Brain norepinephrine and metabolites after treadmill training and wheel running in rats

Regional changes in concentrations of brain norepinephrine [NE] and its metabolites after chronic exercise have not been described for exercise protocols not confounded by other stressors. We examined levels of [NE], 3-methoxy-4-hydroxyphenylglycol [MHPG], and 3,4-dihydroxyphenylglycol [DHPG] in the frontal cortex, hippocampus, pons-medulla, and spinal cord after 8 wk of exercise. Male Sprague-Dawley rats (N = 36) were randomly assigned to three conditions: 1) 24-h access to activity wheel running (WR), 2) treadmill running (TR) at 0 degrees incline for 1 h.d-1 at 25-30 m.min-1, or 3) a sedentary control group (C). Levels (nmol.g-1) of [NE], [MHPG], and [DHPG] were assayed by high performance liquid chromatography with electrochemical detection. Planned contrasts (P < 0.05) indicated that exercise training increased succinate dehydrogenase activity (mmol cytochrome C reduced.min-1.g-1 wet weight) in soleus muscle for TR compared with WR or C. [NE] was higher in the pons-medulla and spinal cord for both TR and WR compared with C. [DHPG] was higher in the pons-medulla for TR compared with C, and [MHPG] was higher in the frontal cortex and in the hippocampus for TR compared with C. Our results suggest that treadmill exercise training is accompanied by brain noradrenergic adaptations consistent with increased metabolism of NE in areas containing NE cell bodies and ascending terminals, whereas treadmill running and wheel running are accompanied by increases in levels of NE in the areas of NE cell bodies and the spinal cord, independently of an exercise training effect.

Stress and social support in high-risk pregnancy

Relationships of stress, social support, and risk in pregnancy were tested in low-income women receiving outpatient antepartal care. Nineteen high-risk and 20 low-risk women completed the State Anxiety Inventory and Brown's Support Behavior Inventory. Urinary catecholamine levels from a single morning urine sample, determined using High Performance Liquid Chromatography, were used as the indicator of physiological stress. There was a significant difference between the groups in epinephrine level, but not in norepinephrine level, anxiety, or social support scores. In the high-risk group, norepinephrine level and partner support were negatively correlated; there were no other significant correlations. In the low-risk group, epinephrine level was positively correlated with norepinephrine level and age; anxiety was negatively correlated with partner support and age.