The Effect of Complex Interventions on Depression and Anxiety in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis.

The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis.

PLoS One. 2013; 8(4): e60532
Coventry PA, Bower P, Keyworth C, Kenning C, Knopp J, Garrett C, Hind D, Malpass A, Dickens C

Depression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective.Systematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n?=?2063) were included in the meta-analysis. Overall, psychological and/or lifestyle interventions were associated with small reductions in symptoms of depression (standardised mean difference -0.28, 95% confidence interval -0.41 to -0.14) and anxiety (standardised mean difference -0.23, 95% confidence interval -0.38 to -0.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference -0.47, 95% confidence interval -0.66 to -0.28), and for anxiety (standardised mean difference -0.45, 95% confidence interval -0.71 to -0.18).Complex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population. HubMed – depression


Are sleep onset/maintenance difficulties associated with medical or psychiatric comorbidities in nondemented community-dwelling older adults?

J Clin Sleep Med. 2013; 9(4): 363-9
Zimmerman ME, Bigal ME, Katz MJ, Derby CA, Lipton RB

Older adults frequently report disruptions in their ability to initiate and maintain sleep. It remains unclear whether these sleep problems are consequent to associated medical comorbidities or if they represent primary sleep disturbances that exist independent of other disorders of senescence. Herein we describe sleep characteristics and associated medical and psychiatric comorbidities among ethnically diverse nondemented older adults.The cross-sectional sample consisted of 702 participants drawn from the Einstein Aging Study (EAS), a community-based study of aging. Sleep onset/maintenance difficulties (SO/MD) were ascertained using responses from the Medical Outcomes Study Sleep Scale (MOS-SS). Participants also completed assessments of medical history, psychological symptoms, and medication use.Participants were an average of 80 ± 5.5 years of age and had 14 ± 3.4 years of education. Older adults reported sleeping an average of 6.5 ± 1.2 h/night. Mild SO/MD was reported in 43% of participants, while moderate/severe SO/MD was reported in 12% of participants. Sleep problems were associated with measures of obesity and symptoms of depression and anxiety. SO/MD was not associated with history of common medical conditions. Use rates of insomnia medication were low (0% to 3%).The prevalence of SO/MD is high in the elderly community-dwelling population and is associated with common psychiatric disorders. With the exception of obesity, SO/MD is not associated with common medical disorders. Further study is necessary to disentangle the nature of the relationship between sleep disturbance and psychiatric comorbidity among older adults. CITATION: Zimmerman ME; Bigal ME; Katz MJ; Derby CA; Lipton RB. Are sleep onset/maintenance difficulties associated with medical or psychiatric comorbidities in nondemented community-dwelling older adults? J Clin Sleep Med 2013;9(4):363-369. HubMed – depression


Effects of serotonin on erythropoietin expression in mouse hippocampus.

Exp Neurobiol. 2013 Mar; 22(1): 45-50
Choi M, Son H

Serotonin (5-hydroxytryptamine, 5-HT), a monoamine neurotransmitter, regulates neurological functions such as mood, sleep, and appetite. Erythropoietin (EPO) is well known for erythropoiesis but has recently emerged as a therapeutic agent in brain diseases. However, the mechanisms that induce EPO in the brain remain unclear. The present study was undertaken to investigate whether the effects of 5-HT involve EPO in murine hippocampal neurons. 5-HT produced a significant increase in neuronal differentiation of hippocampal neural progenitor cells. Expression of erythropoietin was increased in 5-HT-treated cells as well. The actions of 5-HT and EPO appeared to be similar in neurite outgrowth and spine formation. In addition, we show that hippocampal expression of EPO was decreased by chronic unpredictable stress (CUS) and that antidepressant treatment to maintain 5-HT concentration in synaptic cleft reversed this effect. In conclusion, actions of antidepressants might involve EPO induction in the brain. HubMed – depression