1.Decoupled but Intertwined Association Between Dissociation and Depression: The Impact of Sleep and Gastrointestinal Symptoms
Yung-Chi HSIEH ; Chui-De CHIU ; Li-Shiu CHOU ; Ching-Hua LIN ; Dian-Jeng LI
Psychiatry Investigation 2025;22(5):583-590
Objective:
Whether dissociation and depression are distinct constructs remains controversial. The aim of this study was to explore the interrelations and associated factors between them.
Methods:
This study included inpatients with major depressive disorder (MDD) and bipolar disorder with major depressive episode (BD). Clinical rating scales were used to measure levels of depression, dissociation, and psychotic symptoms. Generalized estimating equations were used to estimate interrelations between dissociation and related factors over time, including depression. Moreover, the impacts of individual items of the Hamilton Depression Rating Scale (HAMD) on dissociation were evaluated after multiple adjustments.
Results:
A total of 91 participants were included into the analysis, of whom 59 had MDD and 32 had BD. After standardized treatment, levels of depression and psychotic symptoms significantly decreased, whereas the level of dissociation did not. However, the level of dissociation significantly decreased in the high-dissociation group, and this was positively associated with the change in depression and psychotic symptoms. Female sex and comorbidity with borderline personality disorder were also positively correlated with dissociation. Among items of the HAMD, insomnia and gastrointestinal symptoms contributed to the association between depression and dissociation.
Conclusion
We identified a decoupled but intertwined relationship between dissociation and depression. Clinicians should be aware of this comorbidity and provide timely interventions for dissociation during clinical practice.
2.Decoupled but Intertwined Association Between Dissociation and Depression: The Impact of Sleep and Gastrointestinal Symptoms
Yung-Chi HSIEH ; Chui-De CHIU ; Li-Shiu CHOU ; Ching-Hua LIN ; Dian-Jeng LI
Psychiatry Investigation 2025;22(5):583-590
Objective:
Whether dissociation and depression are distinct constructs remains controversial. The aim of this study was to explore the interrelations and associated factors between them.
Methods:
This study included inpatients with major depressive disorder (MDD) and bipolar disorder with major depressive episode (BD). Clinical rating scales were used to measure levels of depression, dissociation, and psychotic symptoms. Generalized estimating equations were used to estimate interrelations between dissociation and related factors over time, including depression. Moreover, the impacts of individual items of the Hamilton Depression Rating Scale (HAMD) on dissociation were evaluated after multiple adjustments.
Results:
A total of 91 participants were included into the analysis, of whom 59 had MDD and 32 had BD. After standardized treatment, levels of depression and psychotic symptoms significantly decreased, whereas the level of dissociation did not. However, the level of dissociation significantly decreased in the high-dissociation group, and this was positively associated with the change in depression and psychotic symptoms. Female sex and comorbidity with borderline personality disorder were also positively correlated with dissociation. Among items of the HAMD, insomnia and gastrointestinal symptoms contributed to the association between depression and dissociation.
Conclusion
We identified a decoupled but intertwined relationship between dissociation and depression. Clinicians should be aware of this comorbidity and provide timely interventions for dissociation during clinical practice.
3.Mechanism of vanillic acid against cardiac fibrosis induced by isoproterenol in mice based on Drp1/HK1/NLRP3 and mitochondrial apoptosis signaling pathways.
Hai-Bo HE ; Mian WU ; Jie XU ; Qian-Qian XU ; Fang-Zhu WAN ; Hua-Qiao ZHONG ; Ji-Hong ZHANG ; Gang ZHOU ; Hui-Lin QIN ; Hao-Ran LI ; Hai-Ming TANG
China Journal of Chinese Materia Medica 2025;50(8):2193-2208
This study investigated the effects and underlying mechanisms of vanillic acid(VA) against cardiac fibrosis(CF) induced by isoproterenol(ISO) in mice. Male C57BL/6J mice were randomly divided into control group, VA group(100 mg·kg~(-1), ig), ISO group(10 mg·kg~(-1), sc), ISO + VA group(10 mg·kg~(-1), sc + 100 mg·kg~(-1), ig), ISO + dynamin-related protein 1(Drp1) inhibitor(Mdivi-1) group(10 mg·kg~(-1), sc + 50 mg·kg~(-1), ip), and ISO + VA + Mdivi-1 group(10 mg·kg~(-1), sc + 100 mg·kg~(-1), ig + 50 mg·kg~(-1), ip). The treatment groups received the corresponding medications once daily for 14 consecutive days. On the day after the last administration, cardiac functions were evaluated, and serum and cardiac tissue samples were collected. These samples were analyzed for serum aspartate aminotransferase(AST), lactate dehydrogenase(LDH), creatine kinase-MB(CK-MB), cardiac troponin I(cTnI), reactive oxygen species(ROS), interleukin(IL)-1β, IL-4, IL-6, IL-10, IL-18, and tumor necrosis factor-α(TNF-α) levels, as well as cardiac tissue catalase(CAT), glutathione(GSH), malondialdehyde(MDA), myeloperoxidase(MPO), superoxide dismutase(SOD), total antioxidant capacity(T-AOC) activities, and cytochrome C levels in mitochondria and cytoplasm. Hematoxylin-eosin, Masson, uranium acetate and lead citrate staining were used to observe morphological and mitochondrial ultrastructural changes in the cardiac tissues, and myocardial injury area and collagen volume fraction were calculated. Flow cytometry was applied to detect the relative content and M1/M2 polarization of cardiac macrophages. The mRNA expression levels of macrophage polarization markers [CD86, CD206, arginase 1(Arg-1), inducible nitric oxide synthase(iNOS)], CF markers [type Ⅰ collagen(Coll Ⅰ), Coll Ⅲ, α-smooth muscle actin(α-SMA)], and cytokines(IL-1β, IL-4, IL-6, IL-10, IL-18, TNF-α) in cardiac tissues were determined by quantitative real-time PCR. Western blot was used to detect the protein expression levels of Coll Ⅰ, Coll Ⅲ, α-SMA, Drp1, p-Drp1, voltage-dependent anion channel(VDAC), hexokinase 1(HK1), NOD-like receptor protein 3(NLRP3), apoptosis-associated speck-like protein(ASC), caspase-1, cleaved-caspase-1, gasdermin D(GSDMD), cleaved N-terminal gasdermin D(GSDMD-N), IL-1β, IL-18, B-cell lymphoma-2(Bcl-2), B-cell lymphoma-xl(Bcl-xl), Bcl-2-associated death promoter(Bad), Bcl-2-associated X protein(Bax), apoptotic protease activating factor-1(Apaf-1), pro-caspase-3, cleaved-caspase-3, pro-caspase-9, cleaved-caspase-9, poly(ADP-ribose) polymerase-1(PARP-1), and cleaved-PARP-1 in cardiac tissues. The results showed that VA significantly improved cardiac function in mice with CF, reduced myocardial injury area and cardiac index, and decreased serum levels of AST, CK-MB, cTnI, LDH, ROS, IL-1β, IL-6, IL-18, and TNF-α. VA also lowered MDA and MPO levels, mRNA expressions of IL-1β, IL-6, IL-18, and TNF-α, and mRNA and protein expressions of Coll Ⅰ, Coll Ⅲ, and α-SMA in cardiac tissues, and increased serum levels of IL-4 and IL-10, cardiac tissue levels of CAT, GSH, SOD, and T-AOC, and mRNA expressions of IL-4 and IL-10. Additionally, VA ameliorated cardiac pathological damage, inhibited myocardial cell apoptosis, inflammatory infiltration, and collagen fiber deposition, reduced collagen volume fraction, and alleviated mitochondrial damage. VA decreased the ratio of F4/80~+CD86~+ M1 cells and the mRNA expressions of CD86 and iNOS in cardiac tissue, and increased the ratio of F4/80~+CD206~+ M2 cells and the mRNA expressions of CD206 and Arg-1. VA also reduced protein expressions of p-Drp1, VDAC, NLRP3, ASC, caspase-1, cleaved-caspase-1, GSDMD, GSDMD-N, IL-1β, IL-18, Bad, Bax, Apaf-1, cleaved-caspase-3, cleaved-caspase-9, cleaved-PARP-1, and cytoplasmic cytochrome C, and increased the expressions of HK1, Bcl-2, Bcl-xl, pro-caspase-3, pro-caspase-9 proteins, as well as the Bcl-2/Bax and Bcl-xl/Bad ratios and mitochondrial cytochrome C content. These results indicate that VA has a significant ameliorative effect on ISO-induced CF in mice, alleviates ISO-induced oxidative damage and inflammatory response, and its mechanism may be closely related to the inhibition of Drp1/HK1/NLRP3 and mitochondrial apoptosis signaling pathways, suppression of myocardial cell inflammatory infiltration and collagen fiber deposition, reduction of collagen volume fraction and CollⅠ, Coll Ⅲ, and α-SMA expressions, thus mitigating CF.
Animals
;
Isoproterenol/adverse effects*
;
Male
;
Mice
;
Signal Transduction/drug effects*
;
Vanillic Acid/administration & dosage*
;
Dynamins/genetics*
;
Mice, Inbred C57BL
;
Fibrosis/genetics*
;
Apoptosis/drug effects*
;
Mitochondria/metabolism*
;
NLR Family, Pyrin Domain-Containing 3 Protein/genetics*
;
Myocardium/metabolism*
;
Humans
4.Integrated multiomics reveal mechanism of Aidi Injection in attenuating doxorubicin-induced cardiotoxicity.
Yan-Li WANG ; Yu-Jie TU ; Jian-Hua ZHU ; Lin ZHENG ; Yong HUANG ; Jia SUN ; Yong-Jun LI ; Jie PAN ; Chun-Hua LIU ; Yuan LU
China Journal of Chinese Materia Medica 2025;50(8):2245-2259
The combination of Aidi Injection(ADI) and doxorubicin(DOX) is a common strategy in the treatment of cancer, which can achieve synergistic anti-tumor effects while attenuating the cardiotoxicity caused by DOX. This study aims to investigate the mechanism of ADI in attenuating DOX-induced cardiotoxicity by multi-omics. DOX was used to induce cardiotoxicity in mice, and the cardioprotective effects of ADI were evaluated based on biochemical indicators and pathological changes. Based on the results, transcriptomics, proteomics, and metabolomics were employed to analyze the changes of endogenous substances in different physiological states. Furthermore, data from multiple omics were integrated to screen key regulatory pathways by which ADI attenuated DOX-induced cardiotoxicity, and important target proteins were selected for measurement by ELISA kits and immunohistochemical analysis. The results showed that ADI significantly reduced the levels of cardiac troponin T(cTnT) and N-terminal pro-B-type natriuretic peptide(NT-proBNP) and effectively ameliorated myocardial fibrosis and intracellular vacuolization, indicating that ADI showed therapeutic effect on DOX-induced cardiotoxicity. The transcriptomics analysis screened out a total of 400 differentially expressed genes(DEGs), which were mainly enriched in inflammatory response, oxidative stress, and myocardial fibrosis. After proteomics analysis, 70 differentially expressed proteins were selected, which were mainly enriched in the inflammatory response, cardiac function, and energy metabolism. A total of 51 differentially expressed metabolites were screened by the metabolomics analysis, and they were mainly enriched in multiple signaling pathways, including the inflammatory response, lipid metabolism, and energy metabolism. The integrated data of multiple omics showed that linoleic acid metabolism, arachidonic acid metabolism, and glycerophosphate metabolism pathways played an important role in DOX-induced cardiotoxicity, and ADI may exert therapeutic effects by modulating these pathways. Target validation experiments suggested that ADI significantly regulated abnormal protein levels of cyclooxygenase-1(COX-1), cyclooxygenase-2(COX-2), prostaglandin H2(PGH2), and prostaglandin D2(PGD2) in the model group. In conclusion, ADI may attenuate DOX-induced cardiotoxicity by regulating linoleic acid metabolism, arachidonic acid metabolism, and glycerophosphate metabolism, thus alleviating inflammation of the body.
Doxorubicin/toxicity*
;
Animals
;
Mice
;
Cardiotoxicity/genetics*
;
Drugs, Chinese Herbal/administration & dosage*
;
Male
;
Proteomics
;
Metabolomics
;
Injections
;
Humans
;
Multiomics
5.Tanreqing Capsules protect lung and gut of mice infected with influenza virus via "lung-gut axis".
Nai-Fan DUAN ; Yuan-Yuan YU ; Yu-Rong HE ; Feng CHEN ; Lin-Qiong ZHOU ; Ya-Lan LI ; Shi-Qi SUN ; Yan XUE ; Xing ZHANG ; Gui-Hua XU ; Yue-Juan ZHENG ; Wei ZHANG
China Journal of Chinese Materia Medica 2025;50(8):2270-2281
This study aims to explore the mechanism of lung and gut protection by Tanreqing Capsules on the mice infected with influenza virus based on "the lung-gut axis". A total of 110 C57BL/6J mice were randomized into control group, model group, oseltamivir group, and low-and high-dose Tanreqing Capsules groups. Ten mice in each group underwent body weight protection experiments, and the remaining 12 mice underwent experiments for mechanism exploration. Mice were infected with influenza virus A/Puerto Rico/08/1934(PR8) via nasal inhalation for the modeling. The lung tissue was collected on day 3 after gavage, and the lung tissue, colon tissue, and feces were collected on day 7 after gavage for subsequent testing. The results showed that Tanreqing Capsules alleviated the body weight reduction and increased the survival rate caused by PR8 infection. Compared with model group, Tanreqing Capsules can alleviate the lung injury by reducing the lung index, alleviating inflammation and edema in the lung tissue, down-regulating viral gene expression at the late stage of infection, reducing the percentage of neutrophils, and increasing the percentage of T cells. Tanreqing Capsules relieved the gut injury by restoring the colon length, increasing intestinal lumen mucin secretion, alleviating intestinal inflammation, and reducing goblet cell destruction. The gut microbiota analysis showed that Tanreqing Capsules increased species diversity compared with model group. At the phylum level, Tanreqing Capsules significantly increased the abundance of Firmicutes and Actinobacteria, while reducing the abundance of Bacteroidota and Proteobacteria to maintain gut microbiota balance. At the genus level, Tanreqing Capsules significantly increased the abundance of unclassified_f_Lachnospiraceae while reducing the abundance of Bacteroides, Eubacterium, and Phocaeicola to maintain gut microbiota balance. In conclusion, Tanreqing Capsules can alleviate mouse lung and gut injury caused by influenza virus infection and restore the balance of gut microbiota. Treating influenza from the lung and gut can provide new ideas for clinical practice.
Animals
;
Drugs, Chinese Herbal/administration & dosage*
;
Mice
;
Lung/metabolism*
;
Mice, Inbred C57BL
;
Capsules
;
Orthomyxoviridae Infections/virology*
;
Gastrointestinal Microbiome/drug effects*
;
Male
;
Humans
;
Female
;
Influenza A virus/physiology*
;
Influenza, Human/virology*
6.Effects of combined use of active ingredients in Buyang Huanwu Decoction on oxygen-glucose deprivation/reglucose-reoxygenation-induced inflammation and oxidative stress of BV2 cells.
Tian-Qing XIA ; Ying CHEN ; Jian-Lin HUA ; Qin SU ; Cun-Yan DAN ; Meng-Wei RONG ; Shi-Ning GE ; Hong GUO ; Bao-Guo XIAO ; Jie-Zhong YU ; Cun-Gen MA ; Li-Juan SONG
China Journal of Chinese Materia Medica 2025;50(14):3835-3846
This study aims to explore the effects and action mechanisms of the active ingredients in Buyang Huanwu Decoction(BYHWD), namely tetramethylpyrazine(TMP) and hydroxy-safflor yellow A(HSYA), on oxygen-glucose deprivation/reglucose-reoxygenation(OGD/R)-induced inflammation and oxidative stress of microglia(MG). Network pharmacology was used to screen the effective monomer ingredients of BYHWD and determine the safe concentration range for each component. Inflammation and oxidative stress models were established to further screen the best ingredient combination and optimal concentration ratio with the most effective anti-inflammatory and antioxidant effects. OGD/R BV2 cell models were constructed, and BV2 cells in the logarithmic growth phase were divided into a normal group, a model group, an HSYA group, a TMP group, and an HSYA + TMP group. Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of inflammatory cytokines such as interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), and interleukin-6(IL-6). Oxidative stress markers, including superoxide dismutase(SOD), nitric oxide(NO), and malondialdehyde(MDA), were also measured. Western blot was used to analyze the protein expression of both inflammation-related pathway [Toll-like receptor 4(TLR4)/nuclear factor-kappa B(NF-κB)] and oxidative stress-related pathway [nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)]. Immunofluorescence was used to assess the expression of proteins such as inducible nitric oxide synthase(iNOS) and arginase-1(Arg-1). The most effective ingredients for anti-inflammatory and antioxidant effects in BYHWD were TMP and HSYA. Compared to the normal group, the model group showed significantly increased levels of IL-1β, TNF-α, IL-6, NO, and MDA, along with significantly higher protein expression of NF-κB, TLR4, Nrf2, and HO-1 and significantly lower SOD levels. The differences between the two groups were statistically significant. Compared to the model group, both the HSYA group and the TMP group showed significantly reduced levels of IL-1β, TNF-α, IL-6, NO, and MDA, lower expression of NF-κB and TLR4 proteins, higher levels of SOD, and significantly increased protein expression of Nrf2 and HO-1. Additionally, the expression of the M1-type MG marker iNOS was significantly reduced, while the expression of the M2-type MG marker Arg-1 was significantly increased. The results of the HSYA group and the TMP group had statistically significant differences from those of the model group. Compared to the HSYA group and the TMP group, the HSYA + TMP group showed further significant reductions in IL-1β, TNF-α, IL-6, NO, and MDA levels, along with significant reductions in NF-κB and TLR4 protein expression, an increase in SOD levels, and elevated Nrf2 and HO-1 protein expression. Additionally, the expression of the M1-type MG marker iNOS was reduced, while the M2-type MG marker Arg-1 expression increased significantly in the HSYA + TMP group compared to the TMP or HSYA group. The differences in the results were statistically significant between the HSYA + TMP group and the TMP or HSYA group. The findings indicated that the combined use of HSYA and TMP, the active ingredients of BYHWD, can effectively inhibit OGD/R-induced inflammation and oxidative stress of MG, showing superior effects compared to the individual use of either component.
Oxidative Stress/drug effects*
;
Drugs, Chinese Herbal/pharmacology*
;
Animals
;
Mice
;
Glucose/metabolism*
;
Cell Line
;
Inflammation/genetics*
;
Oxygen/metabolism*
;
Pyrazines/pharmacology*
;
Microglia/metabolism*
;
NF-E2-Related Factor 2/immunology*
;
NF-kappa B/immunology*
;
Toll-Like Receptor 4/immunology*
;
Anti-Inflammatory Agents/pharmacology*
;
Humans
7.Endosomal catabolism of phosphatidylinositol 4,5-bisphosphate is fundamental in building resilience against pathogens.
Chao YANG ; Longfeng YAO ; Dan CHEN ; Changling CHEN ; Wenbo LI ; Hua TONG ; Zihang CHENG ; Yanling YAN ; Long LIN ; Jing ZHANG ; Anbing SHI
Protein & Cell 2025;16(3):161-187
Endosomes are characterized by the presence of various phosphoinositides that are essential for defining the membrane properties. However, the interplay between endosomal phosphoinositides metabolism and innate immunity is yet to be fully understood. Here, our findings highlight the evolutionary continuity of RAB-10/Rab10's involvement in regulating innate immunity. Upon infection of Caenorhabditis elegans with Pseudomonas aeruginosa, an increase in RAB-10 activity was observed in the intestine. Conversely, when RAB-10 was absent, the intestinal diacylglycerols (DAGs) decreased, and the animal's response to the pathogen was impaired. Further research revealed that UNC-16/JIP3 acts as an RAB-10 effector, facilitating the recruitment of phospholipase EGL-8 to endosomes. This leads to a decrease in endosomal phosphatidylinositol 4,5-bisphosphate (PI(4,5)P2) and an elevation of DAGs, as well as the activation of the PMK-1/p38 MAPK innate immune pathway. It is noteworthy that the dimerization of UNC-16 is a prerequisite for its interaction with RAB-10(GTP) and the recruitment of EGL-8. Moreover, we ascertained that the rise in RAB-10 activity, due to infection, was attributed to the augmented expression of LET-413/Erbin, and the nuclear receptor NHR-25/NR5A1/2 was determined to be indispensable for this increase. Hence, this study illuminates the significance of endosomal PI(4,5)P2 catabolism in boosting innate immunity and outlines an NHR-25-mediated mechanism for pathogen detection in intestinal epithelia.
Animals
;
Caenorhabditis elegans/genetics*
;
Endosomes/immunology*
;
Caenorhabditis elegans Proteins/immunology*
;
Phosphatidylinositol 4,5-Diphosphate/immunology*
;
Immunity, Innate
;
Pseudomonas aeruginosa/immunology*
;
rab GTP-Binding Proteins/genetics*
;
Diglycerides/metabolism*
8.Decoupled but Intertwined Association Between Dissociation and Depression: The Impact of Sleep and Gastrointestinal Symptoms
Yung-Chi HSIEH ; Chui-De CHIU ; Li-Shiu CHOU ; Ching-Hua LIN ; Dian-Jeng LI
Psychiatry Investigation 2025;22(5):583-590
Objective:
Whether dissociation and depression are distinct constructs remains controversial. The aim of this study was to explore the interrelations and associated factors between them.
Methods:
This study included inpatients with major depressive disorder (MDD) and bipolar disorder with major depressive episode (BD). Clinical rating scales were used to measure levels of depression, dissociation, and psychotic symptoms. Generalized estimating equations were used to estimate interrelations between dissociation and related factors over time, including depression. Moreover, the impacts of individual items of the Hamilton Depression Rating Scale (HAMD) on dissociation were evaluated after multiple adjustments.
Results:
A total of 91 participants were included into the analysis, of whom 59 had MDD and 32 had BD. After standardized treatment, levels of depression and psychotic symptoms significantly decreased, whereas the level of dissociation did not. However, the level of dissociation significantly decreased in the high-dissociation group, and this was positively associated with the change in depression and psychotic symptoms. Female sex and comorbidity with borderline personality disorder were also positively correlated with dissociation. Among items of the HAMD, insomnia and gastrointestinal symptoms contributed to the association between depression and dissociation.
Conclusion
We identified a decoupled but intertwined relationship between dissociation and depression. Clinicians should be aware of this comorbidity and provide timely interventions for dissociation during clinical practice.
9.Decoupled but Intertwined Association Between Dissociation and Depression: The Impact of Sleep and Gastrointestinal Symptoms
Yung-Chi HSIEH ; Chui-De CHIU ; Li-Shiu CHOU ; Ching-Hua LIN ; Dian-Jeng LI
Psychiatry Investigation 2025;22(5):583-590
Objective:
Whether dissociation and depression are distinct constructs remains controversial. The aim of this study was to explore the interrelations and associated factors between them.
Methods:
This study included inpatients with major depressive disorder (MDD) and bipolar disorder with major depressive episode (BD). Clinical rating scales were used to measure levels of depression, dissociation, and psychotic symptoms. Generalized estimating equations were used to estimate interrelations between dissociation and related factors over time, including depression. Moreover, the impacts of individual items of the Hamilton Depression Rating Scale (HAMD) on dissociation were evaluated after multiple adjustments.
Results:
A total of 91 participants were included into the analysis, of whom 59 had MDD and 32 had BD. After standardized treatment, levels of depression and psychotic symptoms significantly decreased, whereas the level of dissociation did not. However, the level of dissociation significantly decreased in the high-dissociation group, and this was positively associated with the change in depression and psychotic symptoms. Female sex and comorbidity with borderline personality disorder were also positively correlated with dissociation. Among items of the HAMD, insomnia and gastrointestinal symptoms contributed to the association between depression and dissociation.
Conclusion
We identified a decoupled but intertwined relationship between dissociation and depression. Clinicians should be aware of this comorbidity and provide timely interventions for dissociation during clinical practice.
10.Decoupled but Intertwined Association Between Dissociation and Depression: The Impact of Sleep and Gastrointestinal Symptoms
Yung-Chi HSIEH ; Chui-De CHIU ; Li-Shiu CHOU ; Ching-Hua LIN ; Dian-Jeng LI
Psychiatry Investigation 2025;22(5):583-590
Objective:
Whether dissociation and depression are distinct constructs remains controversial. The aim of this study was to explore the interrelations and associated factors between them.
Methods:
This study included inpatients with major depressive disorder (MDD) and bipolar disorder with major depressive episode (BD). Clinical rating scales were used to measure levels of depression, dissociation, and psychotic symptoms. Generalized estimating equations were used to estimate interrelations between dissociation and related factors over time, including depression. Moreover, the impacts of individual items of the Hamilton Depression Rating Scale (HAMD) on dissociation were evaluated after multiple adjustments.
Results:
A total of 91 participants were included into the analysis, of whom 59 had MDD and 32 had BD. After standardized treatment, levels of depression and psychotic symptoms significantly decreased, whereas the level of dissociation did not. However, the level of dissociation significantly decreased in the high-dissociation group, and this was positively associated with the change in depression and psychotic symptoms. Female sex and comorbidity with borderline personality disorder were also positively correlated with dissociation. Among items of the HAMD, insomnia and gastrointestinal symptoms contributed to the association between depression and dissociation.
Conclusion
We identified a decoupled but intertwined relationship between dissociation and depression. Clinicians should be aware of this comorbidity and provide timely interventions for dissociation during clinical practice.

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