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Reasons to treat depression rapidly – Depression causes rapid aging> Consider using a rapid – acting antidepressant!
Depression ‘makes us biologically older’ BBC Article
Major depressive disorder and accelerated cellular aging
Patients with major depressive disorder (MDD) have an increased onset risk of aging-related somatic diseases such as heart disease, diabetes, obesity and cancer. This suggests mechanisms of accelerated biological aging among the depressed, which can be indicated by a shorter length of telomeres. We examine whether MDD is associated with accelerated biological aging, and whether depression characteristics such as severity, duration, and psychoactive medication do further impact on biological aging. Data are from the Netherlands Study of Depression and Anxiety, including 1095 current MDD patients, 802 remitted MDD patients and 510 control subjects. Telomere length (TL) was assessed as the telomere sequence copy number (T) compared to a single-copy gene copy number (S) using quantitative polymerase chain reaction. This resulted in a T/S ratio and was converted to base pairs (bp). MDD diagnosis and MDD characteristics were determined by self-report questionnaires and structured psychiatric interviews. Compared with control subjects (mean bp = 5541), sociodemographic-adjusted TL was shorter among remitted MDD patients (mean bp = 5459; P = 0.014) and current MDD patients (mean bp = 5461; P = 0.012). Adjustment for health and lifestyle variables did not reduce the associations. Within the current MDD patients, separate analyses showed that both higher depression severity (P<0.01) and longer symptom duration in the past 4 years (P = 0.01) were associated with shorter TL. Our results demonstrate that depressed patients show accelerated cellular aging according to a ‘dose–response’ gradient: those with the most severe and chronic MDD showed the shortest TL. We also confirmed the imprint of past exposure to depression, as those with remitted MDD had shorter TL than controls
In this large cohort study we demonstrated that currently depressed persons had shorter TL than never-depressed controls. Based on an estimated mean telomere shortening rate of 14–20 bp per year as found in this and other studies,20,23,26 the differences observed indicate 4–6 years of accelerated aging for the current MDD sample as compared to controls. We also showed evidence for the imprint of past exposure to depression since those with remitted MDD also had shorter TL than control subjects. These observed associations remained significant after controlling for lifestyle and somatic health variables, suggesting that the shortened telomeres were not simply due to unhealthylifestyle or poorer somatic health among depressed persons. Finally, the association between MDD and TL showed a ‘dose– response’ gradient, since the most severely and chronically depressed patients had the shortest telomeres.
MDD is thus associated with shortened TL, which resembles accelerated biological aging. The disorder has previously also been associated with dysregulations of the hypothalamus–pituitary– adrenal (HPA) axis,43,45 the immune system,46,47 the autonomic nervous system (ANS)48,49 and increased oxidative stress.50 Shortened telomeres, in turn, are suggested to be a consequence or a concomitant of these dysregulated biological stress systems. In line with this, several in vitro and in vivo studies found increased cortisol,51 oxidative stress52 and pro-inflammatory cytokines53 to be associated with shorter TL. Dysregulations of these stress systems could contribute to telomere shortening in MDD patients.9,12 However, the exact biological mechanisms that mediate the relation between depression and telomere shortening, as well as the direction of the link, remain to be further explored.
Oxidative stress shortens telomeres
Elevated DNA Oxidation and DNA Repair Enzyme Expression in Brain White Matter in Major Depressive Disorder.
The Role of Oxidative Stress in Depressive Disorders
Studies of the World Health Organization suggest that in the year 2020, depressive disorder will be the illness with the highest burden of disease. Especially unipolar depression is the psychiatric disorder with the highest prevalence and incidence, it is cost-intensive and has a relatively high morbidity. Lately, the biological process involved in the aetiology of depression has been the focus of research. Since its emergence, the monoamine hypothesis has been adjusted and extended considerably. An increasing body of evidence points to alterations not only in brain function, but also in neuronal plasticity. The clinical presentations demonstrate these dysfunctions by accompanying cognitive symptoms such as problems with memory and concentration. Modern imaging techniques show volume reduction of the hippocampus and the frontal cortex. These findings are in line with post-mortem studies of patients with depressive disorder and they point to a significant decrease of neuronal and glial cells in cortico-limbic regions which can be seen as a consequence of alterations in neuronal plasticity in this disorder. This could be triggered by an increase of free radicals which in turn eventually leads to cell death and consequently atrophy of vulnerable neuronal and glial cell population in these regions. Therefore, research on increased oxidative stress in unipolar depressive disorder, mediated by elevated concentrations of free radicals, has been undertaken. This review gives a comprehensive overview over the current literature discussing the involvement of oxidative stress and free radicals in depression.
Membrane damage in blood of patients with depression has been shown by elevated of omega 3- fatty-acids  and by increased lipid peroxidation products in patients with DD [42, 45, [46, 47]. Furthermore, DNA-strand brakes have been reported in the blood of these patients . DD has been linked to increased serum levels of malondialdehyde (MDA), a breakdown product of oxidized apolipoprotein B-containing lipoproteins, and thus a marker of the rate of peroxide breakdown [49, 50].
In patients with DD (Depressive Disorders), elevated levels of MDA adversely affect the efficiency of visual-spatial and auditory-verbal working memory, short-term declarative memory and delayed recall declarative memory . Higher concentration of plasma MDA in patients with recurrent depression is associated with the severity of depressive symptoms, both at the beginning of antidepressant pharmacotherapy, and after 8 weeks of treatment. Statistically significant differences were found in the intensity of depressive symptoms, measured on therapy onset versus the examination results after 8 weeks of treatment . Although this is used as a marker of lipid peroxidation, it is considered to be less stable than 8-iso-PGF2a, and more susceptible to confounding factors such as antioxidants from diet . Therefore, the best way to investigate oxidative disruptions to lipids in humans is via assessing levels of F2- isoprostanes [52-54]. These are stable compounds produced in the process of lipid peroxidation [52, 54]. 8-iso-PGF2a are specific F2- isoprostane molecules produced during the peroxidation of arachnidonic acid. However, the mean serum level of 8-iso-PGF2a was shown to be significantly higher in a group of patients with DD, controlling for lifestyle variables such as body mass index, alcohol consumption, and physical activity [55, 56]. Cerebral membrane abnormalities and altered membrane phospholipids have been suggested by an increased choline-containing compound seen in the putamen of patients with DD  which has been interpreted as a result of increased oxidative stress in patients with DD.
A Meta-Analysis of Oxidative Stress Markers in Depression
Results 115 articles met the inclusion criteria. Lower TAC was noted in acute episodes (AEs) of depressed patients (p<0.05). Antioxidants, including serum paraoxonase, uric acid, albumin, high-density lipoprotein cholesterol and zinc levels were lower than controls (p<0.05); the serum uric acid, albumin and vitamin C levels were increased after antidepressant therapy (p<0.05). Oxidative damage products, including red blood cell (RBC) malondialdehyde (MDA), serum MDA and 8-F2-isoprostanes levels were higher than controls (p<0.05). After antidepressant medication, RBC and serum MDA levels were decreased (p<0.05). Moreover, serum peroxide in free radicals levels were higher than controls (p<0.05). There were no difference
Conclusion This meta-analysis supports the facts that the serum TAC, paraoxonase and antioxidant levels are lower, and the serum free radical and oxidative damage product levels are higher than controls in depressed patients. Meanwhile, the antioxidant levels are increased and the oxidative damage product levels are decreased after antidepressant medication. The pathophysiological relationships between oxidative stress and depression, and the potential benefits of antioxidant supplementation deserve further research.
Some studies have demonstrated that depressed patients’ oxidative product levels in their peripheral blood [3, 4], red blood cells (RBC) , mononuclear cells , urine , cerebrospinal fluid  and postmortem brains  were abnormal. Antioxidant system disturbance in peripheral blood has also been reported . Autoimmune responses against neoepitopes induced by oxidative damage of fatty acid and protein membranes have been reported [10, 11]. Lower glutathione (GSH) levels  and a negative relationship between anhedonia severity and occipital GSH levels  were found through magnetic resonance spectroscopy (MRS).
Oxidative stress is defined as a persistent imbalance between oxidation and anti-oxidation, which leads to the damage of cellular macromolecules [14, 15]. The free radicals consist of reactive oxygen species (ROS) and reactive nitrogen species (RNS). The main ROS includes superoxide anion, hydroxy radical and hydrogen peroxide, and the RNS consists of nitric oxide (NO), nitrogen dioxide and peroxynitrite. Nitrite is often used as a marker of NO activity. Interestingly, the brain appears to be more susceptible to the ROS/RNS because of the high content of unsaturated fatty acids, high oxygen consumption per unit weight, high content of key ingredients of lipid peroxidation (LP) and scarcity of antioxidant defence systems . The oxidative products include products of oxidative damage of LP, protein and DNA in depression. As a product of LP, abnormal malondialdehyde (MDA) levels in depression have been reported . 8-F2-isoprostane (8-iso-PGF2α) is another product of LP  that is considered to be a marker of LP because of its chemical stability . The protein carbonyl (PC), 8-hydroxy-2-deoxyguanosine (8-OHdG) and 8-oxo-7, 8-dihydroguanosine (8-oxoGuo) are the markers of protein, DNA and RNA oxidative damage, respectively [3, 20, 21]. The oxidative damage to cellular macromolecules changes the structure of original epitopes, which leads to the generation of new epitopes modified (neoepitopes). The antibodies against oxidative neoepitopes in depression have been found [10, 11, 22–24]. On the other hand, the antioxidant defence systems can be divided into enzymatic and non-enzymatic antioxidants. The nonenzymatic antioxidants include vitamins C and E, albumin, uric acid, high-density lipoprotein cholesterol (HDL-C), GSH, coenzyme Q10 (CoQ10), ceruloplasmin, zinc, selenium, and so on. The enzymatic antioxidants include superoxide dismutase (SOD), glutathione peroxidase (GPX), catalase (CAT), glutathione reductase (GR), paraoxonase 1 (PON1), and so on.
Discussion The present findings support oxidative stress may be disordered in depressed patients, which is demonstrated by abnormal oxidative stress marker levels. In this meta-analysis, at first we found in depressed patients: 1) the serum TAC, PON, uric acid, albumin, HDL-C and zinc levels were lower than controls; 2) the serum peroxide, MDA, 8-iso-PGF2α and RBC MDA levels were higher than controls. To explore the effect of the antidepressant therapy to oxidative stress markers, we reviewed the studies which had changes. And it came to the conclusions: 1) the serum uric acid, albumin, and vitamin C levels were increased; 2) the serum nitrite, RBC and serum MDA levels were decreased.
The serum antioxidant levels are significantly lower in depression in our study and previous reports, including PON, albumin, zinc, uric acid HDL-C, CoQ10  and GSH [4, 38]. Meanwhile, the oxidative damage product levels are significantly higher. The body couldn’t scavenge the excess free radicals (peroxide), leading to damages of main parts of cellular macromolecules such as fatty acids, protein, DNA, RNA and mitochondria. The longitudinal antidepressant therapy can reverse these abnormal oxidative stress parameters. It has proved these phenomena occur in depression, such as increased levels of MDA, 8-iso-PGF2α, 8-oxoGuo and 8-OHdG [3, 21]. Oxidative stress plays a crucial role in the pathophysiology of depression. Some genes may be a potential factor. Lawlor et al (2007) reported the R allele of PON1Q192R was associated with depression . In addition, poor appetite, psychological stressors, obesity, metabolic syndrome, sleep disorders, cigarette smoking and unhealthy lifestyle may also contribute to it . Furthermore, oxidative stress activates the immuneinflammatory pathways . But some studies supported decrease in albumin, zinc and HDL-C levels was probably related to increased levels of pro-inflammatory cytokines (such as interleukin-1 (IL-1) and IL-6) [59, 70–72, 117] during an acute phase response, which illustrated the activated immune-inflammatory pathways also activates the oxidative stress. These two mechanisms influence each other. On the other hand, the oxidative damage to cellular macromolecules changes the structure of original epitopes, which leads to generation of newepitopes modified (neoepitopes). Oxidative neoepitopes reported up to now include the conjugated oleic and azelaic acid, MDA, phosphatidyl inositol (Pi), NO-modified adducts and oxidized low density lipoprotein (oxLDL) [11, 22–24]. Maes et al reported the levels of serum IgG antibody against the oxLDL and IgM antibodies against the conjugated oleic and azelaic acid, MDA, Pi and NO-modified adducts were increased in depression [11, 22–24]. Depleted antioxidant defence in depression suggests that antioxidant supplements may be useful in clinical management. Preliminary evidence has indicated that patients treated with CoQ10 showed improvement in depressive symptoms and decrease in hippocampal oxidative DNA damage . In our analyses, vitamin C and E levels did not differ between depressed patients and controls, but many studies have reported that vitamin C and E supplements could improve depressive moods [150, 151].
Malondialdehyde plasma concentration correlates with declarative and working memory in patients with recurrent depressive disorder
Oxidative stress has been implicated in the cognitive decline, especially in memory impairment. The purpose of this study was to determine the concentration of malondialdehyde (MDA) in patients with recurrent depressive disorders (rDD) and to define relationship between plasma levels of MDA and the cognitive performance. The study comprised 46 patients meeting criteria for rDD. Cognitive function assessment was based on: The Trail Making Test , The Stroop Test, Verbal Fluency Test and Auditory-Verbal Learning Test. The severity of depression symptoms was assessed using the Hamilton Depression Rating Scale (HDRS). Statistically significant differences were found in the intensity of depression symptoms, measured by the HDRS on therapy onset versus the examination results after 8 weeks of treatment (P < 0.001). Considering the 8-week pharmacotherapy period, rDD patients presented better outcomes in cognitive function tests. There was no statistically significant correlation between plasma MDA levels, and the age, disease duration, number of previous depressive episodes and the results in HDRS applied on admission and on discharge. Elevated levels of MDA adversely affected the efficiency of visual-spatial and auditory-verbal working memory, short-term declarative memory and the delayed recall declarative memory. 1. Higher concentration of plasma MDA in rDD patients is associated with the severity of depressive symptoms, both at the beginning of antidepressants pharmacotherapy, and after 8 weeks of its duration. 2. Elevated levels of plasma MDA are related to the impairment of visual-spatial and auditory-verbal working memory and short-term and delayed declarative memory.
Antioxidant /Antidepressant-like Effect of Ascorbic acid (Vitamin C) and Fluoxetine Another study investigated the influence of ascorbic acid (which is an antioxidant with antidepressant-like effects in animals) on both depressive-like behaviour induced by a chronic unpredictable stress (CUS) paradigm and on serum markers of oxidative stress and in cerebral cortex and hippocampus of mice . The CUS-model is an animal model for induced depression-like behaviour in animals. Depressive-like behaviour induced by CUS was accompanied by significantly increased lipid peroxidation (cerebral cortex and hippocampus), decreased catalase (CAT) (cerebral cortex and hippocampus) and glutathione reductase (GR) (hippocampus) activities and reduced levels of glutathione (cerebral cortex). Repeated ascorbic acid as well as fluoxetine administration significantly reversed CUS-induced depressive-like behaviour as well as oxidative damage. No alterations were observed in locomotor activity and glutathione peroxidase (GPx) activity in the same sample. These findings pointed to a rapid and robust effect of ascorbic acid in reversing behavioural and biochemical alterations induced in an animal model . Ascorbic acid treatment, similarly to fluoxetine, reverses depressive-like behavior and brain oxidative damage induced by chronic unpredictable stress.