Abstract
Objectives: To investigate the correlation between evening melatonin timing secretion, dim light melatonin onset (DLMO), and post-stroke depression (PSD) in acute ischemic stroke patients and their influence on the improvement of depressive symptoms.
Materials and Methods: 120 patients with a recent magnetic resonance imaging confirmed stroke were included. Salivary melatonin samples were collected at 5 time points within 1 week after hospitalization (7 p.m.-11 p.m., 1 sample per hour). The circadian phase was defined by calculating DLMO secretion. Post-stroke depressive symptoms were evaluated by the 17-item Hamilton Rating Scale for Depression (HRSD) both on day 7 of hospitalization and 3 months after stroke. Patients were divided into PSD and non-PSD groups based on whether the acute phase HRSD score was ≥8. Similarly, patients were divided into the improved depressive symptoms (IDS) and no improvement in depressive symptoms (non-IDS) groups based on whether the HRSD score at 3 months was lower than at baseline. Neurological recovery at 3 months was assessed using the modified Rankin Scale (mRS).
Results: The difference in DLMO between PSD and non-PSD patients was not statistically significant (p =0.173). In the non-IDS group, there was a significant decrease in melatonin secretion at 10 p.m. (p =0.012), and DLMO was significantly later than in the IDS group (p =0.017). Logistic regression analysis showed that DLMO (OR 1.91, 95%CI:1.13-3.23, p = 0.016) was an independent risk factor for persistent no improvement in depressive symptoms, which was associated with a markedly worse prognosis (p <0.001).
Conclusion: Our findings suggest possible interventions for the very early identification of non- IDS patients.
[http://dx.doi.org/10.1016/j.pharmthera.2017.11.005] [PMID: 29128343]
[http://dx.doi.org/10.1007/s00415-021-10597-4] [PMID: 34052887]
[http://dx.doi.org/10.1080/14737175.2023.2234081] [PMID: 37427452]
[http://dx.doi.org/10.1136/svn-2020-000359] [PMID: 32665365]
[http://dx.doi.org/10.1038/s41573-020-00109-w] [PMID: 33589815]
[PMID: 29151070]
[http://dx.doi.org/10.1093/sleep/zsac104] [PMID: 35522984]
[http://dx.doi.org/10.1016/j.jpsychires.2016.09.030] [PMID: 27716514]
[http://dx.doi.org/10.1016/j.smrv.2016.06.007] [PMID: 27524206]
[http://dx.doi.org/10.1016/j.neubiorev.2023.105383] [PMID: 37678570]
[http://dx.doi.org/10.2196/50072] [PMID: 37800194]
[http://dx.doi.org/10.1159/000528724] [PMID: 37423205]
[http://dx.doi.org/10.1016/j.cca.2011.05.014] [PMID: 21601566]
[http://dx.doi.org/10.1016/j.pnpbp.2006.06.020] [PMID: 16884842]
[http://dx.doi.org/10.1016/j.sleep.2008.03.020] [PMID: 18725185]
[http://dx.doi.org/10.1016/0006-3223(95)00488-2] [PMID: 8894065]
[http://dx.doi.org/10.1016/0022-3956(93)90037-3] [PMID: 8295158]
[http://dx.doi.org/10.1111/j.1532-5415.2005.53221.x] [PMID: 15817019]
[http://dx.doi.org/10.1016/0165-1781(89)90047-4] [PMID: 2748771]
[http://dx.doi.org/10.1016/j.sleep.2019.04.018] [PMID: 31622953]
[http://dx.doi.org/10.1016/j.jad.2015.07.004] [PMID: 26241662]
[http://dx.doi.org/10.1016/j.jphys.2013.12.012] [PMID: 24856948]
[http://dx.doi.org/10.1161/STROKEAHA.117.017866] [PMID: 28626052]
[http://dx.doi.org/10.1111/ijs.12433] [PMID: 25545189]
[http://dx.doi.org/10.1111/jcmm.14170] [PMID: 30734486]
[http://dx.doi.org/10.1016/j.sleep.2021.10.013] [PMID: 34740169]
[http://dx.doi.org/10.14336/AD.2020.0707] [PMID: 33815883]
[http://dx.doi.org/10.1016/j.sleep.2020.04.025] [PMID: 32828696]
[http://dx.doi.org/10.3389/fneur.2021.630638] [PMID: 33841304]
[http://dx.doi.org/10.1016/j.sleep.2016.08.006] [PMID: 27743803]
[http://dx.doi.org/10.5853/jos.2017.02887] [PMID: 29402071]
[http://dx.doi.org/10.1590/1516-4446-2017-2343] [PMID: 29412338]
[http://dx.doi.org/10.1186/1740-3391-6-9] [PMID: 18922153]
[http://dx.doi.org/10.1177/074873049701200507] [PMID: 9376644]
[http://dx.doi.org/10.1016/j.bbi.2021.10.011] [PMID: 34728390]
[http://dx.doi.org/10.3390/ijms232415625] [PMID: 36555265]
[http://dx.doi.org/10.1371/journal.pmed.1002587] [PMID: 29912983]
[http://dx.doi.org/10.1002/biof.1690] [PMID: 33135223]
[http://dx.doi.org/10.1038/s41398-023-02614-z] [PMID: 37802998]
[http://dx.doi.org/10.1016/j.neurol.2019.07.025] [PMID: 31718830]
[http://dx.doi.org/10.3390/biom11071002] [PMID: 34356626]
[http://dx.doi.org/10.3390/nu13103480] [PMID: 34684482]
[http://dx.doi.org/10.1161/01.STR.13.5.635] [PMID: 7123596]
[http://dx.doi.org/10.1001/archpsyc.58.10.925] [PMID: 11576030]