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Concept: Seasonal affective disorder

278

Recent insights into the role of the human microbiota in cognitive and affective functioning have led to the hypothesis that probiotic supplementation may act as an adjuvant strategy to ameliorate or prevent depression.

Concepts: Psychology, Gut flora, Randomized controlled trial, Escherichia coli, Pharmaceutical industry, Probiotic, Seasonal affective disorder, Emotion

205

We wanted to examine tolerability and efficacy of NSI-189, a benzylpiperizine-aminiopyridine neurogenic compound for treating major depressive disorder (MDD). This was a Phase 1B, double blind, randomized, placebo controlled, multiple-dose study with three cohorts. The first cohort received 40 mg q.d. (n=6) or placebo (n=2), the second cohort 40 mg b.i.d. (n=6) or placebo (n=2), and the third cohort 40 mg t.i.d. (n=6) or placebo (n=2). Twenty-four patients with MDD were recruited, with the diagnosis and severity confirmed through remote interviews. Eligible patients received NSI-189 or placebo for 28 days in an inpatient setting with assessments for safety, pharmacokinetics (PK) and efficacy. Outpatient follow-up visits were conducted until day 84 (±3). NSI-189 was relatively well tolerated at all doses, with no serious adverse effects. NSI-189 area under the curve increased in a dose-related and nearly proportional manner across the three cohorts, with a half-life of 17.4-20.5 h. The exploratory efficacy measurements, including Symptoms Of Depression Questionnaire (SDQ), Montgomery-Asberg Depression Scale (MADRS), Clinical Global Impressions-Improvement (CGI-I), and The Massachusetts General Hospital (MGH) Cognitive and Physical Functioning Questionnaire (CPFQ) showed a promising reduction in depressive and cognitive symptoms across all measures for NSI-189, with significant improvement in the SDQ and CPFQ, and a medium to large effect size for all measures. These improvements persisted during the follow-up phase. In summary, NSI-189 shows potential as a treatment for MDD in an early phase study. The main limitation of this preliminary study was the small sample size of each cohort.Molecular Psychiatry advance online publication, 8 December 2015; doi:10.1038/mp.2015.178.

Concepts: Sample size, Cognitive behavioral therapy, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, Dysthymia, Depression, Types of psychological depression

177

Major depressive disorder may be due to psychoneuroimmunological dysfunction, as studies have documented increased levels of a variety of inflammatory mediators in depressed subjects. Nitric oxide (NO) is marker of inflammation, and fractional exhaled NO (FeNO) is a marker of airway inflammation. Plasma NO and FeNO levels have been shown to be lower in subjects with depression in small studies. We sought to assess the association of depression with C-reactive protein (CRP) and FeNO levels in a large and representative sample of the US population.

Concepts: Inflammation, Nitric oxide, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, C-reactive protein, Types of psychological depression, Exhaled nitric oxide

171

BACKGROUND: There is a significant treatment gap for patients with depression. A third of sufferers never seek help, and the vast majority of those who do only do so after considerable delay. Little is understood regarding poor help-seeking rates amongst people with depression, with existing research mainly focussed on the impact of barriers to treatment. The current study explored psychological factors affecting help-seeking behaviour in clinically depressed individuals. METHODS: Semi-structured interviews were conducted with 20 current or previously clinically depressed participants who either had or had not sought professional help. Thematic analysis was used to analyse results. RESULTS: The onset of depressive symptoms created conflict with participants' identity and personal goals. Delays in seeking help were primarily attributed to the desire to protect identity and goals from the threat of depressive symptoms. Participants used avoidance strategies to reduce the perceived threat of depressive symptoms on identity. These strategies interfered with help-seeking. Help-seeking was only undertaken once participants reached a point of acceptance and began to make concessions in their identity and goals, at which time they reduced their use of avoidance. CONCLUSIONS: Difficulties resolving conflict between identity and depressive symptoms may account for significant delays in seeking help for depression. The results have implications for predicting health behaviour and improving treatment uptake for depression, and may inform existing help-seeking models.

Concepts: Cognitive behavioral therapy, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, Dysthymia, Types of psychological depression, Suicide, Leonard Cohen

128

Previous reports of altered grey and white matter structure in Major Depressive Disorder (MDD) have been inconsistent. Recent meta-analyses have, however, reported reduced hippocampal grey matter volume in MDD and reduced white matter integrity in several brain regions. The use of different diagnostic criteria, scanners and imaging sequences may, however, obscure further anatomical differences. In this study, we tested for differences in subcortical grey matter volume (n = 1157) and white matter integrity (n = 1089) between depressed individuals and controls in the subset of 8590 UK Biobank Imaging study participants who had undergone depression assessments. Whilst we found no significant differences in subcortical volumes, significant reductions were found in depressed individuals versus controls in global white matter integrity, as measured by fractional anisotropy (FA) (β = -0.182, p = 0.005). We also found reductions in FA in association/commissural fibres (β = -0.184, pcorrected = 0.010) and thalamic radiations (β = -0.159, pcorrected = 0.020). Tract-specific FA reductions were also found in the left superior longitudinal fasciculus (β = -0.194, pcorrected = 0.025), superior thalamic radiation (β = -0.224, pcorrected = 0.009) and forceps major (β = -0.193, pcorrected = 0.025) in depression (all betas standardised). Our findings provide further evidence for disrupted white matter integrity in MDD.

Concepts: Human brain, Hippocampus, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, Dysthymia, Types of psychological depression, Subcortical ischemic depression

89

A growing body of research demonstrates that individuals diagnosed with major depressive disorder (MDD) are characterized by shortened telomere length, which has been posited to underlie the association between depression and increased instances of medical illness. The temporal nature of the relation between MDD and shortened telomere length, however, is not clear. Importantly, both MDD and telomere length have been associated independently with high levels of stress, implicating dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and anomalous levels of cortisol secretion in this relation. Despite these associations, no study has assessed telomere length or its relation with HPA-axis activity in individuals at risk for depression, before the onset of disorder. In the present study, we assessed cortisol levels in response to a laboratory stressor and telomere length in 97 healthy young daughters of mothers either with recurrent episodes of depression (i.e., daughters at familial risk for depression) or with no history of psychopathology. We found that daughters of depressed mothers had shorter telomeres than did daughters of never-depressed mothers and, further, that shorter telomeres were associated with greater cortisol reactivity to stress. This study is the first to demonstrate that children at familial risk of developing MDD are characterized by accelerated biological aging, operationalized as shortened telomere length, before they had experienced an onset of depression; this may predispose them to develop not only MDD but also other age-related medical illnesses. It is critical, therefore, that we attempt to identify and distinguish genetic and environmental mechanisms that contribute to telomere shortening.Molecular Psychiatry advance online publication, 30 September 2014; doi:10.1038/mp.2014.119.

Concepts: Senescence, Illness, Telomere, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, Depression, Types of psychological depression

73

Adversity, particularly in early life, can cause illness. Clues to the responsible mechanisms may lie with the discovery of molecular signatures of stress, some of which include alterations to an individual’s somatic genome. Here, using genome sequences from 11,670 women, we observed a highly significant association between a stress-related disease, major depression, and the amount of mtDNA (p = 9.00 × 10(-42), odds ratio 1.33 [95% confidence interval [CI] = 1.29-1.37]) and telomere length (p = 2.84 × 10(-14), odds ratio 0.85 [95% CI = 0.81-0.89]). While both telomere length and mtDNA amount were associated with adverse life events, conditional regression analyses showed the molecular changes were contingent on the depressed state. We tested this hypothesis with experiments in mice, demonstrating that stress causes both molecular changes, which are partly reversible and can be elicited by the administration of corticosterone. Together, these results demonstrate that changes in the amount of mtDNA and telomere length are consequences of stress and entering a depressed state. These findings identify increased amounts of mtDNA as a molecular marker of MD and have important implications for understanding how stress causes the disease.

Concepts: DNA, Causality, Illness, Experiment, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, Types of psychological depression

61

BACKGROUND: Psychological effects of air ions have been reported for more than 80 years in the media and scientific literature. This study summarizes a qualitative literature review and quantitative meta-analysis, where applicable, that examines the potential effects of exposure to negative and positive air ions on psychological measures of mood and emotional state. METHODS: A structured literature review was conducted to identify human experimental studies published through August, 2012. Thirty-three studies (1957–2012) evaluating the effects of air ionization on depression, anxiety, mood states, and subjective feelings of mental well-being in humans were included. Five studies on negative ionization and depression (measured using a structured interview guide) were evaluated by level of exposure intensity (high vs. low) using meta-analysis. RESULTS: Consistent ionization effects were not observed for anxiety, mood, relaxation/sleep, and personal comfort. In contrast, meta-analysis results showed that negative ionization, overall, was significantly associated with lower depression ratings, with a stronger association observed at high levels of negative ion exposure (mean summary effect and 95% confidence interval (CI) following high- and low-density exposure: 14.28 (95% CI: 12.93-15.62) and 7.23 (95% CI: 2.62-11.83), respectively). The response to high-density ionization was observed in patients with seasonal or chronic depression, but an effect of low-density ionization was observed only in patients with seasonal depression. However, no relationship between the duration or frequency of ionization treatment on depression ratings was evident. CONCLUSIONS: No consistent influence of positive or negative air ionization on anxiety, mood, relaxation, sleep, and personal comfort measures was observed. Negative air ionization was associated with lower depression scores particularly at the highest exposure level. Future research is needed to evaluate the biological plausibility of this association.

Concepts: Psychology, Ion, Ion source, Seasonal affective disorder, Emotion, Mood disorder, Ions, Air ioniser

51

Although stressful life events (SLEs) predict subsequent risk of developing a major depressive episode (MDE), limited information exists on whether or not race and gender alters the predictive role of SLE on risk of MDE over a long-term period. The current study explored race and gender differences in the long-term predictive role of SLE at baseline (1986) on subsequent risk of MDE 25 years later (2011) in a nationally representative cohort in the United States.

Concepts: United States, Gender role, Race, Major depressive disorder, Major depressive episode, Seasonal affective disorder, Dysthymia, Nationalism

49

Major depressive disorder and bipolar disorder share symptoms that may reflect core mood disorder features. This has led to the pursuit of intermediate phenotypes and a dimensional approach to understand neurobiological disruptions in mood disorders. Executive dysfunction, including cognitive control, may represent a promising intermediate phenotype across major depressive disorder and bipolar disorder. This study examined dimensions of cognitive control in women with major depressive disorder or bipolar disorder in comparison to healthy control subjects using two separate, consecutive experiments. For Experiment 1, participants completed a behavioural cognitive control task (healthy controls = 150, major depressive disorder = 260, bipolar disorder = 202; age range 17-84 years). A sample of those participants (healthy controls = 17, major depressive disorder = 19, and bipolar disorder = 16) completed a similar cognitive control task in an event-related design functional magnetic resonance imaging protocol for Experiment 2. Results for Experiment 1 showed greater impairments on the cognitive control task in patients with mood disorders relative to healthy controls (P < 0.001), with more of those in the mood disorder group falling into the 'impaired' range when using clinical cut-offs (<5th percentile). Experiment 2 revealed only a few areas of shared activation differences in mood disorder greater than healthy controls. Activation analyses using performance as a regressor, irrespective of diagnosis, revealed within and extra-network areas that were more active in poor performers. In summary, performance and activation during cognitive control tasks may represent an intermediate phenotype for mood disorders. However, cognitive control dysfunction is not uniform across women with mood disorders, and activation is linked to performance more so than disease. These findings support subtype and dimensional approaches to understanding risk and expression of mood disorders and are a promising area of inquiry, in line with the Research Domain Criteria initiative of NIMH.

Concepts: Schizophrenia, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, Mood disorder, Dysthymia, Creativity, Mood