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Oudijn MS, Linders JTW, Lok A, Schuurman PR, van den Munckhof P, van Elburg AA, van Wingen GA, Mocking RJT, Denys D. Neural effects of deep brain stimulation on reward and loss anticipation and food viewing in anorexia nervosa: a pilot study. J Eat Disord 2023; 11:140. [PMID: 37605212 PMCID: PMC10440869 DOI: 10.1186/s40337-023-00863-3] [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] [Received: 04/21/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe and life-threatening psychiatric disorder. Initial studies on deep brain stimulation (DBS) in severe, treatment-refractory AN have shown clinical effects. However, the working mechanisms of DBS in AN remain largely unknown. Here, we used a task-based functional MRI approach to understand the pathophysiology of AN. METHODS We performed functional MRI on four AN patients that participated in a pilot study on the efficacy, safety, and functional effects of DBS targeted at the ventral limb of the capsula interna (vALIC). The patients and six gender-matched healthy controls (HC) were investigated at three different time points. We used an adapted version of the monetary incentive delay task to probe generic reward processing in patients and controls, and a food-specific task in patients only. RESULTS At baseline, no significant differences for reward anticipation were found between AN and HC. Significant group (AN and HC) by time (pre- and post-DBS) interactions were found in the right precuneus, right putamen, right ventral and medial orbitofrontal cortex (mOFC). No significant interactions were found in the food viewing task, neither between the conditions high-calorie and low-calorie food images nor between the different time points. This could possibly be due to the small sample size and the lack of a control group. CONCLUSION The results showed a difference in the response of reward-related brain areas post-DBS. This supports the hypotheses that the reward circuitry is involved in the pathogenesis of AN and that DBS affects responsivity of reward-related brain areas. Trial registration Registered in the Netherlands Trial Register ( https://www.trialregister.nl/trial/3322 ): NL3322 (NTR3469).
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Affiliation(s)
- M S Oudijn
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J T W Linders
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A Lok
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P van den Munckhof
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A A van Elburg
- Faculty of Social Sciences, University of Utrecht, Utrecht, The Netherlands
| | - G A van Wingen
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R J T Mocking
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - D Denys
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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van Verseveld M, Mocking RJT, Scheepens D, Ten Doesschate F, Westra M, Schoevers RA, Schene AH, van Wingen GA, van Waarde JA, Ruhé HG. Polyunsaturated fatty acids changes during electroconvulsive therapy in major depressive disorder. J Psychiatr Res 2023; 160:232-239. [PMID: 36868104 DOI: 10.1016/j.jpsychires.2023.02.028] [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] [Received: 11/02/2022] [Revised: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
Polyunsaturated fatty acids (PUFAs) have important electrochemical properties and have been implicated in the pathophysiology of major depressive disorder (MDD) and its treatment. However, the relation of PUFAs with electroconvulsive therapy (ECT) has never been investigated. Therefore, we aimed to explore the associations between PUFA concentrations and response to ECT in patients with MDD. We included 45 patients with unipolar MDD in a multicentre study. To determine PUFA concentrations, we collected blood samples at the first (T0) and twelfth (T12) ECT-session. We assessed depression severity using the Hamilton Rating Scale for Depression (HAM-D) at T0, T12 and at the end of the ECT-course. ECT-response was defined as 'early response' (at T12), 'late response' (after ECT-course) and 'no' response (after the ECT-course). The PUFA chain length index (CLI), unsaturation index (UI) and peroxidation index (PI) and three individual PUFAs (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA] and nervonic acid [NA]) were associated with response to ECT using linear mixed models. Results showed a significant higher CLI in 'late responders' compared to 'non responders'. For NA, 'late responders' showed significantly higher concentrations compared to 'early'- and 'non responders'. In conclusion, this study provides the first indication that PUFAs are associated with the efficacy of ECT. This indicates that PUFAs' influence on neuronal electrochemical properties and neurogenesis may affect ECT outcomes. Thereby, PUFAs form a potentially modifiable factor predicting ECT outcomes, that warrants further investigation in other ECT-cohorts.
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Affiliation(s)
- M van Verseveld
- Rijnstate Hospital, Department of Psychiatry, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands.
| | - R J T Mocking
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, 1105, AZ, Amsterdam, the Netherlands
| | - D Scheepens
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, 1105, AZ, Amsterdam, the Netherlands
| | - F Ten Doesschate
- Rijnstate Hospital, Department of Psychiatry, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - M Westra
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - R A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - A H Schene
- Radboud University Medical Center, Department of Psychiatry, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Kapittelweg 29, 6525 EN, Nijmegen, Netherlands
| | - G A van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, 1105, AZ, Amsterdam, the Netherlands
| | - J A van Waarde
- Rijnstate Hospital, Department of Psychiatry, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - H G Ruhé
- Radboud University Medical Center, Department of Psychiatry, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Kapittelweg 29, 6525 EN, Nijmegen, Netherlands
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Stringer B, Mocking RJT, Rammers D, Koekkoek B. Consultations for refractory cases in mental health services: a descriptive study. BMC Psychiatry 2023; 23:79. [PMID: 36707806 PMCID: PMC9883910 DOI: 10.1186/s12888-023-04559-5] [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] [Received: 01/13/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Yearly, almost six percent, which is more than 1,000.000 people, in the Netherlands receive mental health treatment, which usually improves their quality of life. Concurrently, mental healthcare professionals recognize clinically refractory cases in which improvement fails to occur, with severe ongoing burdens for patients. The Dutch Centre for Consultation and Expertise (CCE) is available to support such refractory cases. The Dutch government's (financial) facilitation of consultation through the CCE is unique in the world. CCE consultations provide therefore unique insight into and an overview of refractory cases in mental health services. The objective of this study was to gain insight into the commonalities underlying the reasons for CCE consultations and the solutions proposed that play roles in (the reduction of) refractory cases for which consultation has been requested. METHODS This descriptive study was conducted with quantitative and qualitative data from 472 CCE consultations in the Netherlands. Using descriptive statistics and thematic content analysis, four exemplary situations were distilled from the qualitative data. RESULTS Most (83%) cases in the sample could be explained with four exemplary situations involving self-harm (24.2%), aggression (21.8%), self-neglect (24.4%), and socially unacceptable behavior (12.5%), respectively. Each situation could be characterized by a specific interaction pattern that unintentionally maintained or aggravated the situation. At the time of closure of the consultation applicants' questions had been answered and their situations had improved in 60.4% of cases. CONCLUSIONS This study offers an overview of approaches that provided new perspectives for patients and professionals in many refractory cases in the Dutch mental health services.
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Affiliation(s)
- B. Stringer
- Center for Consultation and Expertise, Utrecht, The Netherlands
| | - R. J. T. Mocking
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - D. Rammers
- Center for Consultation and Expertise, Utrecht, The Netherlands
| | - B. Koekkoek
- grid.450078.e0000 0000 8809 2093Research Group for Social Psychiatry and Mental Health Nursing, HAN University of Applied Science, Nijmegen, The Netherlands ,grid.491369.00000 0004 0466 1666Pro Persona Mental Health Services, Wolfheze, The Netherlands ,Research Department, Police Academy, Apeldoorn, The Netherlands
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Oudijn MS, Mocking RJT, Wijnker RR, Lok A, Schuurman PR, van den Munckhof P, van Elburg AA, Denys D. Deep brain stimulation of the ventral anterior limb of the capsula interna in patients with treatment-refractory anorexia nervosa. Brain Stimul 2021; 14:1528-1530. [PMID: 34678486 DOI: 10.1016/j.brs.2021.10.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- M S Oudijn
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands.
| | - R J T Mocking
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - R R Wijnker
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - A Lok
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - P R Schuurman
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - P van den Munckhof
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - A A van Elburg
- Faculty of Social Sciences, University of Utrecht, Utrecht, the Netherlands
| | - D Denys
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
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Stringer B, Mocking RJT, Rammers D, Koekkoek B. [Consultation in refractory cases in mental health care: a descriptive study]. Tijdschr Psychiatr 2021; 63:343-350. [PMID: 34043223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Yearly, over 1.000.000 people receive mental health care treatment in the Netherlands. Treatment usually results in improvement in quality of life. Concurrently, each professional recognizes clinically refractory cases in which improvement fails to occur with severe ongoing burden for the client. In the Netherlands, for these clinically refractory cases the Centre of Consultation and Expertise (CCE) is available. The CCE is an independent nation-wide organisation offering free consultations to care providers. Therefore, CCE-consultations provide a unique insight in and overview of refractory cases. AIM Providing overview of and insight into backgrounds and themes that play a role in (the reduction of) refractory cases. METHOD Descriptive study of quantitative and qualitative data from 472 consultations in mental health care. RESULTS 83% of cases could be explained with 4 exemplary vignettes of refractoriness: self-harm, aggression, self-neglect and socially unacceptable behaviour. CONCLUSION Refractory cases result from an interaction pattern that unintentionally maintains or aggravates the situation. This study offers an overview of approaches that proved to be helpful in providing new perspective for clients and professionals in many therapy refractory cases in Dutch mental health care.
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Thesing CS, Lok A, Milaneschi Y, Assies J, Bockting CLH, Figueroa CA, Giltay EJ, Penninx BWJH, Ruhé HG, Schene AH, Bot M, Mocking RJT. Fatty acids and recurrence of major depressive disorder: combined analysis of two Dutch clinical cohorts. Acta Psychiatr Scand 2020; 141:362-373. [PMID: 31785112 PMCID: PMC7216896 DOI: 10.1111/acps.13136] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acid (PUFA) alterations in patients with major depressive disorder (MDD) have been shown to persist after remission. Whether these alterations are risk factors for MDD recurrence remains unknown. Here, we examined whether fatty acids predict time until MDD recurrence in remitted MDD patients. METHODS Data were used from remitted MDD patients of the Netherlands Study of Depression and Anxiety (n = 356) and the Depression Evaluation Longitudinal Therapy Assessment studies (n = 118). Associations of FAs with time until MDD recurrence up to 8-year follow-up were analyzed using Cox regression analyses. Study-specific estimates were pooled using mega- and meta-analysis techniques. RESULTS 27.5% (NESDA) and 56.8% (DELTA) participants had an MDD recurrence. Pooled results showed that no FA was significantly associated with time until MDD recurrence (n-3 PUFAs: hazard ratio (HR) = 1.17, 95% confidence interval (CI) = 0.98-1.41, P = 0.082; n-6 PUFAs: HR = 1.08, 95% CI = 0.84-1.38, P = 0.55). CONCLUSION In remitted MDD patients, circulating PUFAs were not associated with prospective risk of MDD recurrence. Consequently, circulating PUFAs are unlikely to reflect a vulnerability marker for recurrence, so correcting n-3 PUFA 'deficits' through supplementation does not seem a promising option to prevent MDD recurrence.
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Affiliation(s)
- C. S. Thesing
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - A. Lok
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
| | - Y. Milaneschi
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - J. Assies
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
| | - C. L. H. Bockting
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
| | - C. A. Figueroa
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
| | - E. J. Giltay
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - B. W. J. H. Penninx
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - H. G. Ruhé
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands,Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands,Donders Institute for Brain, Cognition and BehaviorRadboud University Medical CenterNijmegenThe Netherlands
| | - A. H. Schene
- Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands,Donders Institute for Brain, Cognition and BehaviorRadboud University Medical CenterNijmegenThe Netherlands
| | - M. Bot
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - R. J. T. Mocking
- Department of PsychiatryAmsterdam Public Health Research InstituteAmsterdam UMCAcademisch Medisch CentrumUniversity of AmsterdamAmsterdamThe Netherlands
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Deenik J, Vermeulen JM, Mocking RJT, Van Assche E, Cahn W. [Lifestyle as medicine in psychiatry]. Tijdschr Psychiatr 2020; 62:920-922. [PMID: 33443741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Oenema A, de Ruijter D, Vingerhoets C, van der Wurff ISM, Bos DJ, Nicolaou M, Bot M, Giltay EJ, Mocking RJT. [Nutrition and mental disorders during the life span: an overview of scientific evidence]. Tijdschr Psychiatr 2020; 62:927-935. [PMID: 33443742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Nutritional interventions are scarcely used in the prevention and treatment of mental disorders.<br/> AIM: To summarize scientific evidence on the relation between nutrition and mental health, across the life span.<br/> METHOD: An overview of the literature based on recent knowledge syntheses, meta-analyses and original studies.<br/> RESULTS: Healthy dietary patterns are associated with a lower risk for depressive symptoms among adults and potentially also among children and adolescents. Dietary interventions can be effective in reducing depressive symptoms among high-risk groups and can have a beneficial effect in the treatment of depression. Meta-analyses of randomised studies have shown that omega-3 fatty acid supplements can be of added value in the treatment of adhd in children and of depression in adults.<br/> CONCLUSION: Promotion of healthy dietary patterns in line with National guidelines for healthy diets is important in the entire spectrum from good mental health to a chronic disorder. More attention for improving healthy dietary patterns among patients with mental disorders can lead to important health gains.
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Abstract
Continuous research into the pathophysiology of psychiatric disorders, such as major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and schizophrenia, suggests an important role for metabolism. This narrative review will provide an up-to-date summary of how metabolism is thought to be involved in the pathophysiology of these psychiatric disorders. We will focus on (I) the important role of fatty acids in these metabolic alterations, (II) whether fatty acid alterations represent epiphenomena or risk factors, and (III) similarities and dissociations in fatty acid alterations between different psychiatric disorders. (Historical) epidemiological evidence links fatty acid intake to psychiatric disorder prevalence, corroborated by altered fatty acid concentrations measured in psychiatric patients. These fatty acid alterations are connected with other concomitant pathophysiological mechanisms, including biological stress (hypothalamic-pituitary-adrenal (HPA)-axis and oxidative stress), inflammation, and brain network structure and function. Metabolomics and lipidomics studies are underway to more deeply investigate this complex network of associated neurometabolic alterations. Supplementation of fatty acids as disease-modifying nutraceuticals has clinical potential, particularly add-on eicosapentaenoic acid (EPA) in depressed patients with markers of increased inflammation. However, by interpreting the observed fatty acid alterations as partly (mal)adaptive phenomena, we attempt to nuance translational expectations and provide new clinical applications for these novel neurometabolic insights, e.g., to predict treatment response or depression recurrence. In conclusion, placing fatty acids in context can contribute to further understanding and optimized treatment of psychiatric disorders, in order to diminish their overwhelming burden of disease.
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Affiliation(s)
- R J T Mocking
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands.
| | - J Assies
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
| | - H G Ruhé
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
- Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A H Schene
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, the Netherlands
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Mocking RJT, Pellikaan CM, Lok A, Assies J, Ruhé HG, Koeter MW, Visser I, Bockting CL, Olff M, Schene AH. DHEAS and cortisol/DHEAS-ratio in recurrent depression: State, or trait predicting 10-year recurrence? Psychoneuroendocrinology 2015; 59:91-101. [PMID: 26036454 DOI: 10.1016/j.psyneuen.2015.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 02/17/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been associated with low dehydroepiandrosterone-sulphate (DHEAS), - particularly relative to high cortisol - although conflicting findings exist. Moreover, it is unclear whether low DHEAS is only present during the depressive state, or manifests as a trait that may reflect vulnerability for recurrence. Therefore, we longitudinally tested whether low DHEAS and high cortisol/DHEAS-ratio in recurrent MDD (I) reflects a trait, and/or (II) varies with depressive state. In addition, we tested associations with (III) previous MDD-episodes, (IV) prospective recurrence, and (V) effects of cognitive therapy. METHODS At study-entry, we cross-sectionally compared morning and evening salivary DHEAS and molar cortisol/DHEAS-ratio of 187 remitted recurrent MDD-patients with 72 matched controls. Subsequently, patients participated in an 8-week randomized controlled cognitive therapy trial. We repeated salivary measures after 3 months and 2 years. We measured clinical symptoms during a 10-year follow-up. RESULTS Remitted patients showed steeper diurnal DHEAS-decline (p<.005) and a flatter diurnal profile of cortisol/DHEAS-ratio (p<.001) than controls. We found no state-effect in DHEAS or cortisol/DHEAS-ratio throughout follow-up and no association with number of previous episodes. Higher morning cortisol/DHEAS-ratio predicted shorter time till recurrence over the 10-year follow-up in interaction with the effects of cognitive therapy (p<.05). Finally, cognitive therapy did not influence DHEAS or cortisol/DHEAS-ratio. CONCLUSIONS Diurnal profiles of DHEAS and cortisol/DHEAS-ratio remain equally altered in between depressive episodes, and may predict future recurrence. This suggests they represent an endophenotypic vulnerability trait rather than a state-effect, which provides a new road to understand recurrent depression and its prevention. TRIAL REGISTRATION www.isrctn.com/ISRCTN68246470.
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Affiliation(s)
- R J T Mocking
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - C M Pellikaan
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - A Lok
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - J Assies
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - H G Ruhé
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; University Medical Center Groningen, Program for Mood and Anxiety Disorders, Department of Psychiatry, The Netherlands
| | - M W Koeter
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - I Visser
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - C L Bockting
- Department of Clinical Psychology, University of Groningen, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - M Olff
- Arq Psychotrauma Expert Group, Diemen, The Netherlands; Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - A H Schene
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
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Assies J, Mocking RJT, Lok A, Ruhé HG, Pouwer F, Schene AH. Effects of oxidative stress on fatty acid- and one-carbon-metabolism in psychiatric and cardiovascular disease comorbidity. Acta Psychiatr Scand 2014; 130:163-80. [PMID: 24649967 PMCID: PMC4171779 DOI: 10.1111/acps.12265] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death in severe psychiatric disorders (depression, schizophrenia). Here, we provide evidence of how the effects of oxidative stress on fatty acid (FA) and one-carbon (1-C) cycle metabolism, which may initially represent adaptive responses, might underlie comorbidity between CVD and psychiatric disorders. METHOD We conducted a literature search and integrated data in a narrative review. RESULTS Oxidative stress, mainly generated in mitochondria, is implicated in both psychiatric and cardiovascular pathophysiology. Oxidative stress affects the intrinsically linked FA and 1-C cycle metabolism: FAs decrease in chain length and unsaturation (particularly omega-3 polyunsaturated FAs), and lipid peroxidation products increase; the 1-C cycle shifts from the methylation to transsulfuration pathway (lower folate and higher homocysteine and antioxidant glutathione). Interestingly, corresponding alterations were reported in psychiatric disorders and CVD. Potential mechanisms through which FA and 1-C cycle metabolism may be involved in brain (neurocognition, mood regulation) and cardiovascular system functioning (inflammation, thrombosis) include membrane peroxidizability and fluidity, eicosanoid synthesis, neuroprotection and epigenetics. CONCLUSION While oxidative-stress-induced alterations in FA and 1-C metabolism may initially enhance oxidative stress resistance, persisting chronically, they may cause damage possibly underlying (co-occurrence of) psychiatric disorders and CVD. This might have implications for research into diagnosis and (preventive) treatment of (CVD in) psychiatric patients.
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Affiliation(s)
- J Assies
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, Amsterdam
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