Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2021

Open Access 01-12-2021 | Affective Disorder | Research article

A cross-sectional study on the association of serum uric acid levels with depressive and anxiety symptoms in people with epilepsy

Authors: Rui Zhong, Qingling Chen, Mengmeng Li, Nan Li, Chaojia Chu, Jing Li, Xinyue Zhang, Weihong Lin

Published in: BMC Psychiatry | Issue 1/2021

Login to get access

Abstract

Background

High serum uric acid (SUA) levels may provide protection against depression and anxiety through its defensive role in oxidative damage. The aim of this study was to test the hypothesis of the independent associations of lower SUA levels with depressive and anxiety symptoms among patients with epilepsy (PWE).

Methods

A cross-sectional study was performed among 320 PWE aged ≥18 years old in Northeast China. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E; Chinese version) and the Generalized Anxiety Disorder-7 scale (GAD-7; Chinese version) were used as screening tools for depressive and anxiety symptoms for PWE. Serum uric acid levels were measured. The associations of SUA levels with depressive and anxiety symptoms were assessed by using binary logistic regression models, with adjustment for the related risk factors (P< 0.05).

Results

Lower SUA tertiles were significantly associated with higher C-NDDI-E and GAD-7 scores compared with the higher two tertiles (p=0.001, and p= 0.002). Patients with depressive symptoms exhibited significantly lower SUA levels compared to those without depressive symptoms (p< 0.001). SUA levels of patients with anxiety symptoms were significantly lower than those of patients without anxiety symptoms (p< 0.001). The first and second SUA tertiles were associated with depressive symptoms, with the third tertile group as the reference group, after adjusting for confounders (first tertile: OR = 4.694, 95% CI = 1.643~ 13.413, P = 0.004; second tertile: OR = 3.440, 95% CI = 1.278~9.256, P = 0.014). However, The first and second SUA tertiles were not associated with the risk of anxiety symptoms compared with the third tertile in the adjusted logistic regression model (First tertile: OR = 1.556, 95% CI = 0.699~3.464, P = 0.279; second tertile: OR = 1.265, 95% CI = 0.607~2.635, P = 0.530).

Conclusion

We found that lower SUA levels were independently associated with depressive symptoms but not with anxiety symptoms among PWE. Further well-designed prospective cohort studies are required to determine the causality of the associations and to further clarify the mechanisms of SUA in depressive symptoms.
Literature
1.
Thijs RD, Surges R, O’Brien TJ, Sander JW. Epilepsy in adults. Lancet. 2019;393(10172):689–701.PubMedCrossRef
2.
Ouriques MS, Sacks C, Hacke W, Brainin M, de Assis FF, Marques PO, Lavados GP, Marinho MF, Hoppe WA, Vaca MD, et al. Priorities to reduce the burden of stroke in Latin American countries. Lancet Neurol. 2019;18(7):674–83.CrossRef
3.
Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: a meta-analysis. Epilepsia. 2017;58(6):973–82.PubMedCrossRef
4.
Kwong KL, Lam D, Tsui S, Ngan M, Tsang B, Lai TS, Lam SM. Anxiety and depression in adolescents with epilepsy. J Child Neurol. 2016;31(2):203–10.PubMedCrossRef
5.
6.
Rai D, Kerr MP, McManus S, Jordanova V, Lewis G, Brugha TS. Epilepsy and psychiatric comorbidity: a nationally representative population-based study. Epilepsia. 2012;53(6):1095–103.PubMedCrossRef
7.
Valente KD, Busatto FG. Depression and temporal lobe epilepsy represent an epiphenomenon sharing similar neural networks: clinical and brain structural evidences. Arq Neuropsiquiatr. 2013;71(3):183–90.PubMedCrossRef
8.
Yeni K, Tulek Z, Simsek OF, Bebek N. Relationships between knowledge, attitudes, stigma, anxiety and depression, and quality of life in epilepsy: a structural equation modeling. Epilepsy Behav. 2018;85:212–7.PubMedCrossRef
9.
Barry JJ, Ettinger AB, Friel P, Gilliam FG, Harden CL, Hermann B, Kanner AM, Caplan R, Plioplys S, Salpekar J, et al. Consensus statement: the evaluation and treatment of people with epilepsy and affective disorders. Epilepsy Behav. 2008;13(Suppl 1):S1–S29.PubMedCrossRef
10.
Snoeijen-Schouwenaars FM, van Ool JS, Tan IY, Aldenkamp AP, Schelhaas HJ, Hendriksen J. Mood, anxiety, and perceived quality of life in adults with epilepsy and intellectual disability. Acta Neurol Scand. 2019;139(6):519–25.PubMedCrossRef
11.
12.
Ames BN, Cathcart R, Schwiers E, Hochstein P. Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: a hypothesis. Proc Natl Acad Sci U S A. 1981;78(11):6858–62.PubMedPubMedCentralCrossRef
13.
Steenkamp LR, Hough CM, Reus VI, Jain FA, Epel ES, James SJ, Morford AE, Mellon SH, Wolkowitz OM, Lindqvist D. Severity of anxiety- but not depression- is associated with oxidative stress in major depressive disorder. J Affect Disord. 2017;219:193–200.PubMedPubMedCentralCrossRef
14.
Shafiee M, Ahmadnezhad M, Tayefi M, Arekhi S, Vatanparast H, Esmaeili H, Moohebati M, Ferns GA, Mokhber N, Arefhosseini SR, et al. Depression and anxiety symptoms are associated with prooxidant-antioxidant balance: a population-based study. J Affect Disord. 2018;238:491–8.PubMedCrossRef
15.
Wen S, Cheng M, Wang H, Yue J, Wang H, Li G, Zheng L, Zhong Z, Peng F. Serum uric acid levels and the clinical characteristics of depression. Clin Biochem. 2012;45(1–2):49–53.PubMedCrossRef
16.
Black CN, Bot M, Scheffer PG, Snieder H, Penninx B. Uric acid in major depressive and anxiety disorders. J Affect Disord. 2018;225:684–90.PubMedCrossRef
17.
Li G, Miao J, Sun W, Song X, Lan Y, Zhao X, Qiu X, Zhang C, Zhu Z, Zhu S. Lower serum uric acid is associated with post-stroke depression at discharge. Front Psychiatry. 2020;11:52.PubMedPubMedCentralCrossRef
18.
Tao R, Li H. High serum uric acid level in adolescent depressive patients. J Affect Disord. 2015;174:464–6.PubMedCrossRef
19.
Wang D, Hu B, Dai Y, Sun J, Liu Z, Feng Y, Cheng F, Zhang X. Serum uric acid is highly associated with epilepsy secondary to cerebral infarction. Neurotox Res. 2019;35(1):63–70.PubMedCrossRef
20.
Ring HA, Heller AJ, Marshall WJ, Johnson AL, Reynolds EH. Plasma uric acid in patients receiving anticonvulsant monotherapy. Epilepsy Res. 1991;8(3):241–4.PubMedCrossRef
21.
Wang HJ, Tan G, Deng Y, He J, He YJ, Zhou D, Liu L. Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China. Acta Neurol Scand. 2018;138(6):541–7.PubMedCrossRef
22.
Gilliam FG, Barry JJ, Hermann BP, Meador KJ, Vahle V, Kanner AM. Rapid detection of major depression in epilepsy: a multicentre study. Lancet Neurol. 2006;5(5):399–405.PubMedCrossRef
23.
Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.PubMedCrossRef
24.
Tong X, An D, Lan L, Zhou X, Zhang Q, Xiao F, Park SP, Kanemoto K, Kanner AM, Zhou D. Validation of the Chinese version of the neurological disorders depression inventory for epilepsy (C-NDDI-E) in West China. Epilepsy Behav. 2015;47:6–10.PubMedCrossRef
25.
Tong X, An D, McGonigal A, Park SP, Zhou D. Validation of the generalized anxiety Disorder-7 (GAD-7) among Chinese people with epilepsy. Epilepsy Res. 2016;120:31–6.PubMedCrossRef
26.
Togha M, Akhondzadeh S, Motamedi M, Ahmadi B, Razeghi S. Allopurinol as adjunctive therapy in intractable epilepsy: a double-blind and placebo-controlled trial. Arch Med Res. 2007;38(3):313–6.PubMedCrossRef
27.
Li Q, Chen D, Zhu LN, Wang HJ, Xu D, Tan G, Zhang Y, Liu L. Depression in people with epilepsy in West China: status, risk factors and treatment gap. Seizure. 2019;66:86–92.PubMedCrossRef
28.
Li Y, Zhao L, Yu D, Ding G. Associations between serum uric acid and depression among middle-aged and elderly participants in China. Psychol Health Med. 2019;24(10):1277–86.PubMedCrossRef
29.
Gao J, Xu W, Han K, Zhu L, Gao L, Shang X. Changes of serum uric acid and total bilirubin in elderly patients with major postischemic stroke depression. Neuropsychiatr Dis Treat. 2018;14:83–93.PubMedCrossRef
30.
Liu T, Zhong S, Liao X, Chen J, He T, Lai S, Jia Y. A meta-analysis of oxidative stress markers in depression. PLoS One. 2015;10(10):e138904.
31.
Jimenez-Fernandez S, Gurpegui M, Diaz-Atienza F, Perez-Costillas L, Gerstenberg M, Correll CU. Oxidative stress and antioxidant parameters in patients with major depressive disorder compared to healthy controls before and after antidepressant treatment: results from a meta-analysis. J Clin Psychiatry. 2015;76(12):1658–67.PubMedCrossRef
32.
Biersner RJ, McHugh WB, Rahe RH. Biochemical and mood responses predictive of stressful diving performance. J Hum Stress. 1984;10(1):43–9.CrossRef
33.
Kasl SV, Cobb S, Brooks GW. Changes in serum uric acid and cholesterol levels in men undergoing job loss. JAMA. 1968;206(7):1500–7.PubMedCrossRef
34.
Moon HJ, Seo JG, Park SP. Perceived stress and its predictors in people with epilepsy. Epilepsy Behav. 2016;62:47–52.PubMedCrossRef
35.
Glantzounis GK, Tsimoyiannis EC, Kappas AM, Galaris DA. Uric acid and oxidative stress. Curr Pharm Des. 2005;11(32):4145–51.PubMedCrossRef
36.
Strazzullo P, Puig JG. Uric acid and oxidative stress: relative impact on cardiovascular risk? Nutr Metab Cardiovasc Dis. 2007;17(6):409–14.PubMedCrossRef
37.
Dasgupta S, Dasgupta A, Mukhopadhayay T, Bhattacharya S, Swaika B, Banarjee U, Chakrabarty P. Serum uric acid: an early indicator of oxidative stress in beta thalassemia population. Mymensingh Med J. 2013;22(3):567–73.PubMed
38.
39.
Black CN, Bot M, Scheffer PG, Cuijpers P, Penninx BW. Is depression associated with increased oxidative stress? A systematic review and meta-analysis. Psychoneuroendocrino. 2015;51:164–75.CrossRef
40.
Geronzi U, Lotti F, Grosso S. Oxidative stress in epilepsy. Expert Rev Neurother. 2018;18(5):427–34.PubMedCrossRef
41.
Moylan S, Maes M, Wray NR, Berk M. The neuroprogressive nature of major depressive disorder: pathways to disease evolution and resistance, and therapeutic implications. Mol Psychiatry. 2013;18(5):595–606.PubMedCrossRef
42.
Bajpai A, Verma AK, Srivastava M, Srivastava R. Oxidative stress and major depression. J Clin Diagn Res. 2014;8(12):C4–7.
43.
Maes M, Galecki P, Chang YS, Berk M. A review on the oxidative and nitrosative stress (O&NS) pathways in major depression and their possible contribution to the (neuro) degenerative processes in that illness. Prog Neuro-Psychopharmacol Biol Psychiatry. 2011;35(3):676–92.CrossRef
44.
Ortiz R, Ulrich H, Zarate CJ, Machado-Vieira R. Purinergic system dysfunction in mood disorders: a key target for developing improved therapeutics. Prog Neuro-Psychopharmacol Biol Psychiatry. 2015;57:117–31.CrossRef
45.
Ali-Sisto T, Tolmunen T, Toffol E, Viinamaki H, Mantyselka P, Valkonen-Korhonen M, Honkalampi K, Ruusunen A, Velagapudi V, Lehto SM. Purine metabolism is dysregulated in patients with major depressive disorder. Psychoneuroendocrino. 2016;70:25–32.CrossRef
Metadata
Title
A cross-sectional study on the association of serum uric acid levels with depressive and anxiety symptoms in people with epilepsy
Authors
Rui Zhong
Qingling Chen
Mengmeng Li
Nan Li
Chaojia Chu
Jing Li
Xinyue Zhang
Weihong Lin
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-03019-8

Other articles of this Issue 1/2021

BMC Psychiatry 1/2021 Go to the issue

Research

A cross-sectional study of mental health and suicidality among trans women in São Paulo, Brazil

Research

Correlates of transitions from alcohol use to disorder diagnosed by DSM-5 in China

Research article

Psychological distress associated with the COVID-19 pandemic and suppression measures during the first wave in Belgium

Research

Associations of FKBP5 polymorphisms and methylation and parenting style with depressive symptoms among Chinese adolescents

Research

Sexual and physical abuse and depressive symptoms in the UK Biobank

Research

Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece