BDNF and Cortisol in the Diagnosis of Cocaine-Induced Depression

Abstract

BackgroundMajor depressive disorder (MDD) and cocaine use disorder (CUD) are related with disability and high mortality rates. The assessment and treatment of psychiatric comorbidity is challenging due to its high prevalence and its clinical severity, mostly due to suicide rates and the presence of medical comorbidities. The aim of this study is to investigate differences in brain derived neurotrophic factor (BDNF) and cortisol plasmatic levels in patients diagnosed with CUD-primary-MDD and CUD-induced-MDD and also to compare them to a sample of MDD patients (without cocaine use), a sample of CUD (without MDD), and a group of healthy controls (HC) after a stress challenge.MethodsA total of 46 subjects were included: MDD (n = 6), CUD (n = 15), CUD-primary-MDD (n = 16), CUD-induced-MDD (n = 9), and 21 HC. Psychiatric comorbidity was assessed with the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders IV (PRISM-IV), and depression severity was measured with the Hamilton Depression Rating Scale (HDRS). Patients were administered the Trier Social Stress Test (TSST) before and after the biological measures, including BDNF, and cortisol levels were obtained.ResultsAfter the TSST, Cohen's d values between CUD-primary-MDD and CUD-induced-MDD increased in each assessment from 0.19 post-TSST to 2.04 post-90-TSST. Pairwise differences among CUD-induced-MDD and both MDD and HC groups had also a large effect size value in post-30-TSST and post-90-TSST. In the case of the BDNF concentrations, CUD-primary-MDD and CUD-induced-MDD in post-90-TSST (12,627.27 ± 5488.09 vs.17,144.84 ± 6581.06, respectively) had a large effect size (0.77).ConclusionResults suggest a different pathogenesis for CUD-induced-MDD with higher levels of cortisol and BDNF compared with CUD-primary-MDD. Such variations should imply different approaches in treatment.

Revisión del trastorno por uso de cocaína y su afectación desde la neuropsicología, neuroimagen y neurobiología

“…Es de destacar que el uso de cocaína a su vez se ha asociado con la aparición de algunos cuadros neuropsiquiátricos, pues su consumo se ha asociado a agitación psicomotriz, alteraciones del sueño, comportamiento suicida y autoagresiones, se ha determinado una asociación entre el consumo de cocaína y la aparición de síntomas psicóticos, incluyendo fantasías suicidas y megalomaníacas e incluso en algunos casos se han evidenciado comportamientos homicidas (Nnadi et al, 2005), otro apartado considerable es que podrían existir trastornos del afecto unipolar inducidos por el uso de cocaína, habiéndose estudiado que los pacientes con consumo crónico y trastornos depresivos secundarias a esta tendrían un mayor nivel en valores de cortisol y en el factor neurotrófico derivado en el cerebro como respuesta al estrés agudo, siendo considerable que este nuevo hallazgo podría generar un marco a la elección idónea y personalizado de antidepresivos para estos paciente con trastornos depresivos secundarios (Fonseca et al, 2022). El uso de cocaína no se asocia solamente a la aparición de episodios depresivos sino de también otros trastornos del ánimo como el trastorno de afecto bipolar (de Azevedo Cardoso et al, 2020), siempre existirá la disyuntiva si el trastorno de afecto bipolar fue el causante del trastorno por uso de sustancias o si este último pudiese gatillar una vulnerabilidad genética y generar el trastorno del ánimo.…”

Enhanced peripheral levels of BDNF and proBDNF: elucidating neurotrophin dynamics in cocaine use disorder

“…Notably, BDNF plays a pivotal role in learning and memory processes, both of which are crucial in the pathophysiology of addiction. With this understanding, BDNF function has been comprehensively investigated in a wide array of addictive disorders, including CUD [ 13 ]. Research has yielded mixed results regarding BDNF levels in CUD patients compared to healthy controls.…”

Antidepressant Medication Does Not Contribute to the Elevated Circulating Concentrations of Acylethanolamides Found in Substance Use Disorder Patients

“…In fact, the co-existence of drug addiction and an additional psychiatric diagnosis is gaining presence in patients demanding treatment for uncontrolled drug use. This special comorbidity has come to be called "dual diagnosis", a reality that has a high prevalence, a significant degree of clinical and social severity, and that usually associates a worsening of the prognosis and an increase in associated health costs [19][20][21]. Furthermore, in patients with these concurrent psychiatric and substance problems, a challenge for effective and rational treatment planning has been described [22].…”