From Neuroendocrinology Letters, 30 June 2014 [Epub ahead of print].
Clinical endocannabinoid deficiency (CECD) revisited: Can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?
Smith SC, Wagner MS.
Medical Advisors, C3 International, 13210 Harbor Bl., Garden Grove, CA 92843, USA.
Ethan B. Russo’s paper of December 1, 2003 explored the concept of a clinical endocannabinoid deficiency (CECD) underlying the pathophysiology of migraine, fibromyalgia, irritable bowel syndrome and other functional conditions alleviated by clinical cannabis.
Available literature was reviewed, including searches via the National Library of medicine database and other sources.
A review of the literature indicates that significant progress has been made since Dr. Ethan B. Russo’s landmark paper, just ten years ago (February 2, 2004). Investigation at that time suggested that cannabinoids can block spinal, peripheral and gastrointestional mechanisms that promote pain in headache, fibromyalgia, irritable bowel syndrome and muscle spasm.
Subsequent research has confirmed that underlying endocannabinoid deficiencies indeed play a role in migraine, fibromyalgia, irritable bowel syndrome and a growing list of other medical conditions. Clinical experience is bearing this out. Further research and especially, clinical trials will further demonstrate the usefulness of medical cannabis. As legal barriers fall and scientific bias fades this will become more apparent.
From the Journal of Psychology Research and Behaviour Management, 2 September 2014.
Pilot study investigating the utility of a specialized online symptom management program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome as compared to an online meditation program.
Arroll MA, Attree EA, Marshall CL, Dancey CP.
Chronic Illness Research Team, School of Psychology, University of East London, London, UK
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term, debilitating condition that impacts numerous areas of individuals’ lives. The two predominant treatment options for ME/CFS are cognitive behavioral therapy and graded exercise therapy; however, many people have found these techniques unacceptable or even damaging. This pilot study aimed to evaluate the utility of a specialized online symptom management program for ME/CFS in comparison to an online meditation program in an effort to ascertain whether this tool could be a further option for those with ME/CFS.
THIS EXPERIMENTAL DESIGN CONSISTED OF TWO INTERVENTIONS: a specialized online symptoms management program (N=19) and a control intervention based on an online meditation website (N=9). A battery of questionnaires, including measures of multidimensional fatigue, illness-specific symptoms, perceived control, and mindful awareness, were completed before the participants commenced use of the programs and following 8 weeks’ use.
Significant differences were found in the areas of chance and powerful others’ locus of control, and sleeping difficulties, but not in ME/CFS symptomatology overall.
The specialized online program described in this study warrants further investigation, as it appears to influence perceived control and key ME/CFS symptoms over time.
From the Journal of Psychosomatic Research, 8 September 2014 (epublished before print).
Cortisol output in adolescents with chronic fatigue syndrome: Pilot study on the comparison with healthy adolescents and change after cognitive behavioural guided self-help treatment
Katharine A. Rimes(*), Andrew S. Papadopoulos, Anthony J. Cleare, Trudie Chalder
– King’s College London, Institute of Psychiatry, London UK
* Corresponding author at: King’s College London, Institute of Psychiatry, Department of Psychology, Box PO77, Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK. Tel.: + 4420 7848 0033; fax: + 44 20 78485006.
This study examined cortisol in adolescents with chronic fatigue syndrome (CFS) compared to healthy adolescents and changes in cortisol after cognitive behavioural guided self-help treatment. Exploratory analyses investigated the association between cortisol output and psychological variables.
Salivary cortisol was measured upon awakening, at 15, 30, 45 and 60 mins afterwards and at 12 noon, 4pm and 8pm, in adolescents with CFS and healthy controls (HC). Groups were matched for age, gender, menarche status, menstrual cycle and awakening time. Twenty-four
adolescents with CFS provided saliva samples six months after treatment. The main outcome measure was total salivary output over the day, calculated by area under the curve (AUC). The salivary awakening response was also assessed.
Cortisol output over the day was significantly lower in the CFS group (n=46) than in healthy controls (n=33). Within the CFS group, lower daily cortisol output was associated with higher self-reported perfectionist striving and prosocial behaviour. There were no significant group differences in the awakening response (n=47 CFS versus n=34 HC). After treatment, adolescents with CFS (n=21) showed a significant increase in daily cortisol output, up to normal levels.
The reduced daily cortisol output in adolescents with CFS is in line with adult findings. Associations between reduced cortisol output and two psychological variables – perfectionism and prosocial behaviour – are consistent with cognitive behavioural models of chronic fatigue syndrome. The mild hypocortisolism is reversible; cortisol output had returned to healthy adolescent levels by six months after cognitive behavioural guided self-help treatment.
Published by the Norwegian University of Science and Technology (NTNU Trondheim), 4 September 2014.
The relationship between insomnia and CFS/ME: The HPA axis as a mediator
Ingrid Helene Berg
Norwegian University of Science and Technology
Fatigue is common in the general population, and is the hallmark of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).
Although the occurrence of sleep difficulties is known to be common in subjects with fatigue, research on insomnia in such subjects is absent.
The current study sought to examine the impact comorbid insomnia has on level of fatigue in subjects with chronic fatigue. The aim of this study is to assess the relationship between insomnia and chronic fatigue, and examine if the relationship is affected by the endocrine activity in the HPA axis.
The following hypotheses were tested: 1) Do patients with chronic fatigue and comorbid insomnia experience more fatigue than patients with chronic fatigue without comorbid insomnia? 2) Do patients with chronic fatigue and with initially comorbid insomnia experience more fatigue after treatment than chronic fatigue patients without comorbid insomnia? 3) Do patients with chronic fatigue who experience improvement in insomnia after treatment also experience less fatigue by the end of treatment compared with patients who do not experience improvement in insomnia? 4) Is the potential relationship between insomnia and chronic fatigue influenced by the activity of the HPA axis as expressed by variation in cortisol output measured by Trier Social Stress Test for Groups (TSST-G)?
The study sample consisted of 75 patients with chronic fatigue. Thirty-three met criteria for insomnia, while 42 did not.
While staying at Hysnes Rehabilitation Center in Trondheim, Norway, they received a work-related Acceptance and Commitment Therapy (ACT) treatment intervention lasting 3.5 weeks. In addition, they participated in a standardized stress test (Trier Social Stress Test) pre- and post-treatment.
Saliva cortisol samples were collected during the test in order to measure variation in cortisol output.
The current finding is the first description of how insomnia in patients with chronic fatigue is associated with higher levels of fatigue (p<.05). Further, this study gives preliminary support indicating that remission of insomnia in patients with chronic fatigue can significantly reduce levels of fatigue (p<.05), and furthermore improve the physiological stress-response (p<.05). These results might encourage clinicians to assess and provide specific treatment for insomnia in patients with chronic fatigue as this might improve their treatment results. An aim for further research should be to investigate the effect of specified treatment for insomnia in patients with chronic fatigue.
From Translational Psychiatry, 14 August 2014.
Blood transcriptomic biomarkers in adult primary care patients with major depressive disorder undergoing cognitive behavioral therapy
E E Redei(1,2,6,*). B M Andrus(2), M J Kwasny(3,4), J Seok(4,5), X Cai(3,4), J Ho(3,4), and D C Mohr(2,3,4,6).
1) The Asher Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
2) Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
3) Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
4) Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
5) School of Electrical Engineering, Korea University, Seoul, Korea
*Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 303 E Chicago Avenue, 13-131, Chicago, IL 60611, USA. E-mail: ude.nretsewhtron@ieder-e
6) These authors contributed equally to this work.
An objective, laboratory-based diagnostic tool could increase the diagnostic accuracy of major depressive disorders (MDDs), identify factors that characterize patients and promote individualized therapy.
The goal of this study was to assess a blood-based biomarker panel, which showed promise in adolescents with MDD, in adult primary care patients with MDD and age-, gender- and race-matched nondepressed (ND) controls.
Patients with MDD received cognitive behavioral therapy (CBT) and clinical assessment using self-reported depression with the Patient Health Questionnaire–9 (PHQ-9). The measures, including blood RNA collection, were obtained before and after 18 weeks of CBT.
Blood transcript levels of nine markers of ADCY3, DGKA, FAM46A, IGSF4A/CADM1, KIAA1539, MARCKS, PSME1, RAPH1 and TLR7, differed significantly between participants with MDD (N=32) and ND controls (N=32) at baseline (q< 0.05). Abundance of the DGKA, KIAA1539 and RAPH1 transcripts remained significantly different between subjects with MDD and ND controls even after post-CBT remission (defined as PHQ-9 <5). The ROC area under the curve for these transcripts demonstrated high discriminative ability between MDD and ND participants, regardless of their current clinical status. Before CBT, significant co-expression network of specific transcripts existed in MDD subjects who subsequently remitted in response to CBT, but not in those who remained depressed. Thus, blood levels of different transcript panels may identify the depressed from the nondepressed among primary care patients, during a depressive episode or in remission, or follow and predict response to CBT in depressed individuals.