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      Vascular and blood-brain barrier-related changes underlie stress responses and resilience in female mice and depression in human tissue

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          Abstract

          Prevalence, symptoms, and treatment of depression suggest that major depressive disorders (MDD) present sex differences. Social stress-induced neurovascular pathology is associated with depressive symptoms in male mice; however, this association is unclear in females. Here, we report that chronic social and subchronic variable stress promotes blood-brain barrier (BBB) alterations in mood-related brain regions of female mice. Targeted disruption of the BBB in the female prefrontal cortex (PFC) induces anxiety- and depression-like behaviours. By comparing the endothelium cell-specific transcriptomic profiling of the mouse male and female PFC, we identify several pathways and genes involved in maladaptive stress responses and resilience to stress. Furthermore, we confirm that the BBB in the PFC of stressed female mice is leaky. Then, we identify circulating vascular biomarkers of chronic stress, such as soluble E-selectin. Similar changes in circulating soluble E-selectin, BBB gene expression and morphology can be found in blood serum and postmortem brain samples from women diagnosed with MDD. Altogether, we propose that BBB dysfunction plays an important role in modulating stress responses in female mice and possibly MDD.

          Abstract

          The vascular, cellular and molecular changes underlying sex differences in mood disorders are unclear. Here, the authors show that blood-brain barrier dysfunction modulates anxiety- and depressive-like behaviors in female mice and endothelium-specific changes associated with maladaptive responses compared to resilience to stress.

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          The PHQ-9: validity of a brief depression severity measure.

          While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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            The PHQ-9

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              Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.

              Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
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                Author and article information

                Contributors
                caroline.menard@fmed.ulaval.ca
                Journal
                Nat Commun
                Nat Commun
                Nature Communications
                Nature Publishing Group UK (London )
                2041-1723
                10 January 2022
                10 January 2022
                2022
                : 13
                : 164
                Affiliations
                [1 ]GRID grid.23856.3a, ISNI 0000 0004 1936 8390, Department of Psychiatry and Neuroscience, , Université Laval and CERVO Brain Research, ; Quebec City, QC Canada
                [2 ]GRID grid.59734.3c, ISNI 0000 0001 0670 2351, Fishberg Department of Neuroscience and the Friedman Brain Institute, , Icahn School of Medicine at Mount Sinai, ; New York, NY USA
                [3 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, Sorbonne Université, ; Paris, France
                [4 ]GRID grid.8217.c, ISNI 0000 0004 1936 9705, Smurfit Institute of Genetics, Trinity College Dublin, Lincoln Place Gate, ; Dublin 2, Ireland
                [5 ]GRID grid.412078.8, ISNI 0000 0001 2353 5268, Department of Psychiatry, , McGill University and Douglas Mental Health University Institute, ; Montreal, QC Canada
                [6 ]GRID grid.414210.2, ISNI 0000 0001 2321 7657, Institut universitaire en santé mentale de Montréal, , Centre intégré universitaire de santé et service sociaux Est, ; Montreal, QC Canada
                Author information
                http://orcid.org/0000-0002-7051-6390
                http://orcid.org/0000-0001-8228-3320
                http://orcid.org/0000-0003-2094-5514
                http://orcid.org/0000-0002-8175-8600
                http://orcid.org/0000-0003-4894-5268
                http://orcid.org/0000-0002-2953-9515
                http://orcid.org/0000-0002-7527-8977
                http://orcid.org/0000-0002-8274-1317
                http://orcid.org/0000-0001-9163-8779
                http://orcid.org/0000-0003-1649-1214
                http://orcid.org/0000-0003-3325-240X
                http://orcid.org/0000-0003-4075-2736
                http://orcid.org/0000-0003-4960-756X
                http://orcid.org/0000-0001-8202-7378
                Article
                27604
                10.1038/s41467-021-27604-x
                8748803
                35013188
                277668c2-9b32-4353-ac8c-3d1e832adf87
                © The Author(s) 2022

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 28 April 2021
                : 9 November 2021
                Funding
                Funded by: This research was supported by the Canadian Institutes for Health Research (CIHR, Project Grant #427011 to C.M.), Fonds de recherche du Quebec – Sante (FRQS, Junior 1 Salary Award to C.M.) and C.M. Sentinel North Research Chair funded by Canada First Research Excellence Fund. L.F.P. and F.C. are supported by a National Institute of Health grant R01MH104559. M.C. is supported by grants from the European Research Council (ERC: Retina-Rhythm), The Irish Research Council (IRC), and an SFI Centres grant supported in part by a research grant from SFI under grant number 16/RC/3948 and co-funded under the European Regional Development fund by FutureNeuro industry partners. L.DA., F.N.K., K.A.D. and F.C. are supported by scholarships or fellowships from CIHR, Sentinel North, FRQS, and the Swiss National Science Foundation, respectively. The Douglas-Bell Canada Brain Bank is funded by the RQSHA (FRQS) and a platform support grant from Healthy Brain Healthy Lives (Canada First Research Excellence Fund).
                Categories
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                © The Author(s) 2022

                Uncategorized
                blood-brain barrier,stress and resilience,diagnostic markers,depression
                Uncategorized
                blood-brain barrier, stress and resilience, diagnostic markers, depression

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