Depressive symptoms in the general population: The 7th Tromsø Study

Background: The prevalence of depressive symptoms may differ in various age groups. The aim of the study was to investigate the point-prevalence of depressive symptoms in the adult general population and in various age groups. The impact of sex, marital status, education, and social support on depressive symptoms was also explored. Methods: The population ≥40 years in the city of Tromsø, Norway, were invited to participate in the survey, of whom 64.7% (n=21,083) participated. All participants with a completed Hospital Anxiety and Depression Scale (HADS) were included in the study. A score ≥8 in the HADS depression subscale (HADS-D) was used to indicate caseness for depression. Results: The caseness for depression was 7.5% for men and 6.3% for women, overall 6.9%. The age groups 40-49 years and 80+ years had highest caseness. The overall HADS-D score for the total population was 2.8 (SD 2.7). The mean HADS-D for men (3.1; SD 2.8) was higher than for women (2.6; SD 2,6) (p<0.001). Low social support, low education and not living with a spouse was associated with higher risk for depressive symptoms. Limitations: The prevalence of depressive symptoms was based on a questionnaire, and represents only an estimate of depression in the population. Participants over 80 years were underrepresented, as fragile elderly and elderly living in nursing homes did not participate. Conclusions: Depressive symptoms were more prevalent in the youngest and oldest age groups. Participants reporting low social support, low education and not living with a spouse had higher risk for depressive symptoms

A four-month home-based tDCS study on patients with Alzheimer’s disease

In the present open-label study, our first aim was to study the tolerability and feasibility of long-term treatment with transcranial direct current stimulation (tDCS) and the second aim was to measure whether the treatment led to cognitive improvement. Participants with AD used a tDCS home-treatment kit inducing a low current (2 mA) via two scalp electrodes 30 minutes daily for 4 months. A total of 8 participants were recruited. The treatment technique was manageable for the participants and their spouses, and no troublesome side effects were reported. No significant effects of treatment were found after 4 months

C-reactive protein levels and depression in older and younger adults - A study of 19,947 individuals. The Tromsø study

In recent years, a connection between depression and inflammation has been established, with a range of immunological changes, both cellular and humoral, presenting during depressive states (Beydoun et al., 2016; Haapakoski et al., 2015; Wium-Andersen et al., 2013). Furthermore, there seems to be a dose-response relationship between depression and inflammation, in the sense that the more severe the depression, the higher the level of systemic inflammation markers, most notably expressed as elevated levels of C-reactive protein (CRP) in peripheral blood (Kohler-Forsberg et al., 2017). Accordingly, CRP has been suggested as a marker of depression severity and depression subtypes, as well as an indicator of specific symptom profiles (Jokela et al., 2016). Furthermore, inflammation has been suggested as a target for treatment with immunomodulatory drugs (Alexopoulos and Morimoto, 2011; Kohler et al., 2014). However, the research populations are predominantly younger adults, mainly in clinical settings, and there are few community-based studies providing comparative analyses of age-groups, or focusing specifically on the older population. For those that do, the results are inconsistent, as some demonstrate an association between CRP and depression (Bondy et al., 2021; Sonsin-Diaz et al., 2020; White et al., 2017), while others do not (Baune et al., 2012; Bremmer et al., 2008; Eurelings et al., 2015; Penninx et al., 2003). Thus, it is still unclear whether the inflammation in depression unfolds to the same extent in depressed older adults as in younger adults, and how the severity of the depression relates to inflammation in different age groups

The antidepressant effect of intermittent theta burst stimulation (iTBS): study protocol for a randomized double-blind sham-controlled trial

Background Intermittent theta burst stimulation (iTBS) when applied over the left dorsolateral prefrontal cortex (DLPFC) has been shown to be equally effective and safe to treat depression compared to traditional repetitive transcranial magnetic stimulation (rTMS) paradigms. This protocol describes a funded single-centre, double-blind, randomized placebo-controlled, clinical trial to investigate the antidepressive effects of iTBS and factors associated with an antidepressive response. Methods In this trial, outpatients (N=96, aged 22–65 years) meeting the diagnostic criteria for at least moderate depression (Montgomery and Aasberg Depression Rating Scale score≥20) will be enrolled prospectively and receive ten, once-a-day sessions of either active iTBS or sham iTBS to the left DLPFC, localized via a neuronavigation system. Participants may have any degree of treatment resistance. Prior to stimulation, participants will undergo a thorough safety screening and a brief diagnostic assessment, genetic analysis of brain-derived neurotropic factor, 5-HTTLPR and 5-HT1A, and cerebral MRI assessments. A selection of neuropsychological tests and questionnaires will be administered prior to stimulation and after ten stimulations. An additional follow-up will be conducted 4 weeks after the last stimulation. The frst participant was enrolled on June 4, 2022. Study completion will be in December 2027. The project is approved by the Regional Ethical Committee of Medicine and Health Sciences, Northern Norway, project number 228765. The trial will be conducted according to Good Clinical Practice and published safety guidelines on rTMS treatment. Discussion The aims of the present trial are to investigate the antidepressive effect of a 10-session iTBS protocol on moderately depressed outpatients and to explore the factors that can explain the reduction in depressive symptoms after iTBS but also a poorer response to the treatment. In separate, but related work packages, the trial will assess how clinical, cognitive, brain imaging and genetic measures at baseline relate to the variability in the antidepressive effects of iTBS

Blue-blocking glasses as additive treatment for mania: Effects on actigraphy-derived sleep parameters

Improvement of sleep is a central treatment goal for patients in a manic state. Blue‐blocking (BB) glasses as adjunctive treatment hasten overall recovery from mania. This method is an evolvement from dark therapy and builds on the discovery of the blue‐light‐sensitive retinal ganglion cell that signals daytime to the brain. We report effects of adjunctive BB glasses on actigraphy‐derived sleep parameters for manic inpatients as compared to placebo. Hospitalized patients with bipolar disorder in a manic state aged 18–70 years were recruited from five clinics in Norway from February 2012 to February 2015. The participants were randomly allocated to wearing BB glasses or placebo (clear glasses) as an adjunctive treatment from 18:00 to 08:00 hours for seven consecutive nights. Sleep and wake were monitored by actigraphy. From 32 eligible patients, 10 patients in each group qualified for the group analyses. The BB group's mean sleep efficiency was significantly higher at night 5 as compared to the placebo group (92.6% vs. 83.1%, p = .027). The 95% confidence interval (CI) was 89.4%–95.8% in the BB group and 75.9%–90.3% in the placebo group. There were fewer nights of interrupted sleep in the BB group: 29.6% versus 43.8% in the placebo group. The BB group received less‐intensive sleep‐promoting pharmacological treatment and showed significantly higher sleep efficiency and more consolidated sleep as compared to the placebo group. Our findings suggest sleep‐promoting effects through deactivating mechanisms. Adjunctive BB glasses seem to be useful for improving sleep for manic patients in the hospital setting.publishedVersio

Risk of malnutrition is associated with mental health symptoms in community living elderly men and women: The Tromsø Study

<p>Abstract</p> <p>Background</p> <p>Little research has been done on the relationship between malnutrition and mental health in community living elderly individuals. In the present study, we aimed to assess the associations between mental health (particularly anxiety and depression) and both the risk of malnutrition and body mass index (BMI, kg/m²) in a large sample of elderly men and women from Tromsø, Norway.</p> <p>Methods</p> <p>In a cross-sectional survey, with 1558 men and 1553 women aged 65 to 87 years, the risk of malnutrition was assessed by the Malnutrition Universal Screening Tool ('MUST'), and mental health was measured by the Symptoms Check List 10 (SCL-10). BMI was categorised into six groups (< 20.0, 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, ≥ 30.0 kg/m²).</p> <p>Results</p> <p>The risk of malnutrition (combining medium and high risk) was found in 5.6% of the men and 8.6% of the women. Significant mental health symptoms were reported by 3.9% of the men and 9.1% of the women. In a model adjusted for age, marital status, smoking and education, significant mental health symptoms (SCL-10 score ≥ 1.85) were positively associated with the risk of malnutrition (odds ratio 3.9 [95% CI 1.7-8.6] in men and 2.5 [95%CI 1.3-4.9] in women), the association was positive also for subthreshold mental health symptoms. For individuals with BMI < 20.0 the adjusted odds ratio for significant mental health symptoms was 2.0 [95% CI 1.0-4.0].</p> <p>Conclusions</p> <p>Impaired mental health was strongly associated with the risk of malnutrition in community living elderly men and women and this association was also significant for subthreshold mental health symptoms.</p

A study of some biological factors of importance to geriatric psychiatry.

Papers number 1 and 2 of the thesis are not available in Munin: 1. Grønli O and Wynn R: 'Normocalcemic hyperparathyroidism and treatment resistant depression', Psychosomatics, 2013 Sep-Oct;54(5):493-7, available at http://dx.doi.org/10.1016/j.psym.2012.10.008 2. Grønli O, Kvamme JM, Jorde R and Wynn R: 'Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis', submitted manuscript. Later published in BMC Psychiatry 2014, 14:134, and available in Munin at http://hdl.handle.net/10037/6934Det er lite kunnskap om vitamin D og sink mangel hos eldre med psykiske lidelser. I en case-control studie fant vi signifikant lavere serum nivå av 25(OH)D i en eldre (>64 år) pasient gruppe sammenlignet med en eldre kontroll gruppe (40.5 nmol/L vs. 65.9 nmol/L). Prevalens av vitamin D mangel (def: 25(OH) D<50 nmol/L) var 71.6% i pasient gruppen mot 20.0% i kontroll gruppen. Det var ikke forskjell i vitamin D mangel mellom pasienter med depresjon og andre psykiske lidelser. I en annen case-control studie fant vi prevalens av sink mangel på 41.0% i en eldre pasient gruppe sammenlignet med 14.4% i en kontroll gruppe. Her ble det funnet litt høyere forekomst av sink mangel i pasienter med andre diagnoser enn depresjon. Videre har vi undersøkt sammenheng mellom sink mangel og risiko for underernæring i en cross-sectional populasjons studie på 1521 menn og kvinner. I en analyse hvor det ble justert for en rekke variabler, fant vi økt risiko for sink mangel hos personer som i henhold til screening verktøy var i risiko for underernæring (OR 2.2, CI: 1.3-3.6). I avhandlingen er også betydning av normokalsemisk hyperparathyroidisme i forhold til psykiske lidelser belyst via en case report og litteratur gjennomgang

A study of some biological factors of importance to geriatric psychiatry.

Det er lite kunnskap om vitamin D og sink mangel hos eldre med psykiske lidelser. I en case-control studie fant vi signifikant lavere serum nivå av 25(OH)D i en eldre (>64 år) pasient gruppe sammenlignet med en eldre kontroll gruppe (40.5 nmol/L vs. 65.9 nmol/L). Prevalens av vitamin D mangel (def: 25(OH) D<50 nmol/L) var 71.6% i pasient gruppen mot 20.0% i kontroll gruppen. Det var ikke forskjell i vitamin D mangel mellom pasienter med depresjon og andre psykiske lidelser. I en annen case-control studie fant vi prevalens av sink mangel på 41.0% i en eldre pasient gruppe sammenlignet med 14.4% i en kontroll gruppe. Her ble det funnet litt høyere forekomst av sink mangel i pasienter med andre diagnoser enn depresjon. Videre har vi undersøkt sammenheng mellom sink mangel og risiko for underernæring i en cross-sectional populasjons studie på 1521 menn og kvinner. I en analyse hvor det ble justert for en rekke variabler, fant vi økt risiko for sink mangel hos personer som i henhold til screening verktøy var i risiko for underernæring (OR 2.2, CI: 1.3-3.6). I avhandlingen er også betydning av normokalsemisk hyperparathyroidisme i forhold til psykiske lidelser belyst via en case report og litteratur gjennomgang