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Rosso G, Maina G, Teobaldi E, Balbo I, Di Salvo G, Montarolo F, Rizzo Pesci N, Tempia F, Hoxha E. Differential diagnosis of unipolar versus bipolar depression by GSK3 levels in peripheral blood: a pilot experimental study. Int J Bipolar Disord 2023; 11:33. [PMID: 37807001 PMCID: PMC10560641 DOI: 10.1186/s40345-023-00314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND The differential diagnosis of patients presenting for the first time with a depressive episode into unipolar disorder versus bipolar disorder is crucial to establish the correct pharmacological therapy (antidepressants vs mood stabilizers), but no biological markers are currently available. Several lines of evidence indicate an involvement of Glycogen Synthase Kinase-3 (GSK3) in the pathophysiology of depression. However, previous reports about GSK3 in peripheral blood were incomplete or inconsistent, so a specific marker is not yet available. The aim was to search for consistent differences in GSK3α and GSK3β or of their phosphorylated forms in samples of peripheral blood from patients with unipolar and bipolar depression. METHODS Mononucleate peripheral blood cells (PBMCs) of samples from patients presenting with a depressive episode were analyzed with the western blot technique. RESULTS The total amount of GSK3β in PBMCs was significantly lower in patients with bipolar disorder than in patients with unipolar depression. The sensitivity based on GSK3β was 85%. GSK3α was not significantly different but allowed a correct detection of 57% of BD patients. The combination in series of GSK3β and GSK3α yields a sensitivity of about 100%, but with 26.7% false negatives. CONCLUSIONS Our results suggest that PBMC GSK3β could be a candidate biomarker for the differential diagnosis of bipolar disorder versus unipolar depression. This finding may help in implementing the still limited panel of peripheral biomarkers for differential diagnosis between unipolar and bipolar disorder in patients presenting with a depressive episode.
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Affiliation(s)
- Gianluca Rosso
- Department of Neurosciences ''Rita Levi Montalcini'', University of Turin, Via Cherasco 15, 10126, Turin, Italy.
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
| | - Giuseppe Maina
- Department of Neurosciences ''Rita Levi Montalcini'', University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Elena Teobaldi
- Department of Neurosciences ''Rita Levi Montalcini'', University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Ilaria Balbo
- Neuroscience Institute Cavalieri Ottolenghi (NICO), Regione Gonzole 10, 10043, Orbassano, Italy
| | - Gabriele Di Salvo
- Department of Neurosciences ''Rita Levi Montalcini'', University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Francesca Montarolo
- Department of Neurosciences ''Rita Levi Montalcini'', University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Neuroscience Institute Cavalieri Ottolenghi (NICO), Regione Gonzole 10, 10043, Orbassano, Italy
| | - Nicola Rizzo Pesci
- Department of Neurosciences ''Rita Levi Montalcini'', University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Filippo Tempia
- Department of Neurosciences ''Rita Levi Montalcini'', University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Neuroscience Institute Cavalieri Ottolenghi (NICO), Regione Gonzole 10, 10043, Orbassano, Italy
| | - Eriola Hoxha
- Department of Neurosciences ''Rita Levi Montalcini'', University of Turin, Via Cherasco 15, 10126, Turin, Italy.
- Neuroscience Institute Cavalieri Ottolenghi (NICO), Regione Gonzole 10, 10043, Orbassano, Italy.
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De Giorgi R, Rizzo Pesci N, Rosso G, Maina G, Cowen PJ, Harmer CJ. The pharmacological bases for repurposing statins in depression: a review of mechanistic studies. Transl Psychiatry 2023; 13:253. [PMID: 37438361 PMCID: PMC10338465 DOI: 10.1038/s41398-023-02533-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
Statins are commonly prescribed medications widely investigated for their potential actions on the brain and mental health. Pre-clinical and clinical evidence suggests that statins may play a role in the treatment of depressive disorders, but only the latter has been systematically assessed. Thus, the physiopathological mechanisms underlying statins' putative antidepressant or depressogenic effects have not been established. This review aims to gather available evidence from mechanistic studies to strengthen the pharmacological basis for repurposing statins in depression. We used a broad, well-validated search strategy over three major databases (Pubmed/MEDLINE, Embase, PsychINFO) to retrieve any mechanistic study investigating statins' effects on depression. The systematic search yielded 8068 records, which were narrowed down to 77 relevant papers. The selected studies (some dealing with more than one bodily system) described several neuropsychopharmacological (44 studies), endocrine-metabolic (17 studies), cardiovascular (6 studies) and immunological (15 studies) mechanisms potentially contributing to the effects of statins on mood. Numerous articles highlighted the beneficial effect of statins on depression, particularly through positive actions on serotonergic neurotransmission, neurogenesis and neuroplasticity, hypothalamic-pituitary axis regulation and modulation of inflammation. The role of other mechanisms, especially the association between statins, lipid metabolism and worsening of depressive symptoms, appears more controversial. Overall, most mechanistic evidence supports an antidepressant activity for statins, likely mediated by a variety of intertwined processes involving several bodily systems. Further research in this area can benefit from measuring relevant biomarkers to inform the selection of patients most likely to respond to statins' antidepressant effects while also improving our understanding of the physiopathological basis of depression.
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Affiliation(s)
- Riccardo De Giorgi
- University of Oxford, Department of Psychiatry, Warneford Hospital, Warneford Lane, Oxfordshire, Oxford, OX3 7JX, United Kingdom.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxfordshire, Oxford, OX3 7JX, United Kingdom.
| | - Nicola Rizzo Pesci
- University of Turin, Department of Neurosciences "Rita Levi Montalcini", Via Cherasco 15, Turin, 10126, Italy
| | - Gianluca Rosso
- University of Turin, Department of Neurosciences "Rita Levi Montalcini", Via Cherasco 15, Turin, 10126, Italy
| | - Giuseppe Maina
- University of Turin, Department of Neurosciences "Rita Levi Montalcini", Via Cherasco 15, Turin, 10126, Italy
| | - Philip J Cowen
- University of Oxford, Department of Psychiatry, Warneford Hospital, Warneford Lane, Oxfordshire, Oxford, OX3 7JX, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxfordshire, Oxford, OX3 7JX, United Kingdom
| | - Catherine J Harmer
- University of Oxford, Department of Psychiatry, Warneford Hospital, Warneford Lane, Oxfordshire, Oxford, OX3 7JX, United Kingdom
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De Giorgi R, Waters S, Pesci NR, Rosso G, Cowen PJ, Harmer CJ. The effects of statin monotherapy on depressive symptoms: A systematic review and meta-analysis. J Affect Disord 2022; 311:336-343. [PMID: 35618167 DOI: 10.1016/j.jad.2022.05.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Statins have been proposed as a strategy for treating depression, but their benefit in the absence of concurrent antidepressant treatment is unclear. This meta-analysis investigated the antidepressant effects of statin monotherapy in the general population. METHODS We conducted a literature search of randomised controlled trials using any statin monotherapy versus any control condition for depressive symptoms. Our primary efficacy outcome was the mean value on any standardised scale for depression at study endpoint. We also measured efficacy at three further timepoints (<6 months, 6-12 months, >12 months), as well as acceptability, tolerability, and safety. Respectively, continuous and dichotomous outcomes were computed using standardised mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI) using a random-effect model. RESULTS Pooled analyses did not show that statin monotherapy improves depressive symptoms at endpoint (N = 2712 SMD = -0.18; 95% CI = -0.41 to 0.04), nor at any other specific timepoint. No difference between statins and control was identified for any of the other outcome measures. DISCUSSION These results differ from those of previous meta-analyses and, compounded by more recently available evidence, suggest that statins may not have intrinsic antidepressant properties, but may be useful for the management of depression in add-on to antidepressants. LIMITATIONS Data from heterogeneous populations and using different statins were pooled, though several sensitivity and subgroup analyses were performed to account for that. PROSPERO registration: CRD42022306653. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=306653.
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Affiliation(s)
- Riccardo De Giorgi
- University of Oxford, Department of Psychiatry, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire OX3 7JX, United Kingdom.
| | - Shona Waters
- University of Oxford, Department of Psychiatry, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire OX3 7JX, United Kingdom
| | - Nicola Rizzo Pesci
- University of Turin, Department of Neurosciences "Rita Levi Montalcini", Via Cherasco 15, Turin 10126, Italy
| | - Gianluca Rosso
- University of Turin, Department of Neurosciences "Rita Levi Montalcini", Via Cherasco 15, Turin 10126, Italy
| | - Philip J Cowen
- University of Oxford, Department of Psychiatry, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire OX3 7JX, United Kingdom
| | - Catherine J Harmer
- University of Oxford, Department of Psychiatry, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire OX3 7JX, United Kingdom
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De Giorgi R, Martens M, Rizzo Pesci N, Cowen PJ, Harmer CJ. The effects of atorvastatin on emotional processing, reward learning, verbal memory and inflammation in healthy volunteers: An experimental medicine study. J Psychopharmacol 2021; 35:1479-1487. [PMID: 34872404 PMCID: PMC8652357 DOI: 10.1177/02698811211060307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Growing evidence from clinical trials and epidemiological studies suggests that statins can have clinically significant antidepressant effects, potentially related to anti-inflammatory action on several neurobiological structures. However, the underlying neuropsychological mechanisms of these effects remain unexplored. AIMS In this experimental medicine trial, we investigated the 7-day effects of the lipophilic statin, atorvastatin on a battery of neuropsychological tests and inflammation in healthy volunteers. METHODS Fifty healthy volunteers were randomised to either 7 days of atorvastatin 20 mg or placebo in a double-blind design. Participants were assessed with psychological questionnaires and a battery of well-validated behavioural tasks assessing emotional processing, which is sensitive to putative antidepressant effects, reward learning and verbal memory, as well as the inflammatory marker, C-reactive protein. RESULTS Compared to placebo, 7-day atorvastatin increased the recognition (p = 0.006), discriminability (p = 0.03) and misclassifications (p = 0.04) of fearful facial expression, independently from subjective states of mood and anxiety, and C-reactive protein levels. Otherwise, atorvastatin did not significantly affect any other psychological and behavioural measure, nor peripheral C-reactive protein. CONCLUSIONS Our results reveal for the first time the early influence of atorvastatin on emotional cognition by increasing the processing of anxiety-related stimuli (i.e. increased recognition, discriminability and misclassifications of fearful facial expression) in healthy volunteers, in the absence of more general effects on negative affective bias. Further studies exploring the effects of statins in depressed patients, especially with raised inflammatory markers, may clarify this finding and inform future clinical trials.
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Affiliation(s)
- Riccardo De Giorgi
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Marieke Martens
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Nicola Rizzo Pesci
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Philip J Cowen
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Catherine J Harmer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
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De Giorgi R, Rizzo Pesci N, Quinton A, De Crescenzo F, Cowen PJ, Harmer CJ. Statins in Depression: An Evidence-Based Overview of Mechanisms and Clinical Studies. Front Psychiatry 2021; 12:702617. [PMID: 34385939 PMCID: PMC8353114 DOI: 10.3389/fpsyt.2021.702617] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Depression is a leading cause of disability, burdened by high levels of non-response to conventional antidepressants. Novel therapeutic strategies targeting non-monoaminergic pathways are sorely needed. The widely available and safe statins have several putative mechanisms of action, especially anti-inflammatory, which make them ideal candidates for repurposing in the treatment of depression. A large number of articles has been published on this topic. The aim of this study is to assess this literature according to evidence-based medicine principles to inform clinical practise and research. Methods: We performed a systematic review of the electronic databases MEDLINE, CENTRAL, Web of Science, CINAHL, and ClinicalTrials.gov, and an unstructured Google Scholar and manual search, until the 9th of April 2021, for all types of clinical studies assessing the effects of statins in depression. Results: Seventy-two studies were retrieved that investigated the effects of statins on the risk of developing depression or on depressive symptoms in both depressed and non-depressed populations. Fifteen studies specifically addressed the effects of statins on inflammatory-related symptoms of anhedonia, psychomotor retardation, anxiety, and sleep disturbances in depression. Most studies suggested a positive effect of statins on the occurrence and severity of depression, with fewer studies showing no effect, while a minority indicated some negative effects. Limitations: We provide a narrative report on all the included studies but did not perform any quantitative analysis, which limits the strength of our conclusions. Conclusions: Robust evidence indicates that statins are unlikely to lead to depressive symptoms in the general population. Promising data suggest a potential role for statins in the treatment of depression. Further clinical studies are needed, especially in specific subgroups of patients identified by pre-treatment assessments of inflammatory and lipid profiles.
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Affiliation(s)
- Riccardo De Giorgi
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Nicola Rizzo Pesci
- Department of Neurosciences “Rita Levi Montalcini,” San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Alice Quinton
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Franco De Crescenzo
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Philip J. Cowen
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Catherine J. Harmer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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De Giorgi R, De Crescenzo F, Rizzo Pesci N, Martens M, Howard W, Cowen PJ, Harmer CJ. Statins for major depressive disorder: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2021; 16:e0249409. [PMID: 33784356 PMCID: PMC8009386 DOI: 10.1371/journal.pone.0249409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The burden of depressive disorder is large and new treatment approaches are required. Repurposing widely available drugs such as statins may be a time- and cost-effective solution. Statins have anti-inflammatory and anti-oxidant properties which have been shown to be relevant to the pathophysiology of depression. This study assesses the efficacy, acceptability, tolerability, and safety of statins in major depressive disorder. METHODS Our study is an update and extension of a previous meta-analysis published in 2016 by Salagre et al. We performed a systematic review (PubMed/MEDLINE, Cochrane CENTRAL, ISI Web of Science, CINAHL, and ClinicalTrials.gov until the 1st September 2020) and meta-analysis of randomized controlled trials using any statin against placebo or any other statin in the treatment of major depressive disorder. Our primary efficacy outcome measure was the mean value on any standardized scale for depressive symptoms at 8 weeks of treatment. We also calculated outcomes for efficacy, response, and remission at 2, 4, and 12 weeks, as well as acceptability (dropouts for any cause), tolerability (dropouts due to any adverse event), and safety (any adverse event) outcomes at the studies' endpoints. Furthermore, we conducted an exploratory network meta-analysis for the primary efficacy outcome to identify potential differences between statins. RESULTS We retrieved five randomized controlled trials meeting our inclusion criteria: four used a statin in addition to an antidepressant and compared it to placebo plus antidepressant, and one compared two statins alone. and one comparing one statin with another. Statins compared to placebo in addition to antidepressants were efficacious at 8 weeks (N = 255, SMD = -0.48, 95% CI = -0.74 to -0. 22) and 12 weeks (N = 134, SMD = -0.47, 95% CI = -0.89 to -0.05, moderate certainty) with no difference for acceptability, tolerability, and safety (low certainty). An exploratory network meta-analysis suggested that the most lipophilic statins, especially simvastatin, could be more efficacious than less lipophilic or hydrophilic molecules. CONCLUSIONS This systematic review suggests the efficacy, acceptability, tolerability, and safety of statins in addition to antidepressants in patients with major depressive disorder. Further clinical trials in different settings are required to test this result. TRIAL RGISTRATION PROSPERO registration: CRD42020170938.
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Affiliation(s)
- Riccardo De Giorgi
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, Oxfordshire, United Kingdom
| | - Franco De Crescenzo
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, Oxfordshire, United Kingdom
| | - Nicola Rizzo Pesci
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Marieke Martens
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Wendy Howard
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Philip J. Cowen
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, Oxfordshire, United Kingdom
| | - Catherine J. Harmer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, Oxfordshire, United Kingdom
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