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Tag: Antidepressant

  • Body temperature fluctuations tied to depression severity

    Body temperature fluctuations tied to depression severity

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    In a recent study published in the journal Scientific Reports, researchers used self-reports and wearable sensors to investigate the relationship between body temperature and depression, examining minor variations between awake and sleeping body temperature and reduced diurnal body temperature amplitude.

    Depression is an important health issue in the United States, with significant expenses for teenagers and young adults. Antidepressant usage has expanded in Western countries, yet existing pharmacologic medicines have limited effectiveness. It is critical to understand the processes that cause depression symptoms and recognize modifiable ones to create innovative therapies. Identifying anomalies related to depression may lead to a biologically homogenous subgroup that responds better to therapies targeting particular abnormalities.

    Study: Elevated body temperature is associated with depressive symptoms: results from the TemPredict Study. Image Credit: DimaBerlin / ShutterstockStudy: Elevated body temperature is associated with depressive symptoms: results from the TemPredict Study. Image Credit: DimaBerlin / Shutterstock

    About the study

    In the present study, researchers explored the association between body temperature and depression using data from the TemPredict Study, which included over 20,000 individuals in seven months. Eligible participants were adults who could converse in English and had mobiles that could link with the wearable sensor.

    The researchers investigated whether higher self-measured body temperature, lower daytime distal-region body temperature amplitudes, and minor differences between awake-time and asleep-time distal temperatures were associated with increased severity of depression. The team collected data on self-measured body temperatures, wearable sensor-recorded minute-level distal-region body temperatures, and self-reported depressive symptoms. The participants measured body temperature once a day with standard thermometers, and wearable sensors measured minute-level distal temperatures recorded using negative temperature coefficient (NTC) thermistors.

    The team sent the participants monthly surveys via email containing the Patient Reported Outcomes Medical Information System (PROMIS) Profile instrument for depressive symptoms experienced in the previous month. They converted the raw PROMIS depression summary scores into T-scores. In baseline surveys, participants self-reported demographic information such as age and sex.

    The researchers used linear regression models to construct odds ratios (ORs) to investigate the association between the mean daily self-documented body temperatures and the PROMIS T-scores. They calculated E-values for sensitivity analyses. The team computed the difference between the daily maximal and minimal distal body temperatures for all individuals to determine the amplitudes for daytime distal body temperatures.

    Results

    The mean age of the research participants who self-reported their body temperature was 47 years, with 53% being male. Participating individuals completed 3.60 of the seven available PROMIS depression tests. The sensor-recorded body temperatures sample consisted of 21,064 participants, with a mean age of 47 years and 56% men. In both unadjusted and adjusted models, the researchers discovered a positive connection between body temperature and depression T-scores. Linear models had E-values higher than the effects of age, sex, and body temperature on depression.

    Average self-reported body temperature by time-of-day. Figure depicts expected diurnal pattern of lowest self-reported body temperatures reported in the early morning hours and higher self-reported body temperatures during daytime hours. Note. Blue line depicts average self-reported body temperature (right Y axis) by time of day; blue shading indicates standard error of the mean. Red shading indicates number of responses (left Y axis) provided at each minute (X axis).Average self-reported body temperature by time-of-day. Figure depicts expected diurnal pattern of lowest self-reported body temperatures reported in the early morning hours and higher self-reported body temperatures during daytime hours. Note. Blue line depicts average self-reported body temperature (right Y axis) by time of day; blue shading indicates standard error of the mean. Red shading indicates number of responses (left Y axis) provided at each minute (X axis).

    The adjusted regressions revealed that body temperatures accounted for unique variances in PROMIS T-scores, while known variances were accounted for by age and gender. The OR value for having mean PROMIS T-scores in the moderate versus normal range increased significantly with every 0.10°C rise in the mean body temperature (OR, 1.0). PROMIS T-scores in moderate and severe ranges (OR, 1.1) were more likely present than within the normal range.

    The team used the receiver-operating characteristic (ROC) curves to analyze PROMIS T-scores, revealing improved differentiation between severe, moderate, and mild depression severity levels, with ROC curve values of 0.8, 0.7, and 0.6, respectively. Based on the corrected model, Youden’s Index has 86% sensitivity in detecting PROMIS T-scores for depression in the severe range but only 34% specificity. The unadjusted model performed best, with 97% sensitivity to identify PROMIS T-scores in the moderate range (with 63% specificity).

    The awake-time distal body temperatures changed slightly higher from the normal range to mild to moderate, with the most marked shift occurring from WNL to severe depression symptoms. Associated statistical tests revealed significant differences in awake-time distal body temperatures, asleep-awake differences in the distal body temperatures, and amplitudes for daytime distal body temperatures, comparing these metrics among participants with severe symptoms and within the normal range. Individuals with severe depression symptoms showed the highest difference in distal body temperatures compared to those with depression symptoms within the normal range.

    Overall, the study findings showed depressive symptoms associated with higher awake-time body temperatures. The collection of thermometer-measured and wearable sensor-recorded body temperatures corroborated the association. Asleep-time distal temperatures were comparable across the different categories of depression and greater than awake-time distal body temperatures, resulting in decreased asleep-awake disparities as depressed symptom severity increased. Individuals who directly target thermoregulatory systems have reported antidepressant effects.

    Journal reference:

    • Mason, A.E., Kasl, P., Soltani, S., et al. Elevated body temperature is associated with depressive symptoms: results from the TemPredict Study. Sci Rep 14, 1884 (2024), DOI: 10.1038/s41598-024-51567-w, https://www.nature.com/articles/s41598-024-51567-w

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  • Most stroke survivors can safely take two types of common antidepressants

    Most stroke survivors can safely take two types of common antidepressants

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    Most stroke survivors were able to safely take two types of common antidepressants, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    Among people with ischemic (clot-caused) stroke, those who began taking an antidepressant known as an SSRI (selective serotonin reuptake inhibitor) and/or an SNRI (serotonin and norepinephrine reuptake inhibitor) for the common conditions of post-stroke depression and anxiety, did not have an increased risk of hemorrhagic (bleeds) stroke or other serious bleeding. This included people taking anticoagulation medications. There was, however, an increased risk of hemorrhagic stroke among stroke patients taking two anti-platelet medications, also called dual anti-platelet therapy or DAPT.

    Mental health conditions, such as depression and anxiety, are very common yet treatable conditions that may develop after a stroke. Our results should reassure clinicians that for most stroke survivors, it is safe to prescribe SSRI and/or SNRI antidepressants early after stroke to treat post-stroke depression and anxiety, which may help optimize their patients’ recovery. However, caution is needed when considering the risk-benefit profile for stroke patients receiving dual anti-platelet therapy because we did find an increased risk of bleeding among this group.”


    Kent P. Simmonds, D.O., Ph.D., study lead author, third-year physical medicine and rehabilitation resident, University of Texas Southwestern Medical Center in Dallas

    According to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update, when considered separately from other cardiovascular diseases, stroke ranks fifth among all causes of death, behind diseases of the heart, cancer, COVID-19 and unintentional injuries/accidents. Approximately one-third of stroke survivors develop poststroke depression. If left untreated, depression may affect quality of life and reduce the chances for optimal poststroke recovery such as returning to their usual daily living activities without assistance.

    The most common classes of antidepressants are SSRIs or SNRIs, and they are widely used and effective for treating anxiety and depression. However, they may not be prescribed at all or early enough after a stroke, when the risk of depression or anxiety is particularly high, due to concerns that they may increase the risk of a hemorrhagic stroke or other serious types of bleeding.

    Researchers looked at the frequency of serious bleeding among hundreds of thousands of stroke survivors who took different types of SSRI and/or SNRI antidepressants (such as sertraline, fluoxetine, citalopram, venlalfaxine). Serious bleeding was defined as bleeding in the brain, digestive tract; and shock, which occurs when bleeding prevents blood from reaching the body’s tissues.

    Researchers also investigated serious bleeding among stroke survivors who took antidepressants combined with different types of blood-thinning medications that are used to prevent future blood clots. These blood-thinning medications may include either anticoagulants or antiplatelet medications. Anticoagulants are prescribed as a single medication and include medications such as warfarin, apixaban and rivaroxaban. Antiplatelet medications may be prescribed as either a single medication (commonly aspirin) or two types of antiplatelet medications can be used in dual antiplatelet therapy. DAPT includes aspirin plus another antiplatelet medication called a P2Y12 inhibitor (such as clopidogrel, prasugrel or ticagrelor).

    The study found:

    • SSRI and SNRIs were generally safe to start during the important early stages of recovery as patients taking these medications were not more likely to develop serious bleeding compared to stroke survivors who did not take an antidepressant. This included ischemic stroke patients who are also taking anti-coagulation therapy.

    • An increased risk of serious bleeding occurred when SSRIs or SNRIs were taken in combination with DAPT treatments (aspirin and blood thinners). However, the overall risk remained low as serious bleeding events were rare.

    • Among ischemic stroke patients on antidepressant medications, there was a 15% increase in the risk of serious bleeding when taking medications from classes such as mirtazapine, bupropion and tricyclics compared to SSRI/SNRIs.

    “Maximizing rehabilitation early after a stroke is essential because recovery is somewhat time-dependent, and most functional gains occur during the first few months after a stroke,” Simmonds said. “Fortunately, dual antiplatelet therapy is often administered for 14, 30 or 90 days, so, when indicated, clinicians may not need to withhold antidepressant medications for prolonged periods of time. Future research should investigate the risk of bleeding associated with the use of anti-depressant and anxiety medications among patients with hemorrhagic or bleeding stroke.”

    According to a 2022 American Heart Association scientific statement, social isolation and loneliness are associated with about a 30% increased risk of heart attack or stroke, or death from either. “Depression may lead to social isolation, and social isolation may increase the likelihood of experiencing depression. The current study helps answer safety issues around the use of antidepressants for treatment of mental health issues that may develop after a stroke,” said Crystal Wiley Cené, M.D., M.P.H., FAHA, chair of the writing group for the Association’s scientific statement, and a professor of clinical medicine and chief administrative officer for health equity, diversity and inclusion at the University of California San Diego Health. Dr. Cené was not involved in this study.

    Study details and design:

    • The retrospective study included electronic medical records data from 666,150 ischemic stroke patients from over 70 large health care centers in the United States: 35,631 were taking SSRI/SNRI antidepressant medication, and 23,241 were taking other antidepressants; however, most (607,278) were not taking any antidepressant.

    • Patients were treated at 70 health care centers over 20 years.

    • Patients were identified from electronic medical records for 2003 through 2023.

    The study had some limitations. Researchers used statistical methods to adjust for differences among the groups that may not have accounted for all the important differences among the groups. The study also did not account for the dosage, duration, or number of antidepressants taken by participants, which may have affected the results.

    Source:

    American Heart Association

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