Mark A. Ellenbogen’s research while affiliated with Concordia University and other places

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Publications (82)


Hypothalamic-pituitary-adrenal axis function in the offspring of parents with bipolar disorder and the impact of the family environment: A pilot study of the Reducing Unwanted Stress in the Home (RUSH) prevention program
  • Article

September 2024

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11 Reads

Psychoneuroendocrinology

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Vanessa Iacono

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[...]

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Mark A. Ellenbogen

PRISMA flowchart of the article search and selection process for the meta-analysis
Forest plot of effect size (Hedge’s g) for mean cortisol levels at discrete timepoints throughout the day. Offspring of parents with a mood disorder were used as the index group, therefore a positive effect size would indicate greater HPA axis activation in high-risk offspring, where as a negative effect size would indicate lower activation
Funnel plot of each sample’s mean weighted effect size by average variance to assess for publication bias for cortisol measured at discrete timepoints of the day
Forest plot of effect size (Hedge’s g) for total daily cortisol output as measured by AUCg. Offspring of parents with a mood disorder were used as the index group, therefore a positive effect size would indicate greater HPA axis activation in high-risk offspring, where as a negative effect size would indicate lower activation
Funnel plot of each sample’s mean weighted effect size by average variance to assess for publication bias for total cortisol output measured as area under the curve from ground (AUCg)

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Hypothalamic–pituitary–adrenal axis functioning in offspring of parents with a major affective disorder: a meta-analytic review
  • Literature Review
  • Publisher preview available

August 2024

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12 Reads

European Child & Adolescent Psychiatry

Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic–pituitary–adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge’s g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.

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The figure depicts parents‘ satisfaction with their social network (A) and reported network size (B) as moderators of the relationship between risk status (having a parent with bipolar disorder or not) and time 2 outcomes (number of symptoms) in the offspring. Low and high social support are depicted as 1 standard deviation below and above the mean, respectively. A: Offspring of parents with bipolar disorder (OBD) with parents reporting high social support satisfaction developed fewer symptoms of subtance use disoders (SUD) at time 2 compared to OBD with parents reporting low satisfaction with their social support and control offspring. B: OBD with parents reporting a large social network developed more symptoms of major depressive disorder and anxiety disorders at time 2 compared to OBD with parents reporting a small network and control offspring
The perceived social support of parents having bipolar disorder impacts their children’s mental health: a 10-year longitudinal study

July 2024

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45 Reads

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1 Citation

International Journal of Bipolar Disorders

Background The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents’ social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring. Methods During offspring’s middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later. Results Parents’ social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents’ social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents’ coping style were found. Conclusions Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents’ social support may thus have a protective function for children in these high-risk families.


Conceptual diagrams of latent growth curve model presented in Data Analysis section
Diagram representing all three separate moderated mediation models
Plotted curves representing changes over time on all three estimated variables between groups
Family dysfunction, stressful life events, and mental health problems across development in the offspring of parents with an affective disorder

Background Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well‐known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD. Methods As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self‐Report, Family Assessment Device, and an in‐house measure, respectively. Results Multi‐group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood. Conclusions OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high‐risk youth.


Figure 1. The consort flow diagram describing study recruitment and exclusion into the randomized controlled trial comparing adjunct oxytocin and psychotherapy and placebo and psychotherapy.
Figure 2. a. The administration of intranasal oxytocin, relative to placebo, increased the rate of improvement (slope) on the Inventory of Depressive Symptomatology-Clinician Rated (IDS-C) at post-treatment and at a six-month follow-up in persons with major depressive disorder undergoing interpersonal psychotherapy. b. The administration of intranasal oxytocin, relative to placebo, improved participants' ratings of the therapeutic alliance on the Working Alliance Inventory-Short Form at session 1 (intercept) in persons with major depressive disorder. The rate of improvement (slope) of the placebo group across 16 sessions of interpersonal therapy was greater than that of the oxytocin group.
The effects of intranasal oxytocin on the efficacy of psychotherapy for major depressive disorder: a pilot randomized controlled trial

March 2024

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68 Reads

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1 Citation

Psychological Medicine

Background Although both pharmacotherapy and psychological treatments are considered to be efficacious in the treatment of major depressive disorder (MDD), one third of patients do not respond to treatment and many experience residual symptoms post-treatment. In this double-blind placebo-controlled randomized control trial (RCT), we assessed whether intranasal oxytocin (OT) augments the therapeutic efficacy of psychotherapy for MDD and improves the therapeutic alliance. Methods Twenty-three volunteers (12 female) with MDD underwent 16 sessions of interpersonal therapy. Prior to each session, volunteers self-administered 24 International Units of intranasal OT ( n = 12; Syntocinon ) or placebo ( n = 11). Depressive symptoms were assessed with the Inventory of Depressive Symptomatology at pre- and post-treatment, and at a six month follow-up. Results Multilevel modeling found a significant effect of OT on the negative slope of depressive symptoms over time ( p < 0.05), with medium-large effect sizes at post-treatment (Cohen's d = 0.75) and follow-up (Cohen's d = 0.82). Drug intervention also predicted the intercept when examining the weekly ratings of the therapeutic alliance ( p < 0.05), such that volunteers receiving OT, relative to placebo, reported improved therapeutic alliance at session 1. The agreement of goals between therapists and participants, a facet of the therapeutic alliance, mediated the relationship between drug intervention and clinical outcome. Conclusion In this pilot study, the administration of intranasal OT, relative to placebo, improved the therapeutic alliance at the beginning of therapy and therapeutic efficacy of psychotherapy in persons with MDD. Future RCTs should attempt to replicate these findings in larger samples with different therapeutic modalities ( ClinicalTrials.gov: NCT02405715 ).


All FoDR categories, subcategories, and codes
Fear of depression recurrence among individuals with remitted depression: a qualitative interview study

February 2024

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59 Reads

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2 Citations

BMC Psychiatry

Background Major Depressive Disorder (MDD) is a prevalent psychiatric condition and the largest contributor to disability worldwide. MDD is highly recurrent, yet little is known about the mechanisms that occur following a Major Depressive Episode (MDE) and underlie recurrence. We explored the concept of fear of depression recurrence (FoDR) and its impact on daily functioning among individuals in remission from MDD. Methods 30 participants (83% female; 37% White; Mage = 27.7, SD = 8.96) underwent semi-structured qualitative interviews. The interviews explored participants’ experiences of FoDR including the frequency, severity, content, triggers, and impact of fears and associated coping strategies. We used content analysis to analyze the transcriptions. Results Most participants (73%) reported having FoDR, with varying frequency, severity, and duration of fears. The triggers and content of participants’ fears often mirrored the symptoms (e.g., low mood, anhedonia) and consequences (e.g., job loss, social withdrawal) endured during past MDEs. Some participants reported a minimal impact of FoDR on daily functioning, whereas others reported a positive (e.g., personal growth) or negative (e.g., increased anxiety) influence.



Fear of depression recurrence among individuals with remitted depression: A qualitative interview study

August 2023

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46 Reads

Background Major Depressive Disorder (MDD) is a prevalent psychiatric condition and the largest contributor to disability worldwide. MDD is highly recurrent, yet little is known about the mechanisms that occur following a Major Depressive Episode (MDE) and underlie recurrence. We explored the concept of fear of depression recurrence (FoDR) and its impact on daily functioning among individuals in remission from MDD. Methods 30 participants (83% female; 37% White; Mage = 27.7, SD = 8.96) underwent semi-structured qualitative interviews. The interviews explored participants' experiences of FoDR including the frequency, severity, content, triggers, and impact of fears and associated coping strategies. We used content analysis to analyze the transcriptions. Results Most participants (73%) reported having FoDR, with varying frequency, severity, and duration of fears. The triggers and content of participants’ fears often mirrored the symptoms (e.g., low mood, anhedonia) and consequences (e.g., job loss, social withdrawal) endured during past MDEs. Some participants reported a minimal impact of FoDR on daily functioning, whereas others reported a positive (e.g., personal growth) or negative (e.g., increased anxiety) influence. Limitations Our sample size did not allow for explorations of differences in FoDR across unique MDD subtypes or sociocultural factors. Conclusions The concept of FoDR may present a window into understanding the unique cognitive and behavioural changes that occur following MDD remission and underlie depression recurrence. Future research should emphasize the development of a FoDR measure so that associations between FoDR and recurrence risk, depressive symptoms, and other indices of functioning can be determined.


Note: Included mediators represent scores yielded from the Parenting Stress Index. Participating in the RUSH program is considered equivalent to having a parent with BD or not (OBD vs. control offspring)
Note: The linear effect of time on all four subscales by intervention group. OBD offspring of parents with bipolar disorder
Reduced parenting stress following a prevention program decreases internalizing and externalizing symptoms in the offspring of parents with bipolar disorder

February 2023

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61 Reads

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3 Citations

International Journal of Bipolar Disorders

Background Offspring of parents with bipolar disorder (OBD) are at risk for developing mental disorders, and the literature suggests that parenting stress may represent an important risk factor linking parental psychopathology to offspring psychopathology. We aimed to investigate whether improvements in parenting stress mediated the relationship between participation in a prevention program and offspring internalizing and externalizing symptoms at follow-up. Methods Families having a parent with BD (N = 25) underwent a 12-week prevention program. Assessments were conducted at pre-intervention, post-intervention, and at 3- and 6-month follow-ups. Families of parents with no affective disorders (i.e., control families) served as a comparison sample (N = 28). The Reducing Unwanted Stress in the Home (RUSH) program aimed to teach communication, problem-solving, and organization skills to improve the rearing environment. Measures included the Parenting Stress Index—4th Edition, the Behaviour Assessment Scales for Children—2nd Edition, and the UCLA Life Stress Interview. Results Families having a parent with BD reported more parenting stress at pre-intervention, and more change across time, than control families. Improvements in parenting stress mediated the relationship between participation in the intervention and reduced offspring internalizing and externalizing symptoms. While families having a parent with BD reported more chronic interpersonal stress at pre-intervention, no intervention effects were found. Conclusions The findings demonstrate that a preventative intervention targeting parenting stress in families may serve to prevent the development of mental disorders in at-risk children.


Intranasal Oxytocin Alters Attention to Emotional Facial Expressions, Particularly for Males and Those with Depressive Symptoms

May 2022

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17 Reads

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5 Citations

Psychoneuroendocrinology

Intranasal oxytocin (OT) can enhance emotion recognition, perhaps by promoting increased attention to social cues. Some studies indicate that individuals with difficulties processing social information, including those with psychopathology, show more pronounced effects in response to OT. As such, there is interest in the potential therapeutic use of OT in populations with deficits in social cognition. The present study examined the effects of intranasal OT on the processing of facial features and selective attention to emotional facial expressions, as well as whether individual differences in depressive symptom severity predict sensitivity to intranasal OT. In a double-blind placebo-controlled within-subject design, eye tracking was used to measure attention to facial features in an emotional expression appraisal task, and attention to emotional expressions in a free-viewing task with a quadrant of multiple faces. OT facilitated the processing of positive cues, enhancing the maintenance of attention to the mouth region of happy faces and to happy faces within a quadrant, with similar effect sizes, despite the latter effect not being statistically significant. Further, persons with depressive symptoms, and particularly males, were sensitive to OT’s effects. For males only, OT, relative to placebo, increased attentional focus to the mouth region of all faces. Individuals with depressive symptoms showed less attentional focus on angry (males only) and sad facial expressions, and more attention to happy faces (particularly for males). Results indicate increased sensitivity to OT in males and persons at risk for depression, with OT administration promoting a positive bias in selective attention to social stimuli.


Citations (64)


... For instance, when a child dies, it affects the father, mother, siblings, and the entire system. In this perspective, the behavior of one member is not only a reaction to the behaviors of other members but also influences them and the whole family system through feedback processes (Trespalacios et al., 2024) Moreover, the family has distinctive rules, capable of adapting to the requirements of its social environment at various stages of its development, either by initiating change itself or evolving in response 130 to incoming information. It also manages to balance two seemingly contradictory functions: achieving harmony and balance with the conflicts it faces for its evolution (Du RocherSchudlich et al., 2008). ...

Reference:

The impact of family dynamics on the evolution of psychopathology
The perceived social support of parents having bipolar disorder impacts their children’s mental health: a 10-year longitudinal study

International Journal of Bipolar Disorders

... Shakeri et al., in their studies, referred to relational variables, including size, support, verification, cohesion, connection strength, intimacy, common activities, and closeness centrality and overlapping as effective factors for intimacy with a spouse and also, noted that intimacy with a spouse has the greatest impact in removing emotional divorce. Also, they referred to attribute variables, including number of children, duration of marriage, knowing the spouse before marriage, having relative with a spouse, affect intimacy with the spouse and emotional divorce [10,11]. ...

Fear of depression recurrence among individuals with remitted depression: a qualitative interview study

BMC Psychiatry

... Research has shown that parents with BD and SZ are likely to report disturbances associated with their parenting practices (27,28). Research shows that such parents are more likely to have difficulties with discipline and control, dependency on the child, boundary setting, parent-child bonding, and experience higher levels of parenting stress (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Difficulties in providing consistent, high-quality parenting are associated with increased mental health problems in children and may provide a partial explanation for the increased risk of mental health problems in the children of parents diagnosed with BD or SZ (36, 40-42). ...

Reduced parenting stress following a prevention program decreases internalizing and externalizing symptoms in the offspring of parents with bipolar disorder

International Journal of Bipolar Disorders

... In healthy participants, intranasal oxytocin administration led to increased eye contact with others, thus improving facial recognition (181) and body language-based emotion recognition (182). In persons at risk for depression, administration of oxytocin facilitated the processing of positive emotional cues (see Figure 1), enhancing the maintenance of attention to the mouth region of happy faces (183). Furthermore, intranasal oxytocin administration improved mood in new mothers who otherwise reported a moderately low mood (184). ...

Intranasal Oxytocin Alters Attention to Emotional Facial Expressions, Particularly for Males and Those with Depressive Symptoms
  • Citing Article
  • May 2022

Psychoneuroendocrinology

... Contextual factors may explain the heterogeneity observed in the human literature on OT. Based on the theory that OT increases the salience of emotional and social cues, rather than indiscriminately promoting prosocial behavior (Shamay-Tsoory & Abu-Akel, 2016), OT's effects on social behavior might be context-dependent (Bartz, Zaki, Bolger, & Ochsner, 2011;Wong, Cardoso, Orlando, Brown, & Ellenbogen, 2021). In a within-subject placebocontrolled study comparing the effects of OT on perceived emotional support during autobiographical memory recall elicited by a computer (non-social context) or a research assistant (social context), OT increased perceived support by the research assistant in the social context among women motivated to affiliate, but decreased perceived emotional support in men and women in the non-social context (Cardoso, Valkanas, Serravalle, & Ellenbogen, 2016). ...

Depressive Symptoms and Social Context Modulate Oxytocin’s Effect on Negative Memory Recall

Social Cognitive and Affective Neuroscience

... These studies, however, added a physiological intervention to a psychological intervention, and it was therefore not possible to ascertain whether IN-OT alone or training alone afforded the most social benefit. To our knowledge, only two studies to date have implemented this full (2 × 2) design, investigating whether a single administration of cognitive bias training and/or IN-OT in young children [56] and healthy students [57] improved feelings of maternal support or social imagery, respectively. Both studies, however, report null effects for IN-OT, but crucially also for all or some aspects of their psychological intervention, and it is, therefore, difficult to compare whether IN-OT or training had any/the most social benefit. ...

Intranasal oxytocin increases state anhedonia following imagery training of positive social outcomes in individuals lower in extraversion, trust-altruism, and openness to experience
  • Citing Article
  • April 2021

International Journal of Psychophysiology

... These findings have implications for the development and improvement of intervention and prevention strategies for the offspring of families having a parent with BD. In addition to current prevention strategies for the OBD which focus on the functioning of the nuclear family (Miklowitz et al. 2020;Resendes et al. 2023;Serravalle et al. 2021), it would be important to promote general and good quality social support from extended family, friends, and the community, since they may provide further protective value against the development of mental health problems for these high-risk children. ...

Improved Parent–Child Interactions Predict Reduced Internalizing Symptoms Among the Offspring of Parents with Bipolar Disorder Undergoing a Prevention Program: A Proof-of-Concept Study
  • Citing Article
  • February 2021

Research on Child and Adolescent Psychopathology

... In the case of facial expressions, however, a great deal of the traces comes from only some parts of the face, especially the eyes and mouth, whereas other parts are less influential, such as the ears and hair. Therefore, it makes sense for ML frameworks to focus only on the primary parts of the face and not pay much attention to other parts of the face [20,28,35,51]. ...

Poor inhibition of personally-relevant facial expressions of sadness and anger predicts an elevated cortisol response following awakening six months later
  • Citing Article
  • February 2020

International Journal of Psychophysiology

... Moreover, consistent with a phenomenon known as assortative mating, individuals with an AD often choose romantic partners who also suffer from a mental disorder [80]. In addition to heightening the risk of genetic transmission [88], partners of parents with an AD also exhibit various psychosocial deficits that might impact child outcomes [93]. Therefore, future studies should attempt at including both parents in their research design and investigate how different patterns of parental AD (i.e., the presence of a major affective disorder in the mother, father or both) may influence offspring HPA axis functioning. ...

A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners

International Journal of Bipolar Disorders

... The reductions in depression and anxiety symptoms and improvement in interpersonal relations in the patient receiving OT resonate with previous findings demonstrating a beneficial effect of OT on psychotherapy outcome when given adjacent to psychotherapy (19,20). As the working alliance is considered the most robust predictor of therapy outcome (21), one potential hypothesis that can be made is that OT affects the outcome indirectly through the facilitation of the therapeutic process. ...

Intranasal oxytocin improves subjective ratings of the therapeutic alliance during psychotherapy for major depressive disorder
  • Citing Article
  • July 2019

Psychoneuroendocrinology