DOCSLIB.ORG

Depressive Disorders—Is It Time to Endorse Different Pathophysiologies? Irina A

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Depressive Disorders—Is It Time to Endorse Different Pathophysiologies? Irina A Psychoneuroendocrinology (2006) 31, 1–15 www.elsevier.com/locate/psyneuen REVIEW Depressive disorders—is it time to endorse different pathophysiologies? Irina A. Antonijevic* Department of Psychiatry, University Medicine, University of Berlin, Charite´, Germany Received 3 October 2004; received in revised form 15 February 2005; accepted 2 April 2005 KEYWORDS Summary Enhanced activity of the hypothalamic-pituitary-adrenal (HPA) axis, Major depression; involving elevated secretion of corticotropin-releasing hormone (CRH), is considered HPA axis; a key neurobiological alteration in major depression. Enhanced CRH secretion is also Sleep EEG; believed to contribute to the typical sleep alterations and the clinical presentation of Serotonin; major depression. Cytokines; While it is acknowledged that HPA overdrive and hypernoradrenergic function is Atypical features associated with melancholic depression, there is growing evidence that hypoactivity of the HPA axis and afferent noradrenergic pathways is present in patients with atypical features of depression. The clinical relevance of such a differentiation is highlighted by findings which suggest distinct responses to pharmacological treatments. Moreover, it has been reported that female patients respond better to selective serotonin re-uptake inhibitors (SSRI) than tricyclic antidepressants. Interestingly, the female predominance among patients with depression seems to be restricted to the atypical subtype. Besides HPA axis activity, distinct alterations of the serotonergic system may also play a critical role for the melancholic and atypical phenotypes, namely a reduced restrained via 5-HT1A autoreceptors in the former and primarily reduced serotonin synthesis in the latter. Moreover, there is evidence for an immune activation in patients with depression, the extent and duration of which may be distinguishable for the melancholic and the atypical subtype. In this regard, lessons can be learned from depressive symptoms in patients with autoimmune disease, associated with different alterations of the HPA axis, and in patients undergoing cytokine therapy. In conclusion, the available data today suggest that clinically relevant differences in the underlying pathophysiology in patients with depression exist. The identifi- cation of distinct endophenotypes for major depression will not only improve our understanding of the disease, but will also contribute to more specific treatment strategies. Q 2005 Elsevier Ltd. All rights reserved. 1. Introduction * Address. Lundbeck Research USA, 170 Williams Drive, Ramsey, NJ 07446, USA. Tel.: C1 201 350 0546; fax: C1 201 There is growing evidence that depressive disorders 818 1011. encompass a group of disorders, which differ with E-mail address: [email protected]. 0306-4530/$ - see front matter Q 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.psyneuen.2005.04.004 2 I.A. Antonijevic regard to hypothalamic–pituitary adrenal (HPA) axis respond more favourably to one rather than another activity, immune functions and the treatment antidepressant medication (Quitkin et al., 1993; response (Kornstein et al., 2000a; Gold and Chrou- Kornstein et al., 2000a; Stewart et al., 2002; Joyce sos, 2002; Murck, 2003; Murck et al., 2005). As early et al., 2004; Murck et al., 2005). This strategy can, as 1992, Chrousos and Gold put forward the in turn, contribute to our understanding of the hypothesis that sustained stress system dysfunc- underlying pathophysiology of subtypes of tion, characterised by either hyper- or hypoactivity depression. Such knowledge may be particularly of the HPA axis, play a role for various pathophy- useful when exploring phenotype–genotype siologic states, including a range of psychiatric, relationships. Though most publications today endocrine and inflammatory diseases (Chrousos and distinguish primarily the melancholic and atypical Gold, 1992). The HPA axis, in turn, plays a critical subtype, it is likely that the identification of further role for sleep regulation, which is distinctly endophenotypes will be possible in the future. disturbed in patients with typical symptoms of The present review summarises recent findings major depression (Kupfer, 1995; Steiger, 2002). on differences with regard to sleep-endocrine and One effort to clinically define a subtype of immunological alterations among patients with depression with a possibly distinct pathophysiology depression. Based on the model proposed by Gold and response to treatment is reflected by the and Chrousos (Gold and Chrousos, 2002), recent renewed discussion about the concept of atypical data on altered regulation of sleep, immune and depression (Quitkin et al., 1993; Posternak and serotonin functions are also integrated. Zimmerman, 2002; Parker et al., 2002; Angst et al., 2002; Benazzi, 2003; Murck, 2003). Though the debate regarding the best clinical criteria for atypical depression continues, the available data 2. HPA axis activity in depressive suggest that the neuroendocrine pathophysiology is disorders different, and even opposite, to that observed in patients with melancholic depression (Chrousos and Many studies have shown that a major depressive Gold, 1992; Gold and Chrousos, 2002; Murck, 2003). episode is characterised by typical neuroendocrine Another interesting field of research focuses on and sleep-EEG alterations. Overactivity of the HPA the role of immune activation for depressive axis, a key neuroendocrine alteration observed in disorders (for review see Licinio and Wong (1999), patients suffering from an acute major depressive Leonard (2001), Anisman and Merali (2002)). episode, is assumed to reflect an elevation of Evidence for an association includes data showing hypothalamic corticotropin-releasing hormone a high incidence of depressive symptoms (CRH) and vasopressin secretion (Gold and Chrousos, in some patients with activation of the inflamma- 1985; Roy et al., 1987; Nemeroff, 1988; Kupfer et al., tory response system. The latter includes in 1990; Lauer et al., 1991; Steiger et al., 1994; Buysse particular patients with cancer, infectious and et al., 1997; Holsboer, 1999; Antonijevic et al., autoimmune diseases (Garland and Zis, 1991; 2000b; Steiger, 2002). Enhanced secretion of CRH is Fassbender et al., 1998; Raison and Miller, considered to play an important role for behavioral 2001; Musselman et al., 2001b; Raison and Miller, symptoms typically associated with major 2003; Musselman et al., 2003; Feinstein, 2004). depression, namely enhanced anxiety, lost respon- Moreover, cytokine therapies, used for treatment siveness to the environment, a diurnal variation with of hepatitis C and cancer, have been repeatedly depressed mood at its worst in the morning, disturbed associated with an enhanced incidence of depress- sleep continuity, psychomotor alterations, ive symptoms (Bonaccorso et al., 2001; Musselman decreased appetite and libido as well as cognitive et al., 2001b; Capuron et al., 2002; Schaefer et al., impairment (Gold and Chrousos, 1985, 2002; Hols- 2003; Capuron et al., 2003a). boer, 1999). The effects of centrally released CRH are A better understanding of the differences in the thought to be mediated by CRH-R1 and R2 receptors underlying pathophysiology is critical for a classifi- in limbic areas such as the hippocampus and the cation of patients based on one hand on the clinical amygdala as well as afferent neurons in the locus presentation and on the other hand on the (neuro-) coeruleus and the dorsal raphe (Holsboer, 1999; biological profile. Ultimately, the identification of Roozendaal et al., 2002; Gold and Chrousos, 2002; endophenotypes for depression will help to Bale and Vale, 2003; Thomas et al., 2003). Seroto- choose the most appropriate treatment for a nergic neurons in the dorsal raphe nucleus, as well given patient (Hasler et al., 2004). Thus, over the as noradrenergic neurons in the brainstem and last years, several publications have suggested the locus coeruleus are important afferents for that subgroups of patients with depression may the regulation of hypothalamic CRH secretion Different pathophysiologies of major depression 3 (Cunningham et al., 1990; Vertes, 1991; Valentino density (Kupfer et al., 1990; Lauer et al., 1991; et al., 1993; Calogero, 1995; Dayas et al., 2001). Steiger et al., 1994; Buysse et al., 1997; Antoni- Moreover, a forward circuit between hypothalamic jevic et al., 2000b). Animal and human studies CRH neurons and noradrenergic neurons of the locus support a critical involvement of central CRH coeruleus, which is involved in the stress response, secretion in these sleep alterations (Ehlers et al., has been described (Valentino et al., 1992, 1993). 1986, 1997; Holsboer et al., 1988; Opp, 1995; Similarly, a circuit exists between brainstem and Chang and Opp, 2001; Steiger, 2002). Thus, CRH dorsal raphe nuclei and the amygdala complex (Imai disturbs sleep continuity, promotes EEG activity in et al., 1986; Vertes, 1991; Van Bockstaele et al., the higher frequency range and reduces slow wave 1998; Linthorst et al., 2002; Commons et al., 2003). sleep (Ehlers et al., 1986, 1997; Holsboer et al., As projections from the amygdala can stimulate the 1988; Opp, 1995; Chang and Opp, 2001; Steiger, HPA axis (Weidenfeld et al., 2002), a vicious circle 2002). Opposite effects have been noted for may sustain enhanced CRH secretion, hyperactivity hypothalamic growth hormone-releasing hormone of the amygdala and noradrenergic system in patients (GHRH), which improves sleep continuity, and with major depression (Roy et
Load more

Recommended publications
  • Suggested Biomarkers for Major Depressive Disorder
    280 Arch Neuropsychiatry 2018;55:280−290 REVIEW https://doi.org/10.5152/npa.2017.19482 Suggested Biomarkers for Major Depressive Disorder Yunus HACIMUSALAR1 , Ertuğrul EŞEL2 1Department of Psychiatry, Kayseri Training and Research Hospital, Kayseri, Turkey 2Department of Psychiatry, Erciyes University Faculty of Medicine, Kayseri, Turkey ABSTRACT Currently, the diagnosis of major depressive disorder (MDD) mainly the hypothalamo-pituitary-adrenal axis, cytokines, and neuroimaging relies on clinical examination and subjective evaluation of depressive may be strong candidates for being biomarkers MDD, and may provide symptoms. There is no non-invasive, quantitative test available today critical information in understanding biological etiology of depression. for the diagnosis of MDD. In MDD, exploration of biomarkers will be Although the findings are not sufficient yet, we think that the results of helpful in diagnosing the disorder as well as in choosing a treatment, epigenetic studies will also provide very important contributions to the and predicting the treatment response. In this article, it is aimed to biomarker research in MDD. review the findings of suggested biomarkers such as growth factors, cytokines and other inflammatory markers, oxidative stress markers, The availability of biomarkers in MDD will be an advancement that will endocrine markers, energy balance hormones, genetic and epigenetic facilitate the diagnosis of the disorder, treatment choices in the early features, and neuroimaging in MDD and to evaluate how these findings stages, and prediction of the course of the disorder. contribute to the pathophysiology of MDD, the prediction of treatment response, severity of the disorder, and identification of subtypes. Among Keywords: Depression, biomarkers, brain-derived neurotrophic factor, these, the findings related to the brain-derived neurotrophic factor, cytokines, genetics, neuroimaging Cite this article as: Hacımusalar Y, Eşel E.
    [Show full text]
  • Models of Insomnia Michael Perlis, Paul Shaw, Georgina Cano, and Colin Espie 78
    Chapter Models of Insomnia Michael Perlis, Paul Shaw, Georgina Cano, and Colin Espie 78 Up until the late 1990s there were only two models regard- history. A simple conditioning history, wherein a stimulus ing the etiology and pathophysiology of insomnia. The is always paired with a single behavior, yields a high prob- relative lack of theoretical perspectives was due to at least ability that the stimulus will yield only one response. A three factors. First, the widespread conceptualization of complex conditioning history, wherein a stimulus is paired insomnia as owing directly to hyperarousal may have made with a variety of behaviors, yields a low probability that it appear that further explanation was not necessary. the stimulus will yield only one response. In persons with Second, the long-time characterization of insomnia as a insomnia, the normal cues associated with sleep (e.g., bed, symptom carried with it the clear implication that insom- bedroom, bedtime, etc.) are often paired with activities nia was not itself worth modeling as a disorder or disease other than sleep. For instance, in an effort to cope with state. Third, for those inclined toward theory, the accep- insomnia, the patient might spend a large amount of time tance of the behavioral models (i.e., the 3P behavioral in the bed and bedroom awake and engaging in activities model and the stimulus control model1,2), and the treat- other than sleep. The coping behavior appears to the ments that were derived from them, might have had the patient to be both reasonable (e.g., staying in bed at least untoward effect of discouraging the development of alter- permits the patients to rest) and reasonably successful native or elaborative models.
    [Show full text]
  • Premenstrual Dysphoric Disorder: How to Alleviate Her Suffering
    Premenstrual dysphoric disorder: How to alleviate her suffering Accurate diagnosis, tailored treatments can greatly improve women’s quality of life pproximately 75% of women experience a premen- strual change in emotional or physical symptoms Acommonly referred to as premenstrual syndrome (PMS). These symptoms—including increased irritability, tension, depressed mood, and somatic complaints such as breast tenderness and bloating—often are mild to moder- ate and cause minimal distress.1 However, approximately 3% to 9% of women experience moderate to severe premen- strual mood symptoms that meet criteria for premenstrual dysphoric disorder (PMDD).2 PMDD includes depressed or labile mood, anxiety, irri- tability, anger, insomnia, difficulty concentrating, and other © IMAGES.COM/CORBIS symptoms that occur exclusively during the 2 weeks before menses and cause significant deterioration in daily func- Laura Wakil, MD tioning. Women with PMDD use general and mental health Third-Year Psychiatry Resident services more often than women without the condition.3 Samantha Meltzer-Brody, MD, MPH They may experience impairment in marital and parental Director, Perinatal Psychiatry Program relationships as severe as that experienced by women with University of North Carolina Center for Women’s 2 Mood Disorders recurrent or chronic major depression. PMDD often responds to treatment. Unfortunately, Susan Girdler, PhD Director, UNC Stress and Health Research Program many women with PMDD do not seek treatment, and up Menstrually Related Mood Disorders Program to 90% may go undiagnosed.4 In this article, we review the University of North Carolina Center for Women’s prevalence, etiology, diagnosis, and treatment of PMDD. Mood Disorders • • • • Department of Psychiatry A complex disorder University of North Carolina at Chapel Hill A distinguishing characteristic of PMDD is the timing of Chapel Hill, NC symptom onset.
    [Show full text]
  • Social Anxiety, Cortisol, and Early-Stage Friendship
    J S P R Article Journal of Social and Personal Relationships Social anxiety, cortisol, 2019, Vol. 36(7) 1954–1974 ª The Author(s) 2018 Article reuse guidelines: and early-stage friendship sagepub.com/journals-permissions DOI: 10.1177/0265407518774915 journals.sagepub.com/home/spr Sarah Ketay1, Keith M. Welker2, Lindsey A. Beck3, Katherine R. Thorson4, and Richard B. Slatcher5 Abstract Socially anxious people report less closeness to others, but very little research has examined how social anxiety is related to closeness in real-time social interactions. The present study investigated social anxiety, closeness, and cortisol reactivity in zero-acquaintance interactions between 84 same-sex dyads (168 participants). Dyads engaged in either a high or low self-disclosure discussion task and completed self- report measures of closeness and desired closeness post-task. Salivary cortisol was collected before, during, and after the self-disclosure task. Multilevel models indi- cated that in the high self-disclosure condition, individuals higher in social anxiety displayed flatter declines in cortisol than those lower in social anxiety; cortisol declines were not significantly related to social anxiety in the low self-disclosure condition. Further, across both conditions, individual’s social anxiety was associated with decreased levels of closeness and desired closeness, particularly when indi- viduals were paired with partners higher in social anxiety. These findings are dis- cussed in relation to previous work on hypothalamic–pituitary–adrenal function, social anxiety, and interpersonal closeness. Keywords Closeness, cortisol, friendship formation, self-disclosure, social anxiety 1 University of Hartford, USA 2 University of Massachusetts Boston, USA 3 Emerson College, USA 4 New York University, USA 5 Wayne State University, USA Corresponding author: Sarah Ketay, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT 06117, USA.
    [Show full text]
  • Investigating the Role of the Central and the Peripheral Benzodiazepine Receptor on Stress and Anxiety Related Parameters
    Investigating the role of the central and the peripheral benzodiazepine receptor on stress and anxiety related parameters Inaugural-Dissertation zur Erlangung der Doktorwürde der Fakultät für Humanwissenschaften der Universität Regensburg vorgelegt von LISA-MARIE BAHR aus Hausen Regensburg 2020 Erstgutachter: Prof. Dr. rer. soc. Andreas Mühlberger Zweitgutachterin: PD Dr. med. habil. Caroline Nothdurfter I ACKNOWLEDGEMENT I wish to thank a number of people that have supported me on this exciting journey and substantially contributed to the success of this work. First of all, I want to thank my supervisors Priv.-Doz. Caroline Nothdurfter and Professor Andreas Mühlberger for always promoting me, being open for any kind of questions and teaching me to take responsibilities. Likewise, I want to thank Professor Jens Schwarzbach for the patient teaching in the fields of brain imaging and for the support in the analysis of our MRI data. Furthermore, I want to thank Professor Rainer Rupprecht for the comprehensive support in organizational and economic matters. I am thankful for the great time and the opportunities I had within my graduate school and wish to thank its spokesperson Professor Inga Neumann and all other supervisors and PhD students of the program, especially Viola Wagner and Kerstin Kuffner for going through this together. The realization of the study would not have been possible without a number of people and I want to thank Franziska Maurer and Kevin Weber for their extensive help in data acquisition, Dr. Johannes Weigl and Dr. Andre Manook for their support concerning the medical parts, Professor Thomas Wetter for the study monitoring, Doris Melchner, Anett Dörfelt, Dr.
    [Show full text]
  • Stress, Mood, and Cortisol During Daily Life in Women with Premenstrual
    Psychoneuroendocrinology 109 (2019) 104372 Contents lists available at ScienceDirect Psychoneuroendocrinology journal homepage: www.elsevier.com/locate/psyneuen Stress, mood, and cortisol during daily life in women with Premenstrual T Dysphoric Disorder (PMDD) ⁎ Theresa Beddiga, Iris Reinhardb, Christine Kuehnera, a Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/ Heidelberg University, Germany b Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany ARTICLE INFO ABSTRACT Keywords: Premenstrual Dysphoric Disorder (PMDD) is characterized by significant emotional, physical and behavioral Premenstrual dysphoric disorder distress during the late luteal phase that remits after menses onset. Outlined as a new diagnostic category in Ambulatory assessment DSM-5, the mechanisms underlying PMDD are still insufficiently known. Previous research suggests that PMDD Daily life stress exacerbates with stressful events, indicating a dysregulation of the hypothalamic-pituitary-adrenal axis. Cortisol However, studies measuring stress-related processes in affected women in real-time and real-life are lacking. We Hypothalamic pituitary adrenal (HPA) axis conducted an Ambulatory Assessment (AA) study to compare subjective stress reactivity together with basal and Multilevel modeling stress-reactive cortisol activity across the menstrual cycle in women with and without PMDD. Women with current PMDD (n = 61) and age- and education matched controls (n = 61) reported momentary mood, rumi- nation, and daily events via smartphones at semi-random time points 8 times a day over two consecutive days per cycle phase (menstrual, follicular, ovulatory, and late luteal). Twenty minutes after assessments participants collected saliva cortisol samples. Three additional morning samples determined the cortisol awakening response (CAR).
    [Show full text]
  • Prospective Study of Insomnia and Incident Asthma in Adults: the HUNT Study
    ORIGINAL ARTICLE ASTHMA Prospective study of insomnia and incident asthma in adults: the HUNT study Ben Brumpton1,2, Xiao-Mei Mai1, Arnulf Langhammer1, Lars Erik Laugsand1, Imre Janszky1,3 and Linn Beate Strand1 Affiliations: 1Dept of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. 2Dept of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, Norway. 3Regional Center for Health Care Improvement, St Olav Hospital, Trondheim, Norway. Correspondence: Ben Brumpton, Dept of Public Health and General Practice, Norwegian University of Science and Technology, NTNU, Postbox 8905, MTFS, NO-7491 Trondheim, Norway. E-mail: [email protected] @ERSpublications People experiencing insomnia symptoms had a higher risk of developing asthma than those without such symptoms http://ow.ly/JNEe306bCmf Cite this article as: Brumpton B, Mai X-M, Langhammer A, et al. Prospective study of insomnia and incident asthma in adults: the HUNT study. Eur Respir J 2017; 49: 1601327 [https://doi.org/10.1183/ 13993003.01327-2016]. ABSTRACT Insomnia is highly prevalent among asthmatics; however, few studies have investigated insomnia symptoms and asthma development. We aimed to investigate the association between insomnia and the risk of incident asthma in a population-based cohort. Among 17927 participants free from asthma at baseline we calculated odds ratios and 95% confidence intervals for the risk of incident asthma among those with insomnia compared to those without. Participants reported sleep initiation problems, sleep maintenance problems and nonrestorative sleep. Chronic insomnia was defined as those reporting one or more insomnia symptom at baseline and 10 years earlier.
    [Show full text]
  • Biological Pathways Associated with Neuroprogression in Bipolar Disorder
    brain sciences Opinion Biological Pathways Associated with Neuroprogression in Bipolar Disorder Bianca Wollenhaupt-Aguiar 1,2 , Flavio Kapczinski 1,2,3,4,5 and Bianca Pfaffenseller 1,2,* 1 Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON L8N 3K7, Canada; [email protected] (B.W.-A.); [email protected] (F.K.) 2 Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada 3 Neuroscience Graduate Program, McMaster University, Hamilton, ON L8S 4L8, Canada 4 Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, Brazil 5 Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil * Correspondence: [email protected] Abstract: There is evidence suggesting clinical progression in a subset of patients with bipolar disorder (BD). This progression is associated with worse clinical outcomes and biological changes. Molecular pathways and biological markers of clinical progression have been identified and may explain the progressive changes associated with this disorder. The biological basis for clinical progression in BD is called neuroprogression. We propose that the following intertwined pathways provide the biological basis of neuroprogression: inflammation, oxidative stress, impaired calcium signaling, endoplasmic reticulum and mitochondrial dysfunction, and impaired neuroplasticity and cellular resilience. The nonlinear interaction of these pathways may worsen clinical outcomes, cognition, and functioning. Understanding neuroprogression in BD is crucial for identifying novel Citation: Wollenhaupt-Aguiar, B.; therapeutic targets, preventing illness progression, and ultimately promoting better outcomes. Kapczinski, F.; Pfaffenseller, B. Biological Pathways Associated with Keywords: biomarkers; bipolar disorder; illness progression; neuroprogression Neuroprogression in Bipolar Disorder.
    [Show full text]
  • The Future Treatment of Insomnia: Exploring the Mechanisms of Action of Current and Emerging Therapies
    Release date: October 2014 | Expiration date: October 31, 2015 | Estimated time to complete activity: 2 hours The Future Treatment of Insomnia: Exploring the Mechanisms of Action of Current and Emerging Therapies An Educational Monograph Based on an Expert Roundtable Discussion Sonia Ancoli-Israel, PhD Allen J. Blaivas, DO David Neubauer, MD Stephen H. Sheldon, DO, FAAP Professor Emeritus of Psychiatry and Medicine Director, Sleep Clinic Associate Professor Professor of Pediatrics Professor of Research VA New Jersey Health Care Johns Hopkins Bayview Medical Northwestern University, Director, Gillin Sleep and Chronomedicine Research Center System Center Feinberg School of Medicine Deputy Director, Stein Institute for Research on Aging Director, Sleep Medicine Center Director of Education, UCSD Sleep Medicine Center Ann and Robert H. Lurie Children’s Department of Psychiatry Hospital of Chicago University of California, San Diego This activity is jointly sponsored by the American Osteopathic Association, Connecticut Osteopathic Medical Society, Massachusetts This activity is supported Osteopathic Society, Rhode Island Society of Osteopathic Physicians & Surgeons, and Impact Education, LLC. by an educational grant from Merck & Co., Inc. The Future Treatment of Insomnia: Exploring the Mechanisms of Action of Current and Emerging Therapies Target Audience Allen J. Blaivas, DO, Faculty, served on an advisory board for Forest Pharmaceuticals, Inc. and serves on a speakers’ bureau for Pfizer Inc. and This activity is for osteopathic physicians and other health care Boehringer Ingelheim. professionals who care for people with insomnia. David Neubauer, MD, Faculty, serves as a consultant for Novo Nordisk Statement of Need and Vanda Pharmaceuticals. The purpose of the initiative is to provide osteopathic physicians with Stephen H.
    [Show full text]
  • Metabolomics in Sleep, Insomnia and Sleep Apnea
    International Journal of Molecular Sciences Review Metabolomics in Sleep, Insomnia and Sleep Apnea Elke Humer 1,* , Christoph Pieh 1 and Georg Brandmayr 2 1 Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; [email protected] 2 Section for Artificial Intelligence and Decision Support, Medical University of Vienna, 1090 Vienna, Austria; [email protected] * Correspondence: [email protected]; Tel.: +43-273-2893-2676 Received: 17 August 2020; Accepted: 29 September 2020; Published: 30 September 2020 Abstract: Sleep-wake disorders are highly prevalent disorders, which can lead to negative effects on cognitive, emotional and interpersonal functioning, and can cause maladaptive metabolic changes. Recent studies support the notion that metabolic processes correlate with sleep. The study of metabolite biomarkers (metabolomics) in a large-scale manner offers unique opportunities to provide insights into the pathology of diseases by revealing alterations in metabolic pathways. This review aims to summarize the status of metabolomic analyses-based knowledge on sleep disorders and to present knowledge in understanding the metabolic role of sleep in psychiatric disorders. Overall, findings suggest that sleep-wake disorders lead to pronounced alterations in specific metabolic pathways, which might contribute to the association of sleep disorders with other psychiatric disorders and medical conditions. These alterations are mainly related to changes in the metabolism of branched-chain amino acids, as well as glucose and lipid metabolism. In insomnia, alterations in branched-chain amino acid and glucose metabolism were shown among studies. In obstructive sleep apnea, biomarkers related to lipid metabolism seem to be of special importance.
    [Show full text]
  • Mechanisms Underlying Tolerance After Long-Term Benzodiazepine Use: a Future for Subtype-Selective GABAA Receptor Modulators?
    Hindawi Publishing Corporation Advances in Pharmacological Sciences Volume 2012, Article ID 416864, 19 pages doi:10.1155/2012/416864 Review Article Mechanisms Underlying Tolerance after Long-Term Benzodiazepine Use: A Future for Subtype-Selective GABAA Receptor Modulators? Christiaan H. Vinkers1, 2 and Berend Olivier1, 3 1 Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands 2 Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands 3 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA Correspondence should be addressed to Christiaan H. Vinkers, [email protected] Received 7 July 2011; Revised 10 October 2011; Accepted 2 November 2011 Academic Editor: John Atack Copyright © 2012 C. H. Vinkers and B. Olivier. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Despite decades of basic and clinical research, our understanding of how benzodiazepines tend to lose their efficacy over time (tolerance) is at least incomplete. In appears that tolerance develops relatively quickly for the sedative and anticonvulsant actions of benzodiazepines, whereas tolerance to anxiolytic and amnesic effects probably does not develop at all. In light of this evidence, we review the current evidence for the neuroadaptive mechanisms underlying benzodiazepine tolerance, including changes of (i) the GABAA receptor (subunit expression and receptor coupling), (ii) intracellular changes stemming from transcriptional and neurotrophic factors, (iii) ionotropic glutamate receptors, (iv) other neurotransmitters (serotonin, dopamine, and acetylcholine systems), and (v) the neurosteroid system.
    [Show full text]
  • Utilizing Common Functional Change Principles to Unify Cognitive Behavioral and Mindfulness-Based Therapies
    Accepted Manuscript Title: All together now: Utilizing common functional change principles to unify cognitive behavioral and mindfulness-based therapies Authors: David M. Fresco, Douglas S. Mennin PII: S2352-250X(18)30215-X DOI: https://doi.org/10.1016/j.copsyc.2018.10.014 Reference: COPSYC 725 To appear in: Please cite this article as: Fresco DM, Mennin DS, All together now: Utilizing common functional change principles to unify cognitive behavioral and mindfulness-based therapies, Current Opinion in Psychology (2018), https://doi.org/10.1016/j.copsyc.2018.10.014 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Running Head: All together now 1 All together now: Utilizing common functional change principles to unify cognitive behavioral and mindfulness-based therapies David M. Fresco* [email protected] Kent State University Case Western Reserve University Douglas S. Mennin Teachers College, Columbia University *Corresponding Author: David M. Fresco, Department of Psychological Sciences, Kent State University, Kent, OH, USA, Author Note: David M. Fresco was supported by National Heart, Lung, and Blood Institute Grant R01HL119977 and National Institute of Nursing Research Grant P30NR015326. ACCEPTED MANUSCRIPT Running Head: All together now 2 Abstract Cognitive behavior therapy (CBT) and mindfulness-based interventions (MBI) have made important contributions to resolving the global burden of mental illness.
    [Show full text]