Changes Of Hypocretin In Major Depressive Disorder And Bipolar Disorder And Internet-based Intervention For COVID-19 Patients With Depression And Anxiety

Objective: To explore the possibility of plasma hypocretin level as a biomarker for depression and bipolar disorder diagnosis and risk assessment.To evaluate the efficacy of internet-based integrated intervention on depression and anxiety symptoms.Methods: From December 2018 to September 2019,we recruited 131 patients including 74 major depressive disorder(MDD)patients and 57 bipolar disorder(BD)patients and 82 healthy controls who were admitted to the department of Psychiatry of the first affiliated hospital,Zhejiang university school of medicine.17 items of Hamilton Depression Scale(17-HAMD)and Hamilton Anxiety Scale(HAMA)were used to assess the severity of depression and anxiety and the intensity of suicidal ideation.Blood sample was collected before treatment,and the plasma concentration of hypocretin-1 was measured by enzyme linked immunosorbent assay(ELISA)after extraction.From February 2,2020 to February 28,2020,we investigated the patients with COVID-19 virus infection in the isolation ward of the department of Psychiatry of the first affiliated hospital,Zhejiang university school of medicine with patients’ health questionnaire-9(PHQ-9)and generalized anxiety disorder questionnaire-7(GAD-7),and used them as the judgment index of their mental stress.A total of 26 patients were enrolled in the study and divided into the intervention group(n= 13,receiving comprehensive Internet-based intervention every day)and the control group(n = 13,only receiving supportive care).The study lasted for 2 weeks for each patient.Each weekend,17-HAMD and HAMA were used to evaluate the severity of depression and anxiety symptoms,as well as the effect of internet-based integrated intervention.Results: In the study of hypocretin,the level of hypocretin-1 in MDD group and BD group was significantly higher than control group(P < 0.001),and the level of hypocretin-1 in BD was significantly higher than MDD(P < 0.001).In MDD group,patients with severe suicidal ideation had higher plasma hypocretin-1 level than those with mild suicidal ideation(P = 0.032).In the control group,there was a significant negative correlation between plasma hypocretin-1 level and age.In the Internet-based intervention study,compared with the control group,the scores of 17-HAMD and HAMA in the intervention group decreased significantly at the end of the first and second weeks(P < 0.005).Conclusions:Plasma hypocretin-1 levels may be helpful in the diagnosis of MDD and BD,and may predict the risk of suicide in MDD patients.Internet-based integrated intervention may be effective in improving depression and anxiety symptoms.