Distinct association of plasma BDNF concentration and cognitive function in depressed patients treated with vortioxetine or escitalopram.

RATIONALE: Cognitive dysfunction is frequent in major depressive disorder (MDD), and brain-derived neurotrophic factor (BDNF) is involved both in regulation of cognition and in therapeutic response in MDD. OBJECTIVES: The aim of this study was to determine if baseline plasma BDNF might predict change in cognitive function in MDD patients treated with vortioxetine or escitalopram, and whether the alterations in BDNF levels correlate with changes in cognitive performance during treatment. METHODS: Drug-naive or drug-free patients with MDD (N=121) were sampled and evaluated at baseline and 4 weeks after treatment initiation with vortioxetine or escitalopram. Cognitive function was evaluated using the F-A-S test, Digit Span test, and Digit Symbol Coding test. Plasma BDNF was determined using ELISA. RESULTS: The results of the study indicate that both vortioxetine (V) and escitalopram (E) improved cognitive functions evaluated with F-A-S test (V: p<0.001; r=-0.427, E: p<0.001; r=-0.370), Digit Symbol Coding test (V: p<0.001; r=-0.706, E: p<0.001; r=-0.435), and Digit Span test-backward span (V: p=0.001; r=-0.311, E: p=0.042; r=-0.185), while only vortioxetine (p<0.001; r=-0.325) improved cognition evaluated with the Digit Span test-forward span. A moderate positive correlation between pretreatment plasma BDNF levels and improvement in cognitive performance was only detected in patients treated with vortioxetine (delta F-A-S test: p=0.011; r=0.325, delta Digit Span test-forward span: p=0.010, r=0.326). CONCLUSIONS: These results suggest that higher baseline plasma BDNF levels might be associated with improvements in verbal fluency and working memory in vortioxetine, but not escitalopram treated patients. Vortioxetine treatment was superior in simple attention efficiency.

Some Psychological, Gastrointestinal and Cardiovascular Consequences of Earthquakes.

In the last 40 years there has been a 6-fold increase in the number of earthquakes worldwide. Devastating earthquakes, 5.5 and 6.2 on Richter scale hit Croatia in 2020 during the brutal pandemic year. Our experience served us as our initial motivation for finding out all clinical outcomes after an earthquake. Previous research has shown increased rates of suicidal thoughts, susceptibility to PTSD and depressive symptomatology. Mental health action plans should be encouraged and well prepared in advance by leading organizations. Studies conducted to date have found that the number of patients with gastric and duodenal ulcers increased as an earthquake aftermath. Other gastrointestinal symptoms were abdominal pain, distension and constipation. Earthquakes provide a good example of how acute stress can trigger cardiovascular events, predominantly through sympathetic nervous activation. Studies conducted to date have found an increased incidence of acute myocardial infarction, stroke, arrhythmias and Takotsubo cardiomyopathy. This review reminds us of the importance of treating psychological and psychosomatic consequences of earthquakes.

Effect of vortioxetine vs. escitalopram on plasma BDNF and platelet serotonin in depressed patients.

Escitalopram and vortioxetine are efficacious antidepressants. They directly target serotonin (5-HT) system, but vortioxetine mechanism of action is distinct from the one of selective serotonin reuptake inhibitors (SSRIs). Treatment with SSRIs decrease platelet 5-HT concentration and increase peripheral brain-derived neurotrophic factor (BDNF) levels. Since vortioxetine has a multimodal mechanism of action, it is expected to have a greater effect on circulatory BDNF concentration, compared to conventional antidepressants. This longitudinal study aimed to explore and compare the effects of 4-weeks of treatment with vortioxetine and escitalopram on plasma BDNF and platelet 5-HT concentration in patients with major depressive disorder (MDD). The results revealed that vortioxetine significantly increased plasma BDNF concentration (p = .018) and significantly decreased platelet 5-HT concentration (p < .001). Treatment with escitalopram significantly decreased platelet 5-HT concentration (p < .001), but it did not affect plasma BDNF concentration (p = .379). Response to vortioxetine was not predicted by baseline plasma BDNF or platelet 5-HT concentration, but response to escitalopram was predicted by baseline platelet 5-HT concentration. These effects might be due to vortioxetine unique mechanism of action, but the clinical implications are unclear. It remains to be determined whether this finding extends during long-term vortioxetine treatment, and which, if any, clinical effects emerge from BDNF increase.

The Role of Religiosity in Coping with Infertility Treatment.

BACKGROUND: To analyze relationship between religiosity and psychological distress in woman undergoing in vitro fertilization. SUBJECTS AND METHODS: The study was based on 103 woman engaged in a fertility treatment with in vitro fertilization. The questionnaires (Religiosity Questionnaire, Clinical Outcomes in Routine Evaluation - Outcome Measure, and socio-demographic questionnaire) were administered by investigators. RESULTS: The results suggest that the level of religiosity significantly differs participants in terms of problems (F=1.92, p=0.01), functioning (F=1.79, p=0.03), risk behaviors (F=3.02, p=0.00), anxiety (F=1.72, p=0.03) and physical problems (F=1.82, p=0.02). There were no significant differences in subjective wellbeing, depression and traumatization according to religiosity. CONCLUSION: Results of a present study point out that religiosity could be considered as a protective factor for psychological distress.

Alexithymia and psychological distress among women undergoing in vitro fertilization.

BACKGROUND: The aim of the current study was to analyze the relationship between alexithymia, anxiety, physical problems, trauma, and psychological distress in women undergoing in vitro fertilization. SUBJECTS AND METHODS: The study was based on 78 women (mean age = 34.4 ys) who were referred to a fertility treatment with in vitro fertilization. The questionnaires (socio-demographic questionnaire, Toronto Alexithymia Scale, and Clinical Outcomes in Routine Evaluation - Outcome Measure) were administered by the investigators. RESULTS: Our results suggest that alexithymia was significantly correlated to anxiety (r=0.506, p=0.00), depression (r=0.591, p=0.00), physical problems (r=0.477, p=0.00), trauma (r=0.512, p=0.00), and psychological distress (r=0.598, p=0.00). Furthermore, high alexithymia group showed significantly higher levels of anxiety (F=4.65, p=0.00), depression (F=2.30, p=0.00), trauma (F=1.80, p=0.00) and general psychological distress (F=2.85, p=0.04) than the low alexithymia group. CONCLUSIONS: Results of the present study point out that alexithymia could be considered a potential risk factor for high levels of anxiety, depression and general psychological distress. It may also be used as an indicator of a need for further psychological support aimed at women undergoing in vitro fertilization.

A prospective, longitudinal study of platelet serotonin and plasma brain-derived neurotrophic factor concentrations in major depression: effects of vortioxetine treatment.

BACKGROUND: Various antidepressants occupy brain serotonin transporter (SERT), decrease platelet serotonin (5-HT) concentration, and normalize reduced plasma brain-derived neurotrophic factor (BDNF) concentrations in depressed patients. Vortioxetine is a recently introduced antidepressant with a multimodal mechanism of action. In addition to SERT inhibition, vortioxetine acts via different 5-HT receptors. To further elucidate its mechanism of action, we have investigated the effects of vortioxetine on platelet 5-HT and plasma BDNF concentrations in patients with major depression. METHODS: Platelet 5-HT and plasma BDNF concentrations were determined in 44 healthy subjects at baseline and in 44 depressed patients before and after 4 weeks of treatment with vortioxetine (5-15 mg daily). Platelet 5-HT concentration was determined using the ortho-phthalaldehyde-enhanced fluorometric method, and plasma BDNF concentration using a commercial enzyme-linked immunosorbent assay (Quantikine ELISA, R&D Systems). RESULTS: At baseline, platelet 5-HT concentrations did not differ between depressed and control subjects, but plasma BDNF values were lower (p = 0.011; ω = 0.80) in depressed patients than in healthy subjects. Vortioxetine treatment significantly (p < 0.0001; ω = 0.80) decreased platelet 5-HT concentration and significantly (p = 0.004; ω = 0.80) increased plasma BDNF concentration in depressed patients compared to their baseline values. Age, gender, and smoking were not significantly associated with platelet 5-HT and plasma BDNF concentrations. CONCLUSION: Despite a novel mechanism of action, vortioxetine shares some common effects with other antidepressants. This study is the first to show that, in addition to clinical improvement, 4 weeks of treatment with vortioxetine (5-15 mg daily), decreased platelet 5-HT and increased plasma BDNF concentrations in depressed patients.

Could alexithymia predict suicide attempts - a study of Croatian war veterans with post-traumatic stress disorder.

BACKGROUND: To investigate the possibility if alexithymia could be used as a predictor of attempted suicide among patients suffering from post-traumatic stress disorder. SUBJECTS AND METHODS: The study was based on 127 veterans from the 1991-1995 war in Croatia. All the patients involved in this study were previously diagnosed with PTSD. The questionnaires (socio-demographic questionnaire, Mississippi scale for combat related PTSD questionnaire, and 20-item Toronto Alexithymia Scale questionnaire) were administered by investigators. RESULTS: The results suggest that alexithymia was significantly associated with attempted suicide (P=0.020). Furthermore, alexithymia remained a significant predictor of an attempted suicide even in the multivariate regression model, which yielded an odds ratio (OR) of 2.87 (95% confidence intervals 1.18-7.00). CONCLUSIONS: These results point out that alexithymia can be considered as a potential risk factor for suicide in this population, suggesting that it may also be used as an indicator of worsening psychological status and attempted suicide in other population groups with higher alexithymia prevalence.

[The relationship between alexithymia and morbidity]. / Povezanost aleksitimije i morbiditeta.

Alexithymia is a tendency to experience psychological distress in the form of somatic symptoms. Alexithymia is a syndrome that is defined by the inability to recognize and express emotions. It is a common feature in patients with psychoactive abuse disorders, post-traumatic stress disorder, and psychosomatic disorders such as gastrointestinal complaints, migraine, dermatological symptoms, and irritable bowel syndrome. Alexithymia is associated with a failure to use adaptive affect regulation such as modulating arousal, appropriately expressing or suppressing emotions, tolerating painful emotions and cognitive assimilation. Alexithymia is presumed to play a very important role in the pathogenesis of medically unexplained physical symptoms and it is a risk factor for a psychosomatic condition. It is of clinical importance that the majority of patients with medically unexplained physical symptoms are able to recognize that their physical symptoms may be related to their depression or anxiety disorder which are the most common mental disorders.

The Connection between Alexithymia and Somatic Morbidity in a Population of Combat Veterans with Chronic PTSD.

PURPOSE: To investigate the connection between alexithymia and somatic illness, or, somatization, in veterans suffering from chronic combat-related post-traumatic stress disorder, PTSD. METHODS: Croatian combat veterans (N=127) were studied at the Department of Psychology, Zagreb Clinical Hospital Center. The diagnosis of PTSD was confirmed and verified according to the International Classification of Diseases (ICD-10). A version of the Mississippi Scale for Combat Related PTSD (M-PTSD) standardized for the Croatian population was used to assess the severity of PTSD. In addition to the clinical interview, the existence of alexithymia was confirmed by the score on the Toronto Alexithymia Scale (TA S-20). RESULTS: A statistically significant association was found between the total number of diagnosed physical illnesses and the scores on three subscales of an alexithymia questionnaire, the TA S-20, with a 1% risk (p<0.01, 0.487; 0.450; 0.335). Regression analysis confirmed the most statistically significant predictive value of the first item of the TA S-20, which refers to difficulty in identifying feelings (=0.408, p=0.019). The total score on the M-PTSD scale correlated significantly to the subscales for alexithymia. There was a statistically significant negative correlation of the total score on the M-PTSD scale with social support. CONCLUSION: The total scores obtained in this study, particularly those related to alexithymia, indicate the importance of this construct in the etiopathogenesis of somatic morbidity in the study population and confirm that as in other countries the TA S-20 is a useful instrument in Croatia for the assessment of this phenomenon.

Life satisfaction in persons of the third age after retirement.

The aim of this research was to determine the role of gender, type of residence, living arrangement, self-rated health status, loneliness, and sense of humor in self-reported life satisfaction in elderly retirees. The study included 300 elderly retirees from Zagreb, Croatia. Demographic data were collected with a structured questionnaire, whereas data on self-reported health status, loneliness, and sense of humor were collected with the UCLA Loneliness Scale, Life Satisfaction Index, HOPA-86, and SF-36 Health Survey. Participants living in a retirement home showed higher life satisfaction than those who lived in their own households. Those who had children showed greater life satisfaction No differences in life satisfaction were found with respect to gender, marital status, or living arrangement. The investigated demographic variables, self-rated health status, self-rated loneliness, and a sense of humor explained 52.8% of variance in life satisfaction. An active sense of humor was the most significant predictor. Living in a retirement home, having children, and having an active sense of humor had a positive influence on self-reported life satisfaction, whereas poorer self-rated health and loneliness had a negative influence. Taking into account the predictors of life satisfaction in preventive activities may contribute to successful aging.

Spiritual well-being, cortisol, and suicidality in Croatian war veterans suffering from PTSD.

We present our preliminary results of work that aims to observe the relationship between the cortisol level, the level of spiritual well-being, and suicidal tendencies in Croatian war veterans suffering from PTSD. The survey was conducted on 17 PTSD veterans who completed the Spiritual Well-Being Scale and the Beck Hopelessness Scale. The plasma cortisol level was obtained by venepuction at 8.00, 12.00, 13.00, 16.00, and 22.00 h. Results showed that veterans with higher spiritual well-being scores had lower cortisol levels, and evening cortisol levels showed significant correlation with suicidal risk. The results of the present study could be a stimulus for further investigation into spiritually based interventions, exploring their impact both on mental status and physical health.