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Daytime Melatonin Levels in Saliva are Associated with Inflammatory Markers and Anxiety Disorders in Young Adults with Psychiatric Disease
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.ORCID iD: 0000-0003-3271-0456
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

The bidirectional interaction between melatonin and the immune system has largely gone unexplored in a clinical context and especially in a psychiatric population. This study explored the association between melatonin during the day and inflammatory cytokines in young adult patients seeking psychiatric care. Samples and data were collected from 108 young adults (mean age 21, SD=2) at an outpatient clinic for affective disorders. Daytime saliva melatonin levels were analyzed with enzyme-linked immunosorbent assay in relation to normalized serum expression levels of 72 inflammatory markers in a proximity extension assay. In a post hoc analysis, the markers with a significant association with melatonin were tested in a generalized linear model to see whether there is a relationship to anxiety disorder or depression. After Bonferroni correction for multiple testing, melatonin levels at 11:00 were positively correlated with cluster of differentiation 5 (CD5; p=4.2e-4, p adj=0.03). Melatonin levels after lunch were correlated with monocyte chemoattractant protein-1 (MCP-1; p=4.2e-4p adj=0.03), monocyte inflammatory protein-1 alpha (MIP-1α; p=6.5e-4p adj=0.047) and vascular endothelial growth factor A (VEGF-A; p=5.3e-6p adj=0.004). In the generalized linear model, positive associations were found between the presence of any anxiety disorder after lunch and melatonin (p=0.046), VEGF-A (p=0.001) and MIP-1α (p=0.001). Daytime saliva levels of melatonin were related to several inflammatory markers in psychiatric patients. This observation likely reflects the bidirectional relationship between melatonin production and the immune system. These findings may have relevance for the understanding of psychiatric disorders and other disorders associated with the same underlying pathogenesis, including low-grade inflammation.

National Category
Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-369409OAI: oai:DiVA.org:uu-369409DiVA, id: diva2:1270315
Available from: 2018-12-12 Created: 2018-12-12 Last updated: 2018-12-12
In thesis
1. Exploring Links between Melatonin, Inflammation and Depression
Open this publication in new window or tab >>Exploring Links between Melatonin, Inflammation and Depression
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Major depressive disorder (MDD) is one of the leading global causes of disease burden. Worse yet, about one third of the patients with MDD do not experience a remission with current treatments. The symptoms of MDD likely represent a variety of underlying pathologic processes and more knowledge about these processes is needed to optimize treatment for MDD. The focus of this thesis was to study the relationship between inflammation, melatonin and symptoms of depression. 

In papers I-III a population of young adults seeking psychiatric care was examined for depressive symptoms, melatonin levels in saliva, gastrointestinal (GI) symptoms and inflammatory markers in blood. In paper IV a cohort of patients with hepatitis C receiving treatment with new direct-acting agents (DAAs) were prospectively followed during treatment for depressive symptoms and sleep.

All patients were diagnosed by means of structured or semi-structured interviews and depressive symptoms were assessed with the self-rating version of the Montgomery Åsberg Depression Rating Scale. Sleep quality was measured by the Pittsburgh Sleep Quality Index, and GI symptoms were assessed with the Gastrointestinal Symptom Rating Scale-IBS. Melatonin in saliva was measured using enzyme-linked immunosorbent assay, and inflammatory markers in blood were analysed by proximity extension assay.

In young adults seeking psychiatric care melatonin levels at bedtime were inversely correlated with depressive symptoms. In those patients with a current depressive episode low melatonin values at bedtime were a negative prognostic factor for response after 6 months (paper I). Postprandial melatonin levels were positively associated with GI symptoms of bloating and pain (paper II). Postprandial melatonin levels were also associated with the inflammatory markers vascular endothelial growth factor A (VEGF-A), monocyte chemoattractant protein-1 (MCP-1) and monocyte inflammatory protein-1α (MIP-1α). Evening levels of melatonin did not correlate with the inflammatory markers. VEGF-A and MCP-1 as well as postprandial levels of melatonin correlated with a diagnosis of anxiety disorder, whereas MIP-1α correlated with MDD (paper III). Patients with hepatitis C underwent treatment with DAAs without experiencing pronounced psychiatric side effects in terms of depressive symptoms or sleep disturbances (paper IV).

In summary, the findings confirm a relationship between bedtime melatonin levels and depressive symptoms. The findings also show a connection between daytime melatonin and GI-symptoms. In addition, the findings indicate an association between inflammation and daytime melatonin. Together these results demonstrate links between melatonin, inflammation and depression. Lastly, interferon-free treatment against hepatitis C did not induce depressive symptoms.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 70
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1526
Keywords
melatonin, inflammation, depression, biomarkers, cytokines, anxiety, hepatitis C
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-369411 (URN)978-91-513-0535-6 (ISBN)
Public defence
2019-02-15, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-01-25 Created: 2018-12-12 Last updated: 2019-02-18

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Sundberg, IsakJacobson, AnnicaRamklint, MiaEkselius, LCunningham, Janet

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