Depression Treatment: Meta-Analyses Indicate Associations Between Neuroendocrine Activation, Deactivation in Neurotrophic and Neuroimaging Markers in Depression After Stroke.

Meta-analyses Indicate Associations between Neuroendocrine Activation, Deactivation in Neurotrophic and Neuroimaging Markers in Depression after Stroke.

Filed under: Depression Treatment

J Stroke Cerebrovasc Dis. 2012 Nov 10;
Noonan K, Carey LM, Crewther SG

BACKGROUND: The association between stroke and depression is well established and has been suggested to be bidirectional. Systemic immune activation, hypothalamic-pituitary-adrenal axis hyperactivity, physiologic changes in the perfusion of blood vessels, the downregulation of neurotrophic factors, and apoptosis and necrosis of neuronal, glial, and endothelial cells have been frequently implicated in this relationship. A better understanding of the biology of poststroke depression could be important for enhancing clinical management. We review the currently available biologic markers of stroke-associated depressive illness (i.e., neurophysiologic, neuroendocrine, immunologic, and neuroimaging markers as well as neurotrophic factors). METHODS: Search strategies included the electronic databases PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library, and Proquest Dissertations (all records through June 2012), the reference lists of retrieved articles, the reference list of relevant reviews, and direct contact with authors of retrieved articles for any additional unpublished data. RESULTS: Thirty-three papers fulfilled the criteria for inclusion. We detected moderate effects for high postdexamethasone cortisol levels (odds ratio [OR] 3.28; 95% confidence interval [CI] 1.28-8.39; P = .01), lower serum brain-derived neurotrophic factor levels (standardised mean difference [SMD] -0.52; 95% CI -0.84 to -0.21; P = .001), smaller amygdala volumes (SMD -0.45; 95% CI -0.89 to -0.02; P = .04), and a small effect for overall brain perfusion reduction (SMD -0.35; 95% CI -0.64 to -0.06; P = .02), respectively, to poststroke depression. CONCLUSIONS: Cortisol-lowering therapies and those that increase blood flow and neurotrophic factors represent promising novel therapeutics for depression subtypes and may reduce the risk of depression in stroke patients.
HubMed – depression


Contributors to self-reported health in a racially and ethnically diverse population: focus on Hispanics.

Filed under: Depression Treatment

Ann Epidemiol. 2012 Nov 10;
Brewer JV, Miyasato GS, Gates MA, Curto TM, Hall SA, McKinlay JB

PURPOSE: To understand if Hispanics report health differently than other racial and ethnic groups after controlling for demographics and risk factors for poor health. METHODS: The sample (N = 5502) included 3201 women, 1767 black, 1859 white, and 1876 Hispanic subjects from the Boston Area Community Health Survey, a population-based survey of English- and Spanish-speaking residents of Boston, Massachusetts, United States, aged 30-79 years in 2002-2005. Multiple logistic regression models were used to examine the association between race/ethnicity (including interview language for Hispanics) and fair/poor self-reported health (F/P SRH) adjusting for gender, age, socioeconomic status, depression, nativity, and comorbidities. RESULTS: Compared with whites, Hispanics interviewed in Spanish were seven times as likely to report F/P SRH (odds ratio, 7.7; 95% confidence interval, 4.9-12.2) after adjusting for potential confounders and those interviewed in English were twice as likely. In analyses stratified by depression and nativity, we observed stronger associations with Hispanic ethnicity in immigrants and nondepressed individuals interviewed in Spanish. CONCLUSIONS: Increased odds of F/P SRH persisted in the Hispanic group even when accounting for interview language and controlling for socioeconomic status, age, depression, and nativity, with interview language mitigating the association. These findings have methodological implications for epidemiologists using SRH across diverse populations.
HubMed – depression


Feasibility of studying brain morphology in major depressive disorder with structural magnetic resonance imaging and clinical data from the electronic medical record: A pilot study.

Filed under: Depression Treatment

Psychiatry Res. 2012 Nov 10;
Hoogenboom WS, Perlis RH, Smoller JW, Zeng-Treitler Q, Gainer VS, Murphy SN, Churchill SE, Kohane IS, Shenton ME, Iosifescu DV

For certain research questions related to long-term outcomes or to rare disorders, designing prospective studies is impractical or prohibitively expensive. Such studies could instead utilize clinical and magnetic resonance imaging data (MRI) collected as part of routine clinical care, stored in the electronic medical record (EMR). Using major depressive disorder (MDD) as a disease model, we examined the feasibility of studying brain morphology and associations with remission using clinical and MRI data exclusively drawn from the EMR. Advanced automated tools were used to select MDD patients and controls from the EMR who had brain MRI data, but no diagnosed brain pathology. MDD patients were further assessed for remission status by review of clinical charts. Twenty MDD patients (eight full-remitters, six partial-remitters, and six non-remitters), and 15 healthy control subjects met all study criteria for advanced morphometric analyses. Compared to controls, MDD patients had significantly smaller right rostral-anterior cingulate volume, and level of non-remission was associated with smaller left hippocampus and left rostral-middle frontal gyrus volume. The use of EMR data for psychiatric research may provide a timely and cost-effective approach with the potential to generate large study samples reflective of the real population with the illness studied.
HubMed – depression


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