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James Vibin A, Niharika N, Valliappan V, Lamo P, Parajuli N, Jat M, Lama S, Agarwal A, Sagar R, Sharma G. Effect of Integrated Yoga as an add-on therapy in adults with clinical depression - A randomized controlled trial. Int J Soc Psychiatry 2024:207640231223431. [PMID: 38279599 DOI: 10.1177/00207640231223431] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 01/28/2024]
Abstract
BACKGROUND Depression is a leading cause of disability and the conventional management has several limitations. Recent studies demonstrated the benefits of yoga in psychological disorders. AIMS To evaluate the efficacy of the Integrated Yoga Module (IYM) to standard care with added yogic education on lifestyle modification (YELM) in patients with clinical depression. METHODS A PROBE trial was conducted at a single tertiary care hospital in India. Adults aged 18 to 64 with clinical depression were randomized to either an IYM or an active control group using a computer-generated mixed block randomization sequence. Both groups received YELM in addition to standard care and the intervention group practiced IYM, for 8 weeks. The primary outcome was the reduction in depression symptoms assessed using the Beck Depression Inventory (BDI-II), and secondary outcomes involved self-compassion, brief resilience, positive and negative experiences, and quality of life, evaluated at 8 weeks. RESULTS The mean ± SD age of participants was 32.2 ± 10.0 and 54.3% were females. The IYM group showed statistically significant improvements in BDI-II scores β = -6.7 (95% CI [-10.8, -2.5]; p = .001), resilience β = 0.4 (95% CI [0.02, 0.80]; p = .037), physical health domain of WHOQOL - BREF β = 10.1 (95% CI [0.7, 19.5]; p = .035) and negative emotions (SPANE-N) β = 2.8 (95% CI [0.1, 5.4]; p = .037). However, no significant differences were found in SCS-SF β = -0.3 (95% CI [-0.7, 0.0]; p = .053). CONCLUSIONS IYM as an adjunct is superior to conventional medical management in reducing symptoms and improving positive psychological resources in clinical depression.
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Affiliation(s)
- Anu James Vibin
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Niharika Niharika
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Valliappan
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Pasang Lamo
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Niranjan Parajuli
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Mansingh Jat
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sudha Lama
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Agarwal
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Hosseinzadeh Kasani P, Lee JE, Park C, Yun CH, Jang JW, Lee SA. Evaluation of nutritional status and clinical depression classification using an explainable machine learning method. Front Nutr 2023; 10:1165854. [PMID: 37229464 PMCID: PMC10203418 DOI: 10.3389/fnut.2023.1165854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/27/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Depression is a prevalent disorder worldwide, with potentially severe implications. It contributes significantly to an increased risk of diseases associated with multiple risk factors. Early accurate diagnosis of depressive symptoms is a critical first step toward management, intervention, and prevention. Various nutritional and dietary compounds have been suggested to be involved in the onset, maintenance, and severity of depressive disorders. Despite the challenges to better understanding the association between nutritional risk factors and the occurrence of depression, assessing the interplay of these markers through supervised machine learning remains to be fully explored. Methods This study aimed to determine the ability of machine learning-based decision support methods to identify the presence of depression using publicly available health data from the Korean National Health and Nutrition Examination Survey. Two exploration techniques, namely, uniform manifold approximation and projection and Pearson correlation, were performed for explanatory analysis among datasets. A grid search optimization with cross-validation was performed to fine-tune the models for classifying depression with the highest accuracy. Several performance measures, including accuracy, precision, recall, F1 score, confusion matrix, areas under the precision-recall and receiver operating characteristic curves, and calibration plot, were used to compare classifier performances. We further investigated the importance of the features provided: visualized interpretation using ELI5, partial dependence plots, and local interpretable using model-agnostic explanations and Shapley additive explanation for the prediction at both the population and individual levels. Results The best model achieved an accuracy of 86.18% for XGBoost and an area under the curve of 84.96% for the random forest model in original dataset and the XGBoost algorithm with an accuracy of 86.02% and an area under the curve of 85.34% in the quantile-based dataset. The explainable results revealed a complementary observation of the relative changes in feature values, and, thus, the importance of emergent depression risks could be identified. Discussion The strength of our approach is the large sample size used for training with a fine-tuned model. The machine learning-based analysis showed that the hyper-tuned model has empirically higher accuracy in classifying patients with depressive disorder, as evidenced by the set of interpretable experiments, and can be an effective solution for disease control.
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Affiliation(s)
- Payam Hosseinzadeh Kasani
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Republic of Korea
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Republic of Korea
| | - Jung Eun Lee
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Republic of Korea
| | - Chihyun Park
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Republic of Korea
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon, Republic of Korea
| | - Cheol-Heui Yun
- Department of Agricultural Biotechnology, Seoul National University, Seoul, Republic of Korea
- Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Republic of Korea
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Sang-Ah Lee
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea
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Yu DJ, Yu AP, Leung CK, Chin EC, Fong DY, Cheng CP, Yau SY, Siu PM. Comparison of moderate and vigorous walking exercise on reducing depression in middle-aged and older adults: A pilot randomized controlled trial. Eur J Sport Sci 2022; 23:1018-1027. [PMID: 35579606 DOI: 10.1080/17461391.2022.2079424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The optimal intensity of physical activity for alleviating depression in middle-aged and older adults remains unclear. The comparative effects of moderate and vigorous physical activity on reducing depression have not been directly examined. The World Health Organization (WHO) physical activity guidelines recommend adults and older adults to accumulate at least 150-300 minutes of moderate or 75-150 minutes of vigorous aerobic-type physical activity weekly or an equivalent combination of both for health benefits including reduced risk of depression. This parallel, assessor-blinded, pilot randomized controlled trial preliminarily compared the effectiveness of the minimal volume of aerobic-type physical activity at different intensities as recommended by WHO (150 minutes of moderate walking exercise and 75 minutes of vigorous walking exercise weekly) on alleviating depression in middle-aged and older adults. Middle-aged and older adults diagnosed with depression were randomized to the control group (CON), moderate walking exercise group (MOD), or vigorous walking exercise group (VIG). The exercise frequency of the moderate and vigorous walking exercise were three times a week and the intervention duration were 12 weeks. The primary outcome was the severity of depression assessed by Beck Depression Inventory. Secondary outcomes included severity of anxiety, sleep quality, quality of life, and cardiorespiratory fitness. Thirty participants completed the study (CON: n = 10, MOD: n = 10, VIG: n = 10). Participants in both MOD and VIG had significantly decreased depression severity after the intervention compared to CON (both p < 0.001). There was no significant difference between MOD and VIG (p = 0.92). Both MOD and VIG interventions also mitigated anxiety severity, improved quality of life and cardiorespiratory fitness. The minimum volume of walking exercise at either moderate or vigorous intensity was found to alleviate depression in middle-aged and older adults.Trial registration: ClinicalTrials.gov identifier: NCT04403373..
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Affiliation(s)
- Danny J Yu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Angus P Yu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Chit K Leung
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Edwin C Chin
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Daniel Y Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Calvin P Cheng
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China.,Department of Psychiatry, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Suk Y Yau
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Parco M Siu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
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Acharya S, Satpathy A, Beura R, Datta P, Das U, Mahapatra P. Assessment of clinical depression in abdominally obese subjects with periodontal disease. Indian J Dent Res 2022; 33:120-125. [PMID: 36254945 DOI: 10.4103/ijdr.ijdr_780_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Depression is a commonly prevailing condition that goes undetected in clinical settings. Both abdominal obesity and periodontal disease have a bearing on mental health and have an impact on the quality of life. OBJECTIVE To assess the level of clinical depression in abdominally obese subjects with periodontal disease. METHODS Two hundred and ten subjects with a mean age of 37.45 ± 9.59 years (males = 117; females = 93) were grouped as per their abdominal obesity and periodontal status and assessed for their clinical depression levels (mental health) using the Centre for Epidemiologic Studies-Depression Scale (CES-D). Collected data were analysed. RESULTS The clinical depression score significantly varied in subjects with different periodontal status in both non-obese (F (2,102) = 113.66, P < 0.0001) and abdominally obese subjects (F (2,102) = 132.04, P < 0.001). Significantly higher depression score was demonstrated in healthy (P < 0.001), gingivitis (P < 0.001), and periodontitis (P < 0.001) groups in abdominally obese subjects. CONCLUSION Clinical depression is significantly associated with abdominal obesity and periodontal disease in subjects with abdominal obesity and severe periodontal disease demonstrating higher depression scores.
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Affiliation(s)
- Sheetal Acharya
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Anurag Satpathy
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Rajdeep Beura
- Department of Periodontics, Hi Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Pratiti Datta
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Utkalika Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT (Deemed to be University), Bhubaneswar, Odisha, India
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5
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Parker G. Clinical depression: the fault not in our stars? Australas Psychiatry 2021; 29:652-654. [PMID: 34126786 DOI: 10.1177/10398562211022750] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To consider how a mental health professional might respond to a newly diagnosed depressed patient who inquires into its potential genetic origins and whether they might pass depression on to their children. METHODS Data are provided on risk and pursuit of genetic pathways. RESULTS As most studies have focussed on DSM-defined major depression - and which is not an entity - no definitive data are available, while there are some few studies indicating a greater genetic risk in those with melancholic than those with non-melancholic depression. CONCLUSION We will not know the genetic contribution to clinical depression unless its key sub-types are evaluated as separate conditions. Findings may assist a clinician's response to an inquiring patient.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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6
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Gupta M, Zubiar F, Gupta N. Turner Syndrome and the Risks of Clinical Depression in Adolescence. Cureus 2021; 13:e19204. [PMID: 34873536 PMCID: PMC8638214 DOI: 10.7759/cureus.19204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/20/2022] Open
Abstract
According to the Center for Disease Control (CDC), 3.2% of children aged 3-17 years have been diagnosed with depression. Many genetic conditions predispose children and adolescents to various mental health problems. Turner syndrome is a common sporadic genetic condition in females with medical issues, developmental delays, and psychiatric comorbidities. There is limited literature about adolescents with a late diagnosis of Turner syndrome and struggles with affective psychopathology. The early recognition and understanding of its unique genetics, neurobiology, and specific clinical manifestations are critical for addressing the needs of these patients.
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Affiliation(s)
- Mayank Gupta
- Psychiatry, Lake Erie College of Osteopathic Medicine, Erie, USA
- Psychiatry and Behavioral Sciences, Clarion Psychiatric Center, Clarion, USA
| | - Faiza Zubiar
- Psychiatry, The Trenton Psychiatric Hospital, Trenton, USA
| | - Nihit Gupta
- Psychiatry, University of West Virginia, Glen Dale, USA
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7
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Costello CA, Liu M, Furey A, Rahman P, Randell EW, Zhai G. Association Between Epidemiological Factors and Nonresponders to Total Joint Replacement Surgery in Primary Osteoarthritis Patients. J Arthroplasty 2021; 36:1502-1510.e5. [PMID: 33288389 DOI: 10.1016/j.arth.2020.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/09/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND While total joint replacement (TJR) is the most effective treatment for end-stage osteoarthritis (OA), one-third of patients do not experience clinically important improvement in pain or function following the surgery. Thus, it is important to identify factors for nonresponders and develop strategies to improve TJR outcomes. METHODS Study participants were patients who underwent TJR (hip/knee) due to OA and completed the WOMAC before and on average 4 years after surgery. Nonresponders (pain nonresponders, function nonresponders, pain and function nonresponders) were determined using the WOMAC change score from baseline to follow-up under two previously reported criteria. Eighty-eight self-reported factors collected by a general health questionnaire were examined for associations with nonresponders. RESULTS A total of 601 patients (30.8% hip and 69.2% knee replacement) were included; 18% of them were found to be either pain or function nonresponders. Nine factors were identified in the univariable analyses to be associated with nonresponders, and 5 of them (clinical depression, multisite musculoskeletal pain [MSMP], younger age, golfer's elbow, and driving more than 4 hours on average per working day) remained significant in the multivariable analyses in at least one of six categories. Clinical depression, having MSMP, and younger age were the major factors to be independently associated with nonresponders across five categories. In addition, two factors (age at menopause and age at hysterectomy) were significantly associated with female nonresponders. CONCLUSION Our data suggested potential roles of pain perception, widespread pain sensitization, patient expectations, and early menopause in females in TJR outcomes, warranting further investigation.
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Affiliation(s)
- Christie A Costello
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ming Liu
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrew Furey
- Division of Orthopaedic Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Proton Rahman
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Edward W Randell
- Discipline of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Guangju Zhai
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Abstract
Interest in digital mental health, driven largely by the need to increase access to mental health services, presents new opportunities as well as challenges. This article provides a selective overview of several new approaches, including chatbots and apps, with a focus on exploring their unique characteristics. To understand the broader issues around digital mental health apps, we discuss recent reviews in this space in the context of how they can inform care today, and how these apps fail to address several important gaps. Framing apps as either tools to augment versus deliver care, we explore ongoing struggles in this space that will determine how apps are used, regulated, and reimbursed for. Realizing that many mental health apps today exist in this still undefined space and often possess no evidence, we conclude with an overview of the American Psychiatric Association (APA)'s app evaluation framework with the goal of offering a more informed approach to these digital tools.
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Affiliation(s)
- John Torous
- Department of Psychiatry and Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - John Halamka
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Chairman of the New England Healthcare Exchange Network, Boston, MA, USA
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9
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Brooks SD, Hileman SM, Chantler PD, Milde SA, Lemaster KA, Frisbee SJ, Shoemaker JK, Jackson DN, Frisbee JC. Protection from chronic stress- and depressive symptom-induced vascular endothelial dysfunction in female rats is abolished by preexisting metabolic disease. Am J Physiol Heart Circ Physiol 2018; 314:H1085-H1097. [PMID: 29451819 DOI: 10.1152/ajpheart.00648.2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 12/25/2022]
Abstract
While it is known that chronic stress and clinical depression are powerful predictors of poor cardiovascular outcomes, recent clinical evidence has identified correlations between the development of metabolic disease and depressive symptoms, creating a combined condition of severely elevated cardiovascular disease risk. In this study, we used the obese Zucker rat (OZRs) and the unpredictable chronic mild stress (UCMS) model to determine the impact of preexisting metabolic disease on the relationship between chronic stress/depressive symptoms and vascular function. Additionally, we determined the impact of metabolic syndrome on sex-based protection from chronic stress/depressive effects on vascular function in female lean Zucker rats (LZRs). In general, vasodilator reactivity was attenuated under control conditions in OZRs compared with LZRs. Although still impaired, conduit arterial and resistance arteriolar dilator reactivity under control conditions in female OZRs was superior to that in male or ovariectomized (OVX) female OZRs, largely because of better maintenance of vascular nitric oxide and prostacyclin levels. However, imposition of metabolic syndrome in combination with UCMS in OZRs further impaired dilator reactivity in both vessel subtypes to a similarly severe extent and abolished any protective effect in female rats compared with male or OVX female rats. The loss of vascular protection in female OZRs with UCMS was reflected in vasodilator metabolite levels, which closely matched those in male and OVX female OZRs subjected to UCMS. These results suggest that presentation of metabolic disease in combination with depressive symptoms can overwhelm the vasoprotection identified in female rats and, thereby, may reflect a severe impairment to normal endothelial function. NEW & NOTEWORTHY This study addresses the protection from chronic stress- and depression-induced vascular dysfunction identified in female compared with male or ovariectomized female rats. We determined the impact of preexisting metabolic disease, a frequent comorbidity of clinical depression in humans, on that vascular protection. With preexisting metabolic syndrome, female rats lost all protection from chronic stress/depressive symptoms and became phenotypically similar to male and ovariectomized female rats, with comparably poor vasoactive dilator metabolite profiles.
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Affiliation(s)
- Steven D Brooks
- Department of Physiology and Pharmacology, West Virginia University , Morgantown, West Virginia
| | - Stanley M Hileman
- Department of Physiology and Pharmacology, West Virginia University , Morgantown, West Virginia
| | - Paul D Chantler
- Department of Exercise Physiology, West Virginia University , Morgantown, West Virginia
| | - Samantha A Milde
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
| | - Kent A Lemaster
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
| | - Stephanie J Frisbee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
| | - J Kevin Shoemaker
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada.,School of Kinesiology, University of Western Ontario , London, Ontario , Canada
| | - Dwayne N Jackson
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
| | - Jefferson C Frisbee
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
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10
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Brooks SD, Hileman SM, Chantler PD, Milde SA, Lemaster KA, Frisbee SJ, Shoemaker JK, Jackson DN, Frisbee JC. Protection from vascular dysfunction in female rats with chronic stress and depressive symptoms. Am J Physiol Heart Circ Physiol 2018; 314:H1070-H1084. [PMID: 29451821 DOI: 10.1152/ajpheart.00647.2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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] [Indexed: 12/17/2022]
Abstract
The increasing prevalence and severity of clinical depression are strongly correlated with vascular disease risk, creating a comorbid condition with poor outcomes but demonstrating a sexual disparity whereby female subjects are at lower risk than male subjects for subsequent cardiovascular events. To determine the potential mechanisms responsible for this protection against stress/depression-induced vasculopathy in female subjects, we exposed male, intact female, and ovariectomized (OVX) female lean Zucker rats to the unpredictable chronic mild stress (UCMS) model for 8 wk and determined depressive symptom severity, vascular reactivity in ex vivo aortic rings and middle cerebral arteries (MCA), and the profile of major metabolites regulating vascular tone. While all groups exhibited severe depressive behaviors from UCMS, severity was significantly greater in female rats than male or OVX female rats. In all groups, endothelium-dependent dilation was depressed in aortic rings and MCAs, although myogenic activation and vascular (MCA) stiffness were not impacted. Higher-resolution results from pharmacological and biochemical assays suggested that vasoactive metabolite profiles were better maintained in female rats with normal gonadal sex steroids than male or OVX female rats, despite increased depressive symptom severity (i.e., higher nitric oxide and prostacyclin and lower H2O2 and thromboxane A2 levels). These results suggest that female rats exhibit more severe depressive behaviors with UCMS but are partially protected from the vasculopathy that afflicts male rats and female rats lacking normal sex hormone profiles. Determining how female sex hormones afford partial vascular protection from chronic stress and depression is a necessary step for addressing the burden of these conditions on cardiovascular health. NEW & NOTEWORTHY This study used a translationally relevant model for chronic stress and elevated depressive symptoms to determine how these factors impact conduit and resistance arteriolar function in otherwise healthy rats. While chronic stress leads to an impaired vascular reactivity associated with elevated oxidant stress, inflammation, and reduced metabolite levels, we demonstrated partial protection from vascular dysfunction in female rats with normal sex hormone profiles compared with male or ovariectomized female rats.
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Affiliation(s)
- Steven D Brooks
- Department of Physiology and Pharmacology, West Virginia University , Morgantown, West Virginia
| | - Stanley M Hileman
- Department of Physiology and Pharmacology, West Virginia University , Morgantown, West Virginia
| | - Paul D Chantler
- Department of Exercise Physiology, West Virginia University , Morgantown, West Virginia
| | - Samantha A Milde
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
| | - Kent A Lemaster
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
| | - Stephanie J Frisbee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
| | - J Kevin Shoemaker
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada.,School of Kinesiology, University of Western Ontario , London, Ontario , Canada
| | - Dwayne N Jackson
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
| | - Jefferson C Frisbee
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Faculty of Health Sciences, University of Western Ontario , London, Ontario , Canada
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11
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van Hoof MJ, van Lang NDJ, Speekenbrink S, van IJzendoorn MH, Vermeiren RRJM. Adult Attachment Interview differentiates adolescents with Childhood Sexual Abuse from those with clinical depression and non-clinical controls. Attach Hum Dev 2015; 17:354-75. [PMID: 26047034 DOI: 10.1080/14616734.2015.1050420] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although attachment representation is considered to be disturbed in traumatized adolescents, it is not known whether this is specific for trauma, as comparative studies with other clinical groups are lacking. Therefore, attachment representation was studied by means of the Adult Attachment Interview in adolescents with Childhood Sexual Abuse (CSA) (N = 21), clinical depression (N = 28) and non-clinical controls (N = 28). Coherence of mind and unresolved loss or trauma, as well as the disorganized attachment classification differentiated the CSA group from the clinical depression group and controls, over and above age, IQ, and psychiatric symptomatology. In the current era of sustained criticism on criteria-based classification, this may well carry substantial clinical relevance. If attachment is a general risk or vulnerability factor underlying specific psychopathology, this may guide diagnostic assessment as well as treatment.
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Affiliation(s)
- Marie-José van Hoof
- a Psychotraumacenter and Department of Child and Adolescent Psychiatry , GGZ Kinderen en Jeugd Rivierduinen , Leiden , The Netherlands
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Stanley SC, Brooks SD, Butcher JT, d'Audiffret AC, Frisbee SJ, Frisbee JC. Protective effect of sex on chronic stress- and depressive behavior-induced vascular dysfunction in BALB/cJ mice. J Appl Physiol (1985) 2014; 117:959-70. [PMID: 25123201 DOI: 10.1152/japplphysiol.00537.2014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The presence of chronic, unresolvable stresses leads to negative health outcomes, including development of clinical depression/depressive disorders, with outcome severity being correlated with depressive symptom severity. One of the major outcomes associated with chronic stress and depression is the development of cardiovascular disease (CVD) and an elevated CVD risk profile. However, in epidemiological research, sex disparities are evident, with premenopausal women suffering from depressive symptoms more acutely than men, but also demonstrating a relative protection from the onset of CVD. Given this, we investigated the differential effect of sex on conduit artery and resistance arteriolar function in male and female mice following 8 wk of an unpredictable chronic mild stress (UCMS) protocol. In males, plasma cortisol and depressive symptom severity (e.g., coat status, anhedonia, delayed grooming) were elevated by UCMS. Endothelium-dependent dilation to methacholine/acetylcholine was impaired in conduit arteries and skeletal muscle arterioles, suggesting a severe loss of nitric oxide bioavailability and increased production of thromboxane A2 vs. prostaglandin I2 associated with elevated reactive oxygen species (ROS) and an increased level of systemic inflammation. Endothelium-independent dilation was intact. In females, depressive symptoms and plasma cortisol increases were more severe than in males, although alterations to vascular reactivity were blunted, including the effects of elevated ROS and inflammation on dilator responses. These results suggest that compared with males, female rats are more susceptible to chronic stress in terms of the severity of depressive behaviors, but that the subsequent development of vasculopathy is blunted owing to an improved ability to tolerate elevated ROS and systemic inflammatory stress.
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Affiliation(s)
- Shyla C Stanley
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia Departments of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Steven D Brooks
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia Departments of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Joshua T Butcher
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia Departments of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Alexandre C d'Audiffret
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia Departments of Vascular and Endovascular Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia; and
| | - Stephanie J Frisbee
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia Health Policy, Leadership and Management, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Jefferson C Frisbee
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia Departments of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia
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Abstract
In this article we discuss the traditional behavioral models of depression and some of the challenges analyzing a phenomenon with such complex and varied features. We present the traditional model and suggest that it does not capture the complexity of the phenomenon, nor do syndromal models of depression that dominate the mainstream conceptualization of depression. Instead, we emphasize ideographic analysis and present depression as a maladaptive dysregulation of an ultimately adaptive elicited emotional response. We emphasize environmental factors, specifically aversive control and private verbal events, in terms of relational frame theory, that may transform an adaptive response into a maladaptive disorder. We consider the role of negative thought processes and rumination, common and debilitating aspects of depression that have traditionally been neglected by behavior analysts.
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Sullivan RM, Gratton A. Lateralized effects of medial prefrontal cortex lesions on neuroendocrine and autonomic stress responses in rats. J Neurosci 1999; 19:2834-40. [PMID: 10087094 PMCID: PMC6786056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/1998] [Revised: 01/19/1999] [Accepted: 01/24/1999] [Indexed: 02/11/2023] Open
Abstract
The medial prefrontal cortex (mPFC) is highly activated by stress and modulates neuroendocrine and autonomic function. Dopaminergic inputs to mPFC facilitate coping ability and demonstrate considerable hemispheric functional lateralization. The present study investigated the potentially lateralized regulation of stress responses at the level of mPFC output neurons, using ibotenic acid lesions. Neuroendocrine function was assessed by plasma corticosterone increases in response to acute or repeated 20 min restraint stress. The primary index of autonomic activation was gastric ulcer development during a separate cold restraint stress. Restraint-induced defecation was also monitored. Plasma corticosterone levels were markedly lower in response to repeated versus acute restraint stress. In acutely restrained animals, right or bilateral, but not left mPFC lesions, decreased prestress corticosterone levels, whereas in repeatedly restrained rats, the same lesions significantly reduced the peak stress-induced corticosterone response. Stress ulcer development (after a single cold restraint stress) was greatly reduced by either right or bilateral mPFC lesions but was unaffected by left lesions. Restraint-induced defecation was elevated in animals with left mPFC lesions. Finally, a left-biased asymmetry in adrenal gland weights was observed across animals, which was unaffected by mPFC lesions. The results suggest that mPFC output neurons demonstrate an intrinsic right brain specialization in both neuroendocrine and autonomic activation. Such findings may be particularly relevant to clinical depression which is associated with both disturbances in stress regulatory systems and hemispheric imbalances in prefrontal function.
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Affiliation(s)
- R M Sullivan
- Douglas Hospital Research Center, Department of Psychiatry, McGill University, Montréal, Québec Canada H4H 1R3
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