The world of mental health treatment is evolving as more information is discovered about its multifaceted pathophysiology. This poster takes a glimpse at one of these factors: the role of neuroinflammation in mood disorders. Above normal levels of inflammation are found in patient’s suffering from depression and bipolar disorder. Elevated inflammation has significant negative effects on the brain that as a result cause dysregulation in mood. Mental health treatments that have been found to effectively address neuroinflammation include nutritional and exercise interventions. The progression of neuroinflammation research in mood disorders gives a positive outlook for patient outcomes as individuals continue to seek evidence-based treatments that are effective for their unique symptomology

Zanders, Andrea

English

Otterbein University

Otterbein University Digital Commons @ Otterbein Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work Summer 2021 Neuroinflammation & Mood Disorders Andrea Zanders zanders1@otterbein.edu Follow this and additional works at: https://digitalcommons.otterbein.edu/stu_msn  Part of the Nursing Commons Recommended Citation Zanders, Andrea, "Neuroinflammation & Mood Disorders" (2021). Nursing Student Class Projects (Formerly MSN). 478. https://digitalcommons.otterbein.edu/stu_msn/478 This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact digitalcommons07@otterbein.edu. Neuroinflammation & Mood Disorders Introduction This poster aims to discuss the pathophysiology of the two main mood disorders: major depressive disorder and bipolar disorder. The exact etiology of these two disorders remains not fully understood, but it is known that the pathophysiology is complex and multifaceted. This poster discusses theories concerning neuroinflammation and their contribution to the pathophysiology of mood disorders. The role of neuroinflammation in mood disorders is a relatively recent area of research that has shown promising results making it worthy of continued attention. By continuing to progress research in this area new and effective treatment can be developed to help individuals all over the world who do not achieve remission with traditional treatments or who continue to have residual lifelong symptoms even after remission. Monoamine hypothesis of depression: the traditional theory of mood disorder pathophysiology which states an imbalance in neurotransmitters is the cause of depression or mania. • Depression: low concentration of norepinephrine, dopamine, and/or serotonin • Mania: high concentration of monoamines such as dopamine, norepinephrine, serotonin, and/or gamma-aminobutyrate • Antidepressant medications balance the levels of these neurotransmitters in the brain by preventing their reuptake and thus increasing the amount available to receptors (Ashok et al., 2017; McCance & Huether, 2019;) Pathophysiology Role of inflammation in pathophysiology of mood disorders Some recent theories investigate the role of inflammation Inflammation is an innate protective response in the body that activates when an injury or threat is detected. Cellular signals release chemicals, or cytokines, that work synergistically to eradicate infection and repair tissue (Rainville & Hodes, 2019). Chronic inflammation results when the initial response is ineffective at achieving homeostasis within the body or if the assault to the body is prolonged (Dey & Hankey Giblin, 2018; Rainville & Hodes, 2019). Chronic inflammation leads to pathosis. (Dey & Hankey Giblin, 2018; Rainville & Hodes, 2019) Normal brain function relies on low levels of inflammatory cytokines (McCance & Huether, 2019). Patients with mood disorders have been found to be in a state of chronic pro-inflammatory production causing elevated numbers (Dey & Hankey Giblin, 2018) (Cottone, 2020) Major Mood Disorder Symptomology Major depressive disorder • Loss of interest or pleasure in activities • Sleep and eating pattern changes • Irritable or down mood • Fatigue, difficulty concentrating • Suicidal ideation Bipolar • Bipolar 1 – Manic episode usually followed by hypomanic or a major depressive episode • Bipolar 2 – Major depressive episode for at least two weeks and a hypomanic episode for 4 days • Manic episode • Elevated or irritable mood • Increased energy and decreased need for sleep • Pressured speech and racing thoughts • Distractibility • Excessive risk taking • Inflated self-confidence (McCance & Huether, 2019) Mood disorder treatments addressing the role of inflammation Poor diet and a sedentary lifestyle have been shown to exacerbate mood disorders and contribute to low-grade chronic inflammation (Gourgouvelis et al., 2018 & Offor et al., 2021). Poor diet also effects production and function of neurotransmitters making someone more susceptible to developing a psychiatric condition (Mikkelsen et al., 2017). A healthy diet and regular exercise have been shown to alleviate mood disorder symptoms (Gourgouvelis et al., 2018; Mikkelsen et al., 2017; Offor et al., 2021) • Several dietary interventions have been shown to decrease systemic inflammation as depicted in the above right illustration (Offor et al., 2021) • Exercise inhibits pro-inflammatory cytokine release and increases anti-inflammatory cytokines production (Mikkelsen et al., 2017) • Large adipocytes increase proinflammatory cytokine release. Regular exercise decreases adipose tissue, and therefore reduces systemic inflammation (Mikkelsen et al., 2017) • The vagus nerve regulates inflammation. Exercise strengthens vagal tone reducing systemic inflammation (Mikkelsen et al., 2017) • Exercise interventions have been shown to be as effective as pharmacological and cognitive behavioral therapy treatments (Gourgouvelis et al., 2018) Andrea Zanders, BSN, RN Otterbein University, Westerville, Ohio Effects of dietary interventions on bio-markers of mental conditions (Offor et al., 2021) References Conclusion The benefits of a healthy diet and regular physical activity are more pronounced for individuals with mood disorders (Kruisdijk et al., 2018). With the role that neuroinflammation plays in the pathophysiology of mood disorders, new treatments that reduce proinflammatory cytokines and reverse their negative effects on the brain could be essential to the future of psychiatric treatment. However, neuroinflammation is only one factor in a complex interaction between genetics, anatomy, physiology, and environment that together either protect against or make one at risk for a mood disorder. Research must continue to progress in the investigation of mood disorder pathophysiology in order to develop diversity in treatment options. The possibility of treatment choice will lead to increased remission rates, decreased relapse rates, and individuals with mood disorders who are able to function more independently and successfully within their families, their communities, and society Elevated proinflammatory cytokines contribute to: • Neural atrophy • Decreased synaptogenesis • Compromised blood-brain barrier • Diversion of tryptophan metabolism from serotonin towards excitotoxic chemicals • Chronic cortisol release and hippocampal damage • Increase in reactive oxidative species These elements have all been found to play a role in the development of mood disorders (McCance & Huether, 2019; Offor et al., 2021; Rakofsky & Rapaport, 2018) Most common proinflammatory cytokines found in patients with mood disorders include IL-1α, IL-β, IL-6, tumor necrosis factor (TNF-α), and C-reactive protein (Dey & Hankey Giblin, 2018; Gourgouvelis et al., 2018; McCance & Huether, 2019; Mikkelsen et al., 2017) High levels of IL-6 are associated with suicidality (Mikkelsen et al., 2017). Most common anti-inflammatory cytokines found in decreased levels include IL-1 receptor antagonist and IL-10 (Gourgouvelis et al., 2018). Antidepressants have been found to also work by decreasing the production of pro-inflammatory cytokines and reversing neural atrophy (Dey & Hankey Giblin, 2018; McCance & Huether, 2019; Rakofsky & Rapaport, 2018) Ashok, A., Marques, T., Jauhar, S., Nour, M. M., Goodwin, G. M., Young, A. H., & Howes, O. D. (2017). The dopamine hypothesis of bipolar affective disorder: The state of the art and implications for treatment. Mol Psychiatry 22, 666–679. https://doi.org/10.1038/mp.2017.16 Cottone, J. G. (2020, May). A better understanding of SSRI antidepressants. Psychology Today. https://www.psychologytoday.com/us/b log/the-cube/202005/better-understanding-ssri-antidepressants Dey, A. & Hankey Giblin, P. A. (2018). Insights into macrophage heterogeneity and cytokine- induced neuroinflammation in major depressive disorder. Pharmaceuticals 11(3), 64. https://doi.org/10.3390/ph11030064 Gourgouvelis, J., Yielder, P., Clarke, S.T., Behbahani, H., & Murphy, B.A. (2018) Exercise leads to better clinical outcomes in those receiving medication plus cognitive behavioral therapy for major depressive disorder. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.000 37 Kruisdijk, F., Hendriksen, I., Tak, E., Beekman, A., & Hopman-Rock, M. (2018). EFFORT-D study process evaluation: Challenges in conducting a trial into the effects of running therapy in patients with major depressive disorder. Ann Gen Psychiatry 17. https://doi.org/10.1186/s12991-018-0181-7 McCance, K. L., & Huether, S. E. (2019). Neurobiology of schizophrenia, mood disorders, anxiety disorders, and obsessive-compulsive disorder. In L. K. Takahashi (Eds.), Pathophysiology: The biologic basis for disease in adults and children (8th ed., pp. 1163-1201). St. Louis, MO: Elsevier/Mosby Mikkelsen, K., Stojanovska, L., Polenakovic, M., Bosevski, M., & Apostolopoulos, V. (2017). Exercise and mental health. Maturitas, 106, 48-56. https://doi.org/10.1016/j.maturitas.201 7.09.003 Offor, S.J., Orish, C.N., Frazzoli, C., & Orisakwe, O.E. (2021). Augmenting clinical interventions in psychiatric disorders: Systematic review and update on nutrition. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.565 583 Rainville, J. R. & Hodes, G. E. (2019). Inflaming sex differences in mood disorders. Neuropsychopharmacology, 44, 184-199. Rakofsky, J. & Rapaport, M. (2018). Mood disorders. Behavioral Neurology and Psychiatry 24(3), 804-827. doi: 10.1212/CON.0000000000000604 post-synaptic nerve ending t Receptor sites @ OTTERBEIN UNIVERSITY 

Neuroinflammation & Mood Disorders

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Neuroinflammation & Mood Disorders

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