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Insomnia in Relation to Suicide and Serotonin in Patients with Major Depressive Disorder

우울증 환자에서 불면과 자살, 세로토닌의 연관성

  • Park, Young-Min (Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kang, Seung-Gul (Department of Psychiatry, Gil Medical Center, Gachon University, School of Medicine) ;
  • Lee, Heon-Jeong (Department of Psychiatry, Anam Hospital, Korea University) ;
  • Kim, Leen (Department of Psychiatry, Anam Hospital, Korea University)
  • 박영민 (인제대학교 의과대학 일산백병원 정신건강의학교실) ;
  • 강승걸 (가천대학교 의과대학 길병원 정신건강의학교실) ;
  • 이헌정 (고려대학교 의과대학 안암병원 정신건강의학교실) ;
  • 김린 (고려대학교 의과대학 안암병원 정신건강의학교실)
  • Received : 2014.05.14
  • Accepted : 2014.06.12
  • Published : 2014.06.30

Abstract

Objectives: The aim of current study is to evaluate the relationship between sleep, suicide and serotonin using some scales and loudness dependence of auditory evoked potentials (LDAEP). Methods: Total 65 patients who met the criteria for major depressive disorder were enrolled in current study. The patients were divided into two subgroups according to their insomnia and a history of suicide attempts. The auditory event-related potentials were measured to evaluate LDAEP before beginning antidepressants. Results: The scores of total Beck Depression Inventory (BDI) and BDI item 9 (suicide) were higher in insomnia subgroup than non-insomnia subgroup (respectively, p=0.0033 and p=0.03). However, LDAEP did not differ each other. The subgroup with a history of suicide attempts had a higher score of BDI item 9 than the subgroup without a history of suicide attempts (p=0.00012). There was a tendency for the LDAEP to be higher in the subgroup with a history of suicide attempts ($1.39{\pm}0.94{\mu}V$) than the sub-group without a history of suicide attempts ($1.05{\pm}0.75{\mu}V$), although the difference was not statistically significant (p=0.078). Conclusion: Suicidality was related to insomnia. In addition, there was a tendency for serotonin activity to be lower in the subgroup with a history of suicide attempts. In future, more studies are needed.

목 적: 세로토닌 활성도와 척도를 이용하여 세로토닌과 수면, 세로토닌과 자살 사고, 자살과 수면과의 상호 관련성을 평가하려고 하였다. 방 법: 주요우울증으로 진단된 65명을 대상으로 선택적 세로토닌 재흡수 억제제를 투여 받기 전 우울증의 심각도, 수면 양상, 자살 사고 정도를 평가하고 소리 자극과 뇌파를 이용하여 세로토닌 활성도 수치를 측정하였다. 결 과: Beck Depression Inventory (BDI) 중 불면 척도를 기준으로 두 군으로 나누어 비교한 결과 불면증이 있는 군은 없는 군에 비해 총 BDI 점수와 BDI 중 자살 항목 점수가 유의하게 높았다. 하지만 두 군 간의 세로토닌 활성도에서 유의한 차이는 없었다. 자살 시도 과거력이 있는 군과 자살 시도 과거력이 없는 군으로 나누어 비교한 결과 자살 시도군이 비시도군보다 BDI 중 자살 항목 점수가 유의하게 높았다. 또한 세로토닌 활성도는 통계적 유의성은 없었으나 자살 시도군에서 세로토닌 활성도가 더 낮은 경향성을 보였다. 결 론: 현재까지의 연구로는 자살, 수면, 세로토닌 모두가 서로 연관되어 있을 것이라는 가설은 아직까지 유효한 것 같다. 하지만 이러한 가설을 보다 명확하게 증명하기 위해서는 더 많은 연구가 필요할 것으로 보인다.

Keywords

References

  1. Chen TJ, Yu YW, Chen MC, Wang SY, Tsai SJ, Lee TW. Serotonin dysfunction and suicide attempts in major depressives: an auditory eventrelated potential study. Neuropsychobiology 2008;52:28-36.
  2. Clancy JJ, Caldwell DF, Oberleas D, Sangiah S, Villeneuve MJ. Effects of chronic tryptophan dietary deficiency on the rat's sleep-wake cycle. Brain Res Bull 1978;3:83-87. https://doi.org/10.1016/0361-9230(78)90064-3
  3. Fitzgerald CT, Messias E, Buysse DJ. Teen sleep and suicidality: results from the youth risk behavior surveys of 2007 and 2009. J Clin Sleep Med 2011;7:351-356.
  4. Kim DH, Park YM. The association between suicidality and serotonergic dysfunction in depressed patients. J Affect Disord 2013;148:72-76. https://doi.org/10.1016/j.jad.2012.11.051
  5. Kohyama J. Sleep, serotonin, and suicide in Japan. J Physiol Anthropol 2011;30:1-8. https://doi.org/10.2114/jpa2.30.1
  6. Lee YJ, Cho SJ, Cho IH, Kim SJ. Insufficient sleep and suicidality in adolescents. Sleep 2012;35:455-460. https://doi.org/10.5665/sleep.1722
  7. Mann JJ. The neurobiology of suicide. Nature Medicine 1998;4:25-30. https://doi.org/10.1038/nm0198-025
  8. Mann JJ, Currier D, Stanley B, Oquendo MA, Amsel LV, Ellis SP. Can biological tests assist prediction of suicide in mood disorders? Int J Neuropsychopharmacol 2006;9:465-474. https://doi.org/10.1017/S1461145705005687
  9. Mann JJ, Huang YY, Underwood MD, Kassir SA, Oppenheim S, Kelly TM, et al. A serotonin transporter gene promoter polymorphism (5-HTTLPR) and prefrontal cortical binding in major depression and suicide. Arch Gen Psychiatry 2000;57:729-738. https://doi.org/10.1001/archpsyc.57.8.729
  10. Mann JJ, McBride PA, Malone KM, DeMeo M, Keilp J. Blunted serotonergic responsivity in depressed inpatients. Neuropsychopharmacology 1995;13:53-64. https://doi.org/10.1016/0893-133X(95)00016-7
  11. Morairty SR, Hedley L, Flores J, Martin R, Kilduff TS. Selective 5-HT2A and 5-HT6 antagonists promote sleep in the rat. Sleep 2008;31:34-44. https://doi.org/10.1093/sleep/31.1.34
  12. Ross CA, Trulson ME, Jacobs BL. Depletion of brain 5-HT following intraventricular 5,7-dihydroxytryptamine fails to disrupt sleep in the rat. Brain Res 1976;114:517-523. https://doi.org/10.1016/0006-8993(76)90975-6