Exploring Associations between C-Reactive Protein and Self-Reported Interoception in Major Depressive Disorder: A Bayesian Analysis.

Major depressive disorder (MDD) is associated with dysfunctional self-reported interoception (i.e., abnormal perception of the body's physiological state) and systemic inflammation, both of which adversely affect treatment response. In this study, we explored associations between C-reactive protein (CRP) and self-reported interoception, to gain more insight into the pathophysiology of interoceptive impairments in MDD. We also aimed to replicate previous findings on the associations of depression and fatigue severity with CRP. The study included 97 depressed individuals, who completed self-administered questionnaires (Multidimensional Assessment of Interoceptive Awareness (MAIA-2); Beck Depression Inventory-II, Multidimensional Fatigue Inventory). CRP concentrations were analyzed in the serum using a particle-enhanced turbidimetric immunoassay. We applied Bayesian inference to estimate robust effect parameters from posterior distributions based on MCMC sampling, and computed Bayes factors (BF10) as indices of relative evidence. The bivariate analysis supported evidence against associations between CRP and self-reported interoception (BF10 ≤ 0.32), except for one dimension (Not-Distracting: r = 0.11, BF10 > 0.43, absence of evidence). Positive correlations with overall depression (r = 0.21, BF10 = 3.19), physical fatigue (r = 0.28, BF10 = 20.64), and reduced activity (r = 0.22, BF10 = 4.67) were found. The multivariate analysis showed moderate evidence that low-grade inflammation predicted higher scores on the MAIA-2 Not-Worrying scale (ß = 0.28, BF10 = 3.97), after controlling for relevant confounders. Inflammatory responses, as measured by CRP, may not be involved in the pathophysiology of dysfunctional self-reported interoception. However, systemic low-grade inflammation could potentially exert a protective effect against worries about pain or discomfort sensations. An immunological involvement in interoceptive impairments cannot be ruled out until future studies considering additional biomarkers of inflammation replicate our findings.

[Touch Medicine - a complementary therapeutic approach exemplified by the treatment of depression]. / Berührungsmedizin ­ ein komplementärer therapeutischer Ansatz unter besonderer Berücksichtigung der Depressionsbehandlung.

Skin-to-skin-contact presents the earliest sensory experience of men and animals. Deprivation of age-relevant touch experiences during infancy results in compromised psychosocial and biological development. The 2021 Nobel Prize in Physiology or Medicine has been awarded for the discoveries of receptors for temperature and touch. Clinical studies have demonstrated the benefit of professional salutary touch for prevention and treatment of various illnesses. However, in the present practice of medicine the application of salutary touch does not meet adequate interest. Proposing a new medical discipline "Touch Medicine" we link the findings of modern touch research to clinical medicine. The treatment of depression which we conceive primarily as a disease afflicting the body will serve as an example to demonstrate the usefulness of touch therapy. Controlled studies and systematic reviews have convincingly shown antidepressive, anxiolytic and analgesic effects of salutary touch. The effectiveness and efficacy of touch therapy has also been demonstrated in many areas such as neonatology, pediatrics, oncology, and geriatrics. We discuss the underlying mechanisms on various explanatory levels including interoceptive and oxytocinergic mechanisms as well as the role of C tactile afferent nerve fibers.

Are the antidepressive effects of massage therapy mediated by restoration of impaired interoceptive functioning? A novel hypothetical mechanism.

Interoception is an individual person's sense of the physiological condition of his/her entire body. Recent research has shown that depression is associated with impaired interoceptive accuracy. Treatments that can improve disturbed interoception are scarce in clinical practice and could complement established therapies. Accumulating evidence suggests that massage therapy significantly alleviates symptoms of depression. However, the mechanisms underlying these effects have remained unclear. We are going to propose a novel mechanism linking these antidepressive effects to a massage-induced modulation of interoceptive states. Particularly affective massage therapy applies slow, rhythmic, and caress-like touch that stimulates C tactile (CT) afferents in the non-glabrous skin. CT mediated touch elicits responses in interoceptive brain areas (e.g. the insular cortex) that have been associated with abnormal interoceptive representations in depressed subjects. Thus, we hypothesize that antidepressive effects of massage therapy are mediated by restoration of the impaired interoceptive functioning through stimulation of CT afferents or related interoceptive structures. If our proposed mechanism is valid, massage is probably one of the most ancient interoceptive treatments.

[The efficacy of Slow Stroke Massage in depression]. / Die Slow Stroke Massage als ein körpertherapeutischer Ansatz bei Depression.

UNLABELLED: Depression afflicts the whole organism, body as well as experience and behaviour. Therefore, therapeutic touch, i.e. a direct body-to-body approach might be helpful in depression, as it has been known and practiced in medicine centuries ago. We investigated the antidepressive effects of an one hour lasting, relaxing, very sensitive soft treatment (Slow Stroke Massage) in a double controlled study comparing massage with a control condition and also comparing effects in depressed patients vs. healthy subjects. The treatment was repeated 5 times within intervals of 2-3 days. Data of 32 acutely depressed in-patients was analyzed. The pre-post-differences in various dimensions were significantly greater during massage than during the control condition. They were also more marked in patients as compared to healthy subjects. CONCLUSION: Slow Stroke Massage can be used effectively and safely as a complimentary therapeutic strategy in depressed patients.

[Which evaluations are fundamental for medical training in pharmacotherapy?]. / Welche Evaluation als Grundlage ärztlicher Ausbildung in der Pharmakotherapie?

In Germany the medical profession is regulated by the state. The state defines the contents of the medical training within the clear boundaries of scientific medicine, which differs from science or biological medicine. The concepts and practice of many complementary therapeutic or diagnostic methods such as homeopathy do not fit within this state-set frame. Medical students, therefore, must be well acquainted with accepted scientific criteria by which we evaluate the value and validity of various therapeutic approaches. Lecturing pharmacotherapy implies posing questions such as: How do I come to statements which can be falsified? Within which constructs are they valid? Within which social context are they meaningful? Which aspects of reality must stay out of focus in order to reach such statements? This will help students to understand the frequent cognitive dissociations between doctors and patients as to concepts of disease and therapy, and the potential reasons why patients often prefer alternative medicine. Alternative methods can be openly discussed and evaluated on the basis of a critical methodology. For the sake of optimal patient care, "pluralistic" approaches towards setting valid therapeutic rules and standards are no alternative during the periods of basic medical training.

[Pharmacologic management of atrial fibrillation by specialists in internal medicine, cardiologists, and general practitioners (GPs) in Berlin]. / Ambulante Therapiegewohnheiten der Berliner Arzteschaft bei der medikamentösen Kardioversion von Vorhofflimmern.

BACKGROUND AND PURPOSE: Atrial fibrillation (AF) is the most frequent form of arrhythmia with a prevalence of 9%. During the last 15 years, there have been considerable changes of antiarrhythmic treatment. Aim of the present study was to investigate in which way general practitioners (GPs) as well as specialists in internal medicine and cardiologists in private practice are managing treatment of AF in the German capital. METHODS: A random sample of physicians practicing in all parts of Berlin were interviewed in written or oral form about their common attitudes to cardioversion, maintenance treatment, and anticoagulation in patients with AF. RESULTS: A very conservative, restrictive attitude in using internationally recommended antiarrhythmic drugs and anticoagulation was observed. Cardioversion is performed over too long time periods. CONCLUSIONS: The findings indicate uncertainty and lack of quality assurance in the management of AF and underline the necessity to follow the existing international guidelines more carefully.

Effects of supraphysiological thyroxine administration in healthy controls and patients with depressive disorders.

BACKGROUND: Thyroxine (T(4)) in supraphysiological doses has been found to be an effective supplemental treatment in open studies for refractory mood disorders. Unexpectedly, only minimal side effects have been reported. The goal of the present study was to investigate whether healthy controls and depressed patients differ in their ability to tolerate supraphysiological doses of T(4). METHODS: This was an 8-week open study to investigate side effects and levels of thyroid hormones in 13 healthy controls and to compare results with those of 13 patients with refractory depression (unipolar and bipolar) undergoing the similar procedures and T(4) dosing regimen in a previous augmentation study. RESULTS: The rate of discontinuation due to side effects was significantly higher in the control group than for the patients (38% versus 0%). The severity of the side effects in the controls increased significantly during treatment with T(4). The side effect scores of the patients were higher than those of the controls prior to T(4) treatment, but did not change significantly during the treatment period. Although the serum concentrations of thyroid hormones rose significantly in both groups, concentrations of fT(3) and fT(4) were significantly higher in the controls. CONCLUSIONS: Healthy controls and depressed patients respond significantly differently to supraphysiological T(4). Healthy controls experience higher elevations of thyroid hormones in response to supraphysiological T(4), thus inducing significantly more side effects and discontinuation. LIMITATIONS: Open-label study; groups were studied at different times; in contrast to healthy controls, depressed patients were also taking antidepressants. CLINICAL RELEVANCE: Studies provide safety and tolerability data on treatment with supraphysiological doses of T(4).