6(10), e00538 (2016). In the meantime, to ensure continued support, we are displaying the site without styles http://creativecommons.org/licenses/by/4.0/, https://www.mdpi.com/2072-6643/12/6/1661/s1, Total and ionized calcium and magnesium are significantly lowered in drug-nave depressed patients: effects of antidepressants and associations with immune activation. Patients with MG likely experience chronic dysregulation of the hormonal stress axis and the . Our data based on the HADS questionnaire suggests an underdiagnosis of depression and anxiety disorder MG patients. [45] found that concentrations of both magnesium and zinc (Zn) were reduced in the hippocampal tissue of suicide victims, along with an altered glutamatergic NMDA activity in the hippocampus. Fatigue in myasthenia gravis: Risk factors and impact on quality of life. & Wu, B. Post-traumatic stress disorder symptoms after respiratory insufficiency in patients with myasthenia gravis. Huang J.H., Lu Y.F., Cheng F.C., Lee J.N., Tsai L.C. 1993;41(1):69-86. Verywell Health's content is for informational and educational purposes only. Magnesium is the fourth most abundant mineral ion, and the intake comes mainly from the ingestion of leafy green vegetables, whole grains, nuts, and fish. 10(1), 46. https://doi.org/10.1186/1471-2377-10-46 (2010). Ann. The Department of Psychiatry is committed to providing the highest quality in care to patients of all ages in a compassionate, safe and patient-focused manner. J. Neurosurg. Mlyniec K. Zinc in the glutamatergic theory of depression. As depicted above, Fard et al. More popular! 15(1), 319. Sleep difficulties were reported by 63.0%. Another relevant finding that supports the notion of magnesium antidepressant activity is the one linking magnesium deficiency to dysregulation in the hypothalamicpituitaryadrenal (HPA) axis, which is well known to be involved in the pathogenesis of anxiety disorders and depression [41]. PubMed Central Magnesium also appears to be involved in both prevention and reversal of movement disorders induced by the chronic use of typical antipsychotics. MeSH PubMed Neuromuscul. We observed an improved HRQoL after thymectomy. Ryszewska-Pokraniewicz B., Mach A., Skalski M., Januszko P., Wawrzyniak Z.M., Poleszak E., Nowak G., Pilc A., Radziwo-Zaleska M. Effects of Magnesium Supplementation on Unipolar Depression: A Placebo-Controlled Study and Review of the Importance of Dosing and Magnesium Status in the Therapeutic Response. Yes. Amongst MG patients with high MG severity, anxiety was twice as common as in patients with low disease severity (38.4% vs. 19.4%). Nervenarzt. Estimated marginal means with 95%CI for MGQOL15 scale scores after full adjustment for depression, gender, thymectomy, other autoimmune disease, cardiovascular disease, IVIG/Rituximab, myasthenic crisis/exacerbation, duration, disease latency age, education, marital status. A possible explanation could be due to the particular pharmacokinetics of magnesium. Sci. UNC Department of Medicine. The following are available online at https://www.mdpi.com/2072-6643/12/6/1661/s1, Supplementary Materials: SEARCH SYNTAX. Indeed, patients with therapy refractory depression appear to have lower central nervous system magnesium levels in comparison to health controls [61]. Magnesium protects cognitive functions and synaptic plasticity in streptozotocin-induced sporadic Alzheimers model. Wolfe, G. I. et al. (2019) [64] considered Patient Health Questionnaire (PHQ) scores in a large cohort of 3604 healthy adults and showed a significant relationship between serum magnesium and symptoms. The functions of vitamin C in the brain include acting as a co-factor for dopamine beta-hydroxylase in the conversion of dopamine to noradrenaline, involvement in the modulation of both dopaminergic and glutamatergic neurotransmission, and regulation of catecholamine and acetylcholine release from synaptic vesicles. Aging Health 17(2), 125147. Adjusting for symptoms of depression decreased the estimated strength of this association (estimated marginal means for severe versus mild MG severity=15 [13; 17]; p0.001). The question to what extent psychiatric symptoms are involved in MG is still open. Google Scholar. The same was observed for escalation therapy with IVIG or Rituximab (estimated marginal means of MG-QoL15 scale score for escalation therapy vs. no escalation therapy=3.83 95%CI [1.83; 5.84]). and A.B. Indeed, the total concentration of magnesium is mainly intracellular and free ion concentration does not always correlate with whole concentration. Our study highlights the importance of increasing the awareness of mental health conditions and the necessity for implementing diagnostic measures, such as easy-to-use screening tools. Among micronutrients, magnesium (Mg2+) plays a critical role in brain function and mood since it is essential for optimal nerve transmission and it is involved in the formation of membrane phospholipids. It emerged in the 1960s and quickly gained popularity. Clipboard, Search History, and several other advanced features are temporarily unavailable. Considering to the exclusion criteria, 52 questionnaires had to be excluded. A large retrospective study by Raj et al. Magnesium can suppress the ability of the hippocampus to stimulate the ultimate release of stress hormone, it can reduce the release of ACTH (the hormone that tells your adrenal glands to get in . Z Klin Psychol Psychopathol Psychother. MGQOL15=Myasthenia gravis Quality of Life Score, short version; HADS=Hospital Anxiety and Depression Scale. Myniec K., Gawe M., Doboszewska U., Starowicz G., Nowak G. The Role of Elements in Anxiety. The mediating role of illness perception and self-efficacy beliefs. Correspondence to -, Am J Psychiatry. Evaluation of Whole Blood Trace Element Levels in Chinese Children with Autism Spectrum Disorder. Specifically, for psychiatric illnesses, multiple studies have been performed in which magnesium serum levels were assessed in cohorts of patients with depression [19], SCZ [20], addiction disorders [21], AD [22] and ADHD [23]. Thus, the authors suggested that, in depressed patients, magnesium levels could be used to predict the effect of ketamine [99]. Life Outcomes 8(1), 129. https://doi.org/10.1186/1477-7525-8-129 (2010). Suzuki Y, Utsugisawa K, Suzuki S, Nagane Y, Masuda M, Kabasawa C, Shimizu Y, Utsumi H, Uchiyama S, Fujihara K, Suzuki N. BMJ Open. Impact of oral nutritional supplementation on hospital outcomes. Kanner, A. M. Should neurologists be trained to recognize and treat comorbid depression of neurologic disorders? Rev. MG Counselling, Clinical Social Work/Therapist, Shelburne, ON, L9V, (226) 790-3739, There are many reasons why people choose to access counselling. Not only that, if MG is causing severe difficulties walking or coordinating movements, using orthotics (or orthopedic devices), such as walkers, braces, or canes can also help. Lassale C., Batty G.D., Baghdadli A., Jacka F., Snchez-Villegas A., Kivimki M., Akbaraly T. Healthy dietary indices and risk of depressive outcomes: A systematic review and meta-analysis of observational studies. Phelan D., Molero P., Martnez-Gonzlez M.A., Molendijk M. Magnesium and mood disorders: Systematic review and meta-analysis. Captions: (PHQ-9) Patient Health Questionnaire-9; (GAD-7) Generalized Anxiety Disorders-7; (EPDS) Edinburgh Postnatal Depression Scale; (SSTAI) Spielberger State-Trait Anxiety Inventory; (ADHD-RS-IV) ADHD Rating Scale IV; (DASS-42) Depression Anxiety Stress Scales; (CGAS) Children Global Assessment Scale; (+) positive outcome; () negative outcome; () unclear outcome. Mg is effective for mild-to-moderate depression in adults, 17 patients (6 M, 11 F; mean age 48.115.5) + 20 hc (10 M, 10 F; mean age 49.712.3), Fluoxetine (20 to 40 mg/die) treatment was augmented with either placebo or Mg 40 mg 3/die (equivalent to 3.30 mEq of Mg-aspartate). Prez-Piar, M. et al. Thus, the purpose of the present study was to Neurol. A comprehensive search of all studies using or analyzing the effect of magnesium in psychiatric disorders were conducted on the PubMed database from 1 January 2019 to 30 March 2020. Indeed, the review carried out by Serefko et al. It is a disease-specific health-related QoL scale, with lower scores indicating a higher HRQoL. Also, MG patients experience a reduced health-related quality of life (HRQoL). Three of them reported no significant differences in magnesium serum levels in Generalized Anxiety Disorder (GAD), Panic Disorder and anxiety symptoms during a major depressive episode [55,61,66]. PsychMG provides the platform for you to communicate your needs as a psychiatrist. Poleszak E., Wla P., Kedzierska E., Nieoczym D., Wrbel A., Fidecka S., Pilc A., Nowak G. NMDA/glutamate mechanism of antidepressant-like action of magnesium in forced swim test in mice. Law, C., Flaherty, C. V. & Bandyopadhyay, S. A review of psychiatric comorbidity in Myasthenia gravis. Abumaria N., Yin B., Zhang L., Li X.Y., Chen T., Descalzi G., Zhao L., Ahn M., Luo L., Ran C., et al. The overlap of myasthenic and depressive symptoms in MG patients (with or without comorbid depression) leads to difficulties for physicians in making an adequate diagnosis. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 19902017: A systematic analysis for the Global Burden of disease study 2017. https://doi.org/10.1007/s00415-010-5549-9, https://doi.org/10.1007/s00115-008-2467-5, https://doi.org/10.1001/archneur.1993.00540060055018, https://doi.org/10.1080/13548506.2020.1807577, https://doi.org/10.2165/00023210-200721060-00004, https://doi.org/10.1016/S0272-6386(12)80589-0, https://doi.org/10.1080/08870446.2012.759223, https://doi.org/10.1016/S0140-6736(18)32279-7, https://www.aerzteblatt.de/int/article.asp?id=51635, http://creativecommons.org/licenses/by/4.0/. Google Scholar. Patient-reported symptom severity in a nationwide myasthenia gravis cohort: Cross-sectional analysis of the Swedish GEMG study. Some epidemiological or observational studies reported that greater dietary intake of magnesium is linked to a general reduced risk of depressive disorders or fewer depressive symptoms [50,51]. 2022 Dec 16;17(1):313. doi: 10.1186/s13019-022-02081-5. PubMed In cooperation with the German Myasthenia Society (self-help group for MG in Germany; DMG), we reached out to all 3280 members via postal mail between April and October 2017 asking them to fill out a questionnaire. The HADS is a screening instrument with high validity and reliability (sensitivity and specificity 0.8; Cronbachs alpha for Anxiety: 0.83 and for Depression: 0.82) to detect depression and anxiety amongst patients with somatic diseases14. Regression analyses showed varying predictors across outcomes with no one of the predictors being consistently identified across different variables. The most substantial pieces of evidence on the efficacy of these interventions are probably those coming from n-3 polyunsaturated fatty acids (n-3PUFAs) supplementation in depression [14,15], which, in a few years, will likely become part of the standard therapy for depression [16]. 1. Provided by the Springer Nature SharedIt content-sharing initiative. motivational general-mastery (MG-M) imagery has been shown to increase self-efficacy among athletic populations (O, et al., 2014); however, there is a paucity of research regarding the influence of imagery, particularly individualized MG-M imagery, on the self-efficacy of youth athletes specifically. Coping strategies include: Since MG is a neuromuscular disorder, it affects communication between the nerves and muscles. Psychological symptoms preceding diagnosed myasthenia gravis. & Rodriguez, A. official website and that any information you provide is encrypted Received 2020 Apr 11; Accepted 2020 May 25. Before We collected a total of 32 articles: 18 on Depressive Disorders (DD), four on Anxiety Disorders (AD), four on Attention Deficit Hyperactivity Disorder (ADHD), three on Autism Spectrum Disorder (ASD), one on ObsessiveCompulsive Disorder (OCD), one on Schizophrenia (SCZ) and one on Eating Disorders (ED). This variability can be explained by the considerable heterogeneity of the cohorts, sample sizes, clinical measures, and assessment methods, including the diagnostic criteria used. 14, 23 (2014). Since our founding in 2009, The Assistance Fund has helped more than 160,000 children and adults access the treatment they need to stay healthy or manage a life-threatening, chronic, or rare disease. The prevalence of psychiatric comorbidities in the general population in Germany25 is much lower when compared to this studys findings of related symptoms in the MG cohort data (15.4% vs. 35.5% for anxiety; 8.2% vs. 30.8% for symptoms of depression, and 2.3% vs. 4.9% for PTSD). 3,240 results on the web. 1993;41(1):69-86 Inclusion in an NLM database does not imply endorsement of, or agreement with, Woodward G., Wan J.C.M., Viswanath K., Zaman R. Serum Vitamin D and Magnesium levels in a psychiatric cohort. Health Med. By Mark Gurarie The question to what extent psychiatric symptoms are involved in MG is still open. Since the search was re-run on a weekly basis, data from newly included study were updated accordingly. Australas 50, 4144 (2018). Also, MG is an unpredictable disease with a relapsing and remitting course necessitating the use of chronic medication with potential side-effects that impair quality of life [6,7,8] and may cause psychological stress and predispose to depression . In the light of these results, several studies [54,56,64] suggested that, for adults seen in primary care, lower serum magnesium levels were associated with depressive symptoms, ultimately supporting the use of supplemental magnesium as a therapy. In weak patients psychopathological disturbances are frequently reported and misdiagnosed as a psychiatric disorder. 27(1), 204209 (2020). Google Scholar. What Makes MG Worse. Relevant articles were obtained and included in the review if (a) they reported an exposure to magnesium, (b) included psychiatric symptoms as an outcome measure and (c) enrolled human participants and reported a trial or an observational study. Activities of daily life (AdL) are also reduced in MG patients7. Unable to load your collection due to an error, Unable to load your delegates due to an error. In the literature so far, the prevalence of depression in MG patients differed between 14 and 58%9,20, whereas the prevalence of anxiety disorders ranged between 20 and 55%21,22,23,. Psychiatric comorbidities like depression, anxiety disorder, or posttraumatic stress disorder (PTSD) are highly prevalent in smaller cohorts of MG patients, with prevalences of depression ranging from 14 to 58%8,9. Higher Mg concentration in the platelets of suicidal patients, considered a Ca antagonist, may represent a compensatory attempt to restrain Ca activity, Hypomagnesemia in adolescents with eating disorders hospitalized for medical instability, 541 hospitalized adolescents aged 1021 years with an eating disorder from 2007 to 2010, DSM-IV criteria; clinical characteristics, 15.9% developed hypomagnesemia. More recently, Murck et al. Winther G., Pyndt Jrgensen B.M., Elfving B., Nielsen D.S., Kihl P., Lund S., Sorensen D.B., Wegener G. Dietary magnesium deficiency alters gut microbiota and leads to depressive-like behaviour. Tips to keep in mind include: If MG is making it difficult to swallow, you may need to work with your care team to come up with dietary adjustments you can make. Risk factors for depression include dietary patterns. Assessment of health-related quality of life in patients with myasthenia gravis in Belgrade (Serbia). 1Neurologic Clinic, Fondazione IRCCS Istituto neurologico Carlo Besta, 20133 Milan, Italy, 2Department of Neurosciences and Mental Health, Fondazione IRCCS Ca Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; moc.liamg@oniloppaic.anitnelav (V.C. In contrast, the difficulty in clearly distinguishing symptoms of depression from fatigability and fatigue symptoms of MG might lead to delayed or misdiagnosis in MG patients30. J. Rehabil. Specifically, Rucklidge et al. National Library of Medicine Exclusion criteria were participants age under 18, missing diagnosis of MG, and insufficiently completed questionnaires, defined a priori in case less than fifty percent of all items answered. Effects of elevated magnesium and substrate on neuronal numbers and neurite outgrowth of neural stem/progenitor cells in vitro. doi: 10.1136/bmjopen-2011-000313. In the largest study to date which has been conducted prior to 2010, 38.6% of 1518 patients had a diagnosed depression10, the rates were three times higher than in our study but close to the results of HADS. To answer these questions, we performed a comprehensive review in which we included all studies that involved patients with a wide variety of psychiatric disorders where magnesium levels were assessed and/or magnesium supplementation was given. designed the study protocol and performed the first search and related analyses; V.C. 1). Cowan J.A. Then data items collected were analyzed according to the following variables that were abstracted for each article (see Supplementary Materials). Nechifor M. Magnesium in addictionA general view. The final search strategy for PubMed was designed by AB and the search syntax is reported in the Supplementary Materials. Rafsten, L., Danielsson, A. Its not easy living with a condition that can't be cured or reversed, and that many may not understand. Seyama T., Kamei Y., Iriyama T., Imada S., Ichinose M., Toshimitsu M., Fujii T., Asou H. Pretreatment with magnesium sulfate attenuates white matter damage by preventing cell death of developing oligodendrocytes. (2019) [65], who conducted a study on overweight pregnant women, also reported a positive significant correlation. Pandemic illnesses, such as the H1N1 influenza (swine flu) are often highly publicized in the mass media and can be associated with high levels of anxiety and compensatory behavior (e.g., using hand sanitizers). Steca, P. et al. Furthermore, the authors found that, compared to those with normal serum magnesium levels, patients with hypomagnesemia were older, with longer illness durations, more likely to be purging, and more likely to have an alkaline urine. HHS Vulnerability Disclosure, Help performed the study strategy, literature search and study descriptions; G.D., A.B., B.V., P.B. ; D.M., U.H., S.L. Physiopedia contributors. Therefore, based on this evidence, showing the key role of magnesium in influencing mechanisms that may lead to depression, further studies investigating the impact of antidepressant drugs on intracellular magnesium concentration in neurons are required. These tools might help to diagnose and treat comorbid mental health conditions in MG patients more effectively. The process of the identification and inclusion of trials is summarized in Figure 1 (PRISMA diagram). Biological Plausibility of Magnesium for Brain and Psychiatric Disorders. Vitamin and mineral status of children with autism spectrum disorder in Hainan Province of China: Associations with symptoms. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Fan, X., Xing, C., Yang, L., Wang, J. This is consistent with the results of a previous study of eighty patients33. Firth J., Teasdale S.B., Allott K., Siskind D., Marx W., Cotter J., Veronese N., Schuch F., Smith L., Solmi M., et al. Introduction: Magnesium is an essential cation involved in many functions within the central nervous system, including transmission and intracellular signal transduction. The case report presented here shows exemplary that psychopathological disturbances in exacerbated myasthenic patients are temporary and completely reversible after adequate somatic therapy. Braz, N. F. T. et al. So far, the detection and adequate treatment of mood disorders in MG patients seems insufficient12,13. Association between magnesium intake and depression and anxiety in community-dwelling adults: The Hordaland Health Study. The authors declare no conflict of interest. 2007;21(6):473-81. doi: 10.2165/00023210-200721060-00004. A genetic predisposition to autoimmune disorders and certain lifestyle factors contribute to the risk of this disease. Veronese N., Demurtas J., Pesolillo G., Celotto S., Barnini T., Calusi G., Caruso M.G., Notarnicola M., Reddavide R., Stubbs B., et al. This study was supported by the German Research Foundation (Exc 257 NeuroCure). Interestingly, Medhi et al. Similarly, regarding eating disorders, we found only one study where the presence of various internal conditions seems to mask the pathophysiological role of magnesium. Moreover, in an animal model, magnesium was found to reduce the severity of movement disorders via the prevention of the formation of reactive oxygen species in cortical areas, striatum and substantia nigra [48]. The site is secure. (2017) [83] did not find a significant effect of magnesium sulfate in affecting depression. A higher awareness of mental illnesses like depression or anxiety is urgently required in MG care. Managing this condition, then, means being aware of how youre feeling, and adjusting your daily life to support your therapy. Off. and D.M. No refund was given. Ther. I care deeply about my clients and believe that teamwork is key to the therapeutic relationship. Pochwat B., Szewczyk B., Sowa-Kucma M., Siwek A., Doboszewska U., Piekoszewski W., Gruca P., Papp M., Nowak G. Antidepressant-like activity of magnesium in the chronic mild stress model in rats: Alterations in the NMDA receptor subunits. Rucklidge J.J., Egglestonb M.J.F., Darlinga K.A., Stevensc A.J., Kennedyc M.A., Frampton C.M. Most of the results of the reviewed studies focused on depression and depressive symptoms and only a small number of studies concerning other psychiatric disorders were found. Adjusted MGQOL15 scale scores for different severities of depression according to HADS. Furthermore, it seems that magnesium levels are lowered in the course of several mental disorders, especially depression. To distinguish between myasthenic crisis and exacerbation, we asked patients not only whether they had a "myasthenic crisis" but also whether they were treated in an intensive care unit setting in that case.