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Reduced brain leptin in patients with major depressive disorder and in suicide victims

Molecular Psychiatry volume 11, pages 800–801 (2006)Cite this article

The aetiology of major depressive disorder (MDD) has been linked, variously, to brain monoaminergic neuronal dysfunction, alterations in monoamine receptor sensitivity and stress-induced activation of the hypothalamic–pituitary–adrenal axis. In an effort to unify these observations, Duman et al.1 recently proposed the neurotrophic hypothesis of depression. Duman posits that vulnerability to depression induced by stress-induced activation of the HPA-axis and the therapeutic action of antidepressant treatments are both due to intracellular mechanisms that decrease or increase, respectively, neurotrophic factors necessary for the survival and function of particular neurons.1 While most attention has focused on brain-derived neurotophic factor, in an elegant study, leptin was recently demonstrated to act as a neurotrophic factor in the mouse hypothalamus, rapidly influencing neuronal arborisation.2 With this as a basis, and given that we have previously demonstrated leptin production by the brain in healthy subjects,3, 4 we hypothesised that patients with MDD, controlled for gender, age and obesity, would exhibit a reduction in brain leptin production.

Twenty patients (8 males/12 females, aged 45±3 years, body mass index (BMI) 27±1) fulfilling the DSM-IV diagnostic criteria for MDD and 20 healthy subjects (10 males/10 females, aged 40±2 years, BMI 26±1) were recruited following local media advertisement. Patients with depression were either newly diagnosed or currently untreated after a recent relapse. Following initial telephone screening, patients were interviewed by a psychiatrist utilising a structured clinical interview (Mini International Neuropsychiatric Interview (MINI)). Hamilton Depression Scale (17 item) and Beck Depression Inventory (BDI-1) were used to monitor severity. Eligibility for entry was determined by HamD>18, BDI>18, positive for major depression on MINI and assessed as having a significant major depression as the primary illness on interview by a psychiatrist. Patients with comorbid panic or anxiety disorders were included in the study if the primary diagnosis was depression and any panic/anxiety was secondary to their depression. All participants had a general medical review and examination by a medical practitioner to exclude any previously undiagnosed medical conditions. Exclusion criteria included coexistent physical illness and comorbid psychotic disorders, eating disorders, mental retardation, high suicide risk, cluster borderline personality disorders and epilepsy. The research protocol conformed to the relevant guidelines of the National Health and Medical Research Council of Australia and was approved by the Alfred Hospital Ethics Review Committee. Written informed consent was obtained from each subject prior to the study. The process of consent, to which an honest, open, and explicit patient information sheet was central, preserved the autonomy of the participants. Healthy volunteers were paid a nominal amount of US$75 for their participation. Following the study patients with MDD were referred to a psychiatrist for clinical management.

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References

  1. Duman RS, Heninger GR, Nestler EJ . Arch Gen Psychiatry 1997; 54: 597–606.

  2. Pinto S, Roseberry AG, Liu H, Diano S, Shanabrough M, Cai X et al. Science 2004; 304: 110–115.

  3. Esler M, Vaz M, Collier G, Nestel P, Jennings G, Kaye D et al. Lancet 1998; 351: 879.

  4. Lambert G, Johansson M, Agren H, Friberg P . Arch Gen Psychiatry 2000; 57: 787–793.

  5. Lambert GW, Eisenhofer G, Cox HS, Horne M, Kalff V, Kelly M et al. Life Sci 1991; 49: 1061–1072.

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Acknowledgements

This work was supported by a National Health and Medical Research Council (NHMRC) of Australia Project Grant, an NHMRC Career Development Fellowship (GL) and an Australian Rotary Health Fund Grant.

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  1. Human Neurotransmitter Laboratory, Baker Heart Research Institute, Melbourne, VIC, Australia

    N Eikelis, M Esler, D Barton, T Dawood, G Wiesner & G Lambert

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  1. N Eikelis
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Eikelis, N., Esler, M., Barton, D. et al. Reduced brain leptin in patients with major depressive disorder and in suicide victims. Mol Psychiatry 11, 800–801 (2006). https://doi.org/10.1038/sj.mp.4001862

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