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1.
iScience ; 24(11): 103312, 2021 Nov 19.
Article in English | MEDLINE | ID: mdl-34765928

ABSTRACT

Converging evidence indicates that major depressive disorder (MDD) and metabolic disorders might be mediated by shared (patho)biological pathways. However, the converging cellular and molecular signatures remain unknown. Here, we investigated metabolic dysfunction on a systemic, cellular, and molecular level in unmedicated patients with MDD compared with matched healthy controls (HC). Despite comparable BMI scores and absence of cardiometabolic disease, patients with MDD presented with significant dyslipidemia. On a cellular level, T cells obtained from patients with MDD exhibited reduced respiratory and glycolytic capacity. Gene expression analysis revealed increased carnitine palmitoyltransferase IA (CPT1a) levels in T cells, the rate-limiting enzyme for mitochondrial long-chain fatty acid oxidation. Together, our results indicate metabolic dysfunction in unmedicated, non-overweight patients with MDD on a systemic, cellular, and molecular level. This evidence for reduced mitochondrial respiration in T cells of patients with MDD provides translation of previous animal studies regarding a putative role of altered immunometabolism in depression pathobiology.

2.
PeerJ ; 6: e6037, 2018.
Article in English | MEDLINE | ID: mdl-30581662

ABSTRACT

BACKGROUND: Only few aerobic exercise intervention trials specifically targeting cognitive functioning have been performed in multiple sclerosis. OBJECTIVE AND METHODS: This randomized controlled trial with 34 patients in the intervention group (IG) (mean: 38.2 years (±9.6)) and 34 patients in the control group (CG) (mean: 39.6 years (±9.7)) aimed to determine the effects of aerobic exercise on cognition in relapsing-remitting multiple sclerosis (RRMS). The primary outcome was verbal learning assessed by the verbal learning and memory test (VLMT). Patients were randomized to an IG or a waitlist CG. Patients in the IG exercised according to an individually tailored training schedule (with two to three sessions per week for 12 weeks). The primary analysis was carried out using the intention-to-treat (ITT) sample with ANCOVA adjusting for baseline scores. RESULTS: A total of 77 patients with RRMS were screened and 68 participants randomized (CG n = 34; IG n = 34). The sample comprised 68% females, had a mean age of 39 years, a mean disease duration of 6.3 years, and a mean expanded disability status scale of 1.8. No significant effects were detected in the ITT analysis for the primary endpoint VLMT or any other cognitive measures. Moreover, no significant treatment effects were observed for quality of life, fatigue, or depressive symptoms. CONCLUSION: This study failed to demonstrate beneficial effects of aerobic exercise on cognition in RRMS. The trial was prospectively registered at clinicaltrials.gov (NCT02005237).

3.
Front Immunol ; 9: 2693, 2018.
Article in English | MEDLINE | ID: mdl-30532752

ABSTRACT

Several lines of evidence have strongly implicated inflammatory processes in the pathobiology of major depressive disorder (MDD). However, the cellular origin of inflammatory signals and their specificity remain unclear. We examined the phenotype and glucocorticoid signaling in key cell populations of the innate immune system (monocytes) vs. adaptive immunity (T cells) in a sample of 35 well-characterized, antidepressant-free patients with MDD and 35 healthy controls individually matched for age, sex, smoking status and body mass index. Monocyte and T cell phenotype was assessed by flow cytometry. Cell-specific steroid signaling was determined by mRNA expression of pre-receptor regulation (11ß-hydroxysteroid dehydrogenase type 1; 11ß -HSD1), steroid receptor expression [glucocorticoid receptor (GR) and mineralocorticoid receptor (MR)], and the downstream target glucocorticoid-induced leucine-zipper (GILZ). We also collected salivary cortisol samples (8:00 a.m. and 10:00 p.m.) on two consecutive days. Patients showed a shift toward a pro-inflammatory phenotype characterized by higher frequency and higher absolute numbers of non-classical monocytes. No group differences were observed in major T cell subset frequencies and phenotype. Correspondingly, gene expression indicative of steroid resistance (i.e., lower expression of GR and GILZ) in patients with MDD was specific to monocytes and not observed in T cells. Monocyte phenotype and steroid receptor expression was not related to cortisol levels or serum levels of IL-6, IL-1ß, or TNF-α. Our results thus suggest that in MDD, cells of the innate and adaptive immune system are differentially affected with shifts in monocyte subsets and lower expression of steroid signaling related genes.


Subject(s)
Depressive Disorder, Major/immunology , Monocytes/immunology , Signal Transduction/immunology , Steroids/immunology , 11-beta-Hydroxysteroid Dehydrogenases/immunology , Adolescent , Adult , Depressive Disorder, Major/pathology , Female , Gene Expression Regulation/immunology , Humans , Male , Middle Aged , Monocytes/pathology , Receptors, Glucocorticoid/immunology , Receptors, Mineralocorticoid/immunology , T-Lymphocytes/immunology , Transcription Factors/immunology
4.
Lancet Psychiatry ; 4(9): 725-732, 2017 09.
Article in English | MEDLINE | ID: mdl-28396067

ABSTRACT

In psychiatry, comparative analyses of therapeutic options and the aggregation of data from clinical trials across different therapeutic approaches play an important role in clinical decision making, treatment guidelines, and health policy. This approach assumes that trials of pharmacological and behavioural therapies generally produce the same level of evidence when properly designed. However, trial design for behavioural interventions has some unique characteristics and control groups vary widely, which influence the effects observed in any given trial. In this Personal View, we review various control conditions typically used in psychiatry, outline their effect on the internal validity and expected effect size of a trial, and propose a decision framework for choosing a control condition depending on the risk to the patient population and the stage of development of the therapeutic intervention. We argue that the choice of control group and its justification need to be taken into consideration when comparing behavioural and pharmacological therapies.


Subject(s)
Behavior Therapy , Control Groups , Decision Making , Humans , Psychiatry/methods , Randomized Controlled Trials as Topic/methods , Research Design
5.
EPMA J ; 7: 25, 2016.
Article in English | MEDLINE | ID: mdl-27904656

ABSTRACT

More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.

6.
Mult Scler ; 22(11): 1476-1484, 2016 10.
Article in English | MEDLINE | ID: mdl-26746809

ABSTRACT

BACKGROUND: Depression is a common co-morbidity in patients with multiple sclerosis (MS). While somatic symptoms of MS correlate with depression levels, it is unclear whether the clinical presentation of MS-associated depression differs from patients with "idiopathic" major depressive disorder (MDD). OBJECTIVE: To compare the clinical phenotype of depression among MS and idiopathic MDD patients. METHODS: Mean relative contribution of individual Beck Depression Inventory-II (BDI-II) items was evaluated among n = 139 patients with relapsing-remitting MS and n = 85 MDD patients without somatic illness. Next, comparisons were repeated in n = 38 MS with clinically relevant depressive symptoms (BDI-II > 19) and n = 38 MDD patients matched for sex, age, and depression severity. Finally, the underlying construct of depression was compared across groups using confirmatory factor analysis (CFA). RESULTS: Comparisons on a whole-group level produced the expected differences along somatic/non-somatic symptoms. However, when appropriately controlling for depression severity, age, and sex, only four items contributed differentially to BDI-II total scores in MS versus MDD. CFA suggested that the underlying depression construct is essentially identical in both groups. CONCLUSION: The clinical phenotype of "idiopathic" MDD and MS-associated depression appears similar when adequately examined. The relevance of these findings for psychotherapeutic approaches for MS-associated depression should be explored in future studies.


Subject(s)
Depressive Disorder, Major/psychology , Multiple Sclerosis, Relapsing-Remitting/psychology , Adult , Aged , Case-Control Studies , Depressive Disorder, Major/complications , Female , Humans , Male , Middle Aged , Multiple Sclerosis, Relapsing-Remitting/complications , Phenotype , Severity of Illness Index , Young Adult
7.
Biol Psychiatry ; 79(9): e73-e74, 2016 May 01.
Article in English | MEDLINE | ID: mdl-26382597
9.
CNS Neurol Disord Drug Targets ; 13(4): 673-83, 2014.
Article in English | MEDLINE | ID: mdl-24938776

ABSTRACT

Depressive disorders have, for a sizeable extent, proven resilient to pharmacotherapy. Established drugs such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-noradrenaline reuptake inhibitors (SNRIs) often provide inadequate symptom relief and sometimes fail altogether. Recently, interest in antidepressant effects of scopolamine, a non-selective muscarinic acetylcholine receptor (mAChR) antagonist, has arisen. Initial evidence suggests that scopolamine provides relatively rapid and long-lasting symptom alleviation for unipolar and bipolar depressed patients. At the same time, side effects of medical dosages appear mild and transient in nature. The aim of the present review is to tentatively discuss the antidepressant potential of scopolamine and to outline putative neurobiological pathways. Clearly, mAChR antagonism provides an intriguing novel therapeutical approach for treating depressive disorders.


Subject(s)
Antidepressive Agents/pharmacology , Depressive Disorder/drug therapy , Muscarinic Antagonists/pharmacology , Scopolamine/pharmacology , Animals , Antidepressive Agents/adverse effects , Brain/drug effects , Brain/physiopathology , Depressive Disorder/physiopathology , Humans , Muscarinic Antagonists/adverse effects , Scopolamine/adverse effects
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