Posttraumatic Stress Disorder Comorbid With Major Depression: Factors Mediating the Association With Suicidal Behavior

Oquendo, María A.; Brent, David A.; Birmaher, Boris; Greenhill, Laurence L.; Kolko, David J.; Stanley, Bárbara; Zelazny, Jamie; Burke, Ainsley K.; Firinciogullari, Sekip; Ellis, Steven P.; Mann, J. John

doi:10.1176/appi.ajp.162.3.560

Cited by 256 publications

(171 citation statements)

References 53 publications

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“…In comparison with patients with depression, PTSD patients went to sleep later, needed two times more time to fall asleep, got up earlier and their total duration of sleep was shorter. Th ese fi ndings are corresponding to the results of studies by other authors that showed more signifi cant reductions in the quality of sleep among PTSD patients than in patients with depression, especially if depression occurred as a comorbidity of PTSD 18 . Th ese fi ndings fi t well into the symptomatology of continuous overexcitation of PTSD patients as the cause of their poorer sleep quality 20 .…”

Section: Discussionsupporting

confidence: 85%

“…High scores on the Beck Depression Inventory among veterans in our study are not surprising, considering a high prevalence of depression as a comorbid disorder in PTSD patients 17,18 . It is diffi cult to ascertain whether the depressive disorder is a result of comorbidity, or the high scores on the Beck Depression Inventory arise from the symptomatology of PTSD.…”

Section: Discussionsupporting

confidence: 48%

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Comparison of Sleep Disturbances in Post-Traumatic Stress Disorder and Depression Patients

Britvić

Antičević

Klepac

2016

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SUMMARY -Th e aim of this study was to explore diff erences in the intensity of depressiveness, sleep disturbances and sleepiness between post-traumatic stress disorder (PTSD) patients and patients with depression. A total of 170 patients were examined, including 120 PTSD patients and 50 patients with depression. All participants completed the Beck Depression Inventory, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Th e results showed diff erence in the subjective assessment of sleep quality between the war veterans with PTSD and civilians with depression, without signifi cant diff erences between them in the level of depressiveness and sleepiness. Considering the fact that insomnia can occur as an early, covert sign of both PTSD and depression and that diff erences in the intensity of sleep disturbances between the groups were established, the use of these and similar instruments for the assessment of sleep quality can be useful in distinguishing patients with PTSD and depression, treatment of their sleep disturbances, and prevention of more severe symptoms in both diagnostic categories.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 48%

Comparison of Sleep Disturbances in Post-Traumatic Stress Disorder and Depression Patients

Britvić

Antičević

Klepac

2016

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“…Pharmacological interventions may include acetyl-Lcarnitine (LAC), a donor of acetyl groups that has been shown to rapidly counteract depressive-like behavior and rectify glutamate dysregulation (18). Behavioral and pharmacological interventions that are rapid may be useful in relation to suicide prevention because they can quickly alleviate depression, counteract impulsiveness, and improve self-regulatory ability (39,40). Furthering our understanding of how stress affects glutamate homeostasis, altering glutamate pre-and postsynaptic receptors, will ultimately contribute to improved therapeutics for more rapidly promoting resilience through more balanced cognitive function and decision making.…”

Section: Discussionmentioning

confidence: 99%

Stress dynamically regulates behavior and glutamatergic gene expression in hippocampus by opening a window of epigenetic plasticity

Nasca

Zelli

Bigio

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

130

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Excitatory amino acids play a key role in both adaptive and deleterious effects of stressors on the brain, and dysregulated glutamate homeostasis has been associated with psychiatric and neurological disorders. Here, we elucidate mechanisms of epigenetic plasticity in the hippocampus in the interactions between a history of chronic stress and familiar and novel acute stressors that alter expression of anxiety-and depressive-like behaviors. We demonstrate that acute restraint and acute forced swim stressors induce differential effects on these behaviors in naive mice and in mice with a history of chronic-restraint stress (CRS). They reveal a key role for epigenetic up-and down-regulation of the putative presynaptic type 2 metabotropic glutamate (mGlu2) receptors and the postsynaptic NR1/NMDA receptors in the hippocampus and particularly in the dentate gyrus (DG), a region of active neurogenesis and a target of antidepressant treatment. We show changes in DG long-term potentiation (LTP) that parallel behavioral responses, with habituation to the same acute restraint stressor and sensitization to a novel forced-swim stressor. In WT mice after CRS and in unstressed mice with a BDNF loss-of-function allele (BDNF Val66Met), we show that the epigenetic activator of histone acetylation, P300, plays a pivotal role in the dynamic up-and down-regulation of mGlu2 in hippocampus via histone-3-lysine-27-acetylation (H3K27Ac) when acute stressors are applied. These hippocampal responses reveal a window of epigenetic plasticity that may be useful for treatment of disorders in which glutamatergic transmission is dysregulated.S tress effects on higher brain regions, such as hippocampus, are known to involve actions of excitatory amino acids to induce structural and functional changes depending upon the type, intensity, and duration of the stressor (1). These differential responses, including determining susceptibility versus resilience to stress, contribute to the pathophysiology of debilitating stress-related disorders (2-5). The hippocampus is a brain region noted for its plasticity in response to stress and sensitivity to adrenal steroid hormones (6). Acute stress enhances synaptic plasticity that is associated with improved cognition and other adaptive functions whereas chronic stress produces opposite effects mediating, in the hippocampus, spine synapse turnover, dendritic shrinkage, impaired long-term potentiation (LTP), and suppression of adult neurogenesis in the dentate gyrus (DG) (1, 7). Importantly, neuroanatomical changes in response to repeated stress recover in young adult animals, based upon the restoration of dendritic length and branching and spine density (8). However, there are underlying changes that can be seen at the level of gene expression and epigenetic regulation that indicate that the brain is continually changing (9, 10). Epigenetic modifications, such as acetylation of histones, have also been involved in the consolidation of contextual memories that allow the brain to respond and adapt to changes in ...

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“…Because parental sexual abuse is related to so many other factors that might affect suicidal risk in the child, such as parental aggression, mood disorder, post-traumatic stress disorder, borderline personality disorder, and substance abuse (3,10,11), the salience of parental history of abuse in predicting child-onset suicidal behavior requires clarification from longitudinal studies.…”

mentioning

confidence: 99%

Familial Pathways to Early-Onset Suicidal Behavior: Familial and Individual Antecedents of Suicidal Behavior

Melhem¹,

Brent

Ziegler³

et al. 2007

AJP

Self Cite

162

129

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Objective-The authors sought to identify clinical predictors of new-onset suicidal behavior in children of parents with a history of mood disorder and suicidal behavior.Method-In a prospective study of offspring of parents with mood disorders, 365 offspring (average age, 20 years) of 203 parents were followed for up to 6 years. Offspring with incident suicide attempts or emergency referrals for suicidal ideation or behavior ("incident events") were compared with offspring without such events on demographic and clinical characteristics. Multivariate analyses were conducted to examine predictors of incident events and predictors of time to incident event.Results-Offspring of probands who had made suicide attempts, compared with offspring of parents with mood disorders who had not made attempts, had a higher rate of incident suicide attempts (4.1% versus 0.6%, relative risk=6.5) as well as overall suicidal events (8.3% versus 1.9%, relative risk=4.4). Mood disorder and self-reported impulsive aggression in offspring and a history of sexual abuse and self-reported depression in parents predicted earlier time to, and greater hazard of, an incident suicidal event.Conclusions-In offspring of parents with mood disorders, precursors of early-onset suicidal behavior include mood disorder and impulsive aggression as well as parental history of suicide attempt, sexual abuse, and self-reported depression. These results suggest that efforts to prevent the familial transmission of early-onset suicidal behavior by targeting these domains could reduce the morbidity of suicidal behavior in high-risk youths.The literature on suicide demonstrates, on the basis of adoption, twin, and family studies, that suicidal behavior aggregates in families and that the familial transmission of suicidal behavior cannot be explained by the transmission of major psychiatric disorders alone (1). However, nearly all of these family genetic studies are cross-sectional, which means that little is known about the precursors of suicidal behavior that place offspring of suicidal individuals at increased risk of suicidal behavior and the causal models to explain how suicidal behavior is transmitted from parent to child.Nevertheless, the literature provides clues as to the mechanisms and precursors of familial transmission of suicidal behavior. Longitudinal community studies show that precursors of youthful suicidal behavior include depression, suicidal ideation, behavioral symptoms, child NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript maltreatment, and family history of suicidal behavior (2-4). Cross-sectional studies have shown that the familial aggregation for suicidal behavior is related to the trait of impulsive aggression. Higher levels of impulsive aggression in those who attempt or compete suicide are associated with greater family aggregation for suicidal behavior (5, 6), and higher levels of impulsive aggression in parents are associated with child suicidal behavior (7). In one cross-sectional study, the famili...

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Posttraumatic Stress Disorder Comorbid With Major Depression: Factors Mediating the Association With Suicidal Behavior

Cited by 256 publications

References 53 publications

Comparison of Sleep Disturbances in Post-Traumatic Stress Disorder and Depression Patients

Comparison of Sleep Disturbances in Post-Traumatic Stress Disorder and Depression Patients

Stress dynamically regulates behavior and glutamatergic gene expression in hippocampus by opening a window of epigenetic plasticity

Familial Pathways to Early-Onset Suicidal Behavior: Familial and Individual Antecedents of Suicidal Behavior

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