Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-24T09:29:14.772Z Has data issue: false hasContentIssue false

Depressive Symptoms are Associated with low Serotonin Levels in Plasma but are not 5–HTTLPR Genotype Dependent in Older Adults

Published online by Cambridge University Press:  30 April 2021

Pedro Enrique Trujillo-Hernández
Affiliation:
Universidad Autónoma de Coahuila (Mexico)
Aide Sáenz-Galindo
Affiliation:
Universidad Autónoma de Coahuila (Mexico)
Odila Saucedo-Cárdenas
Affiliation:
Universidad Autónoma de Nuevo León (Mexico)
María de los Ángeles Villarreal-Reyna
Affiliation:
Universidad Autónoma de Coahuila (Mexico)
Mauricio Andrés Salinas-Santander
Affiliation:
Universidad Autónoma de Coahuila (Mexico)
Ana Laura Carrillo-Cervantes
Affiliation:
Universidad Autónoma de Coahuila (Mexico)
Reyna Torres-Obregón
Affiliation:
Universidad Autónoma de Coahuila (Mexico)
Sandra Cecilia Esparza-González*
Affiliation:
Universidad Autónoma de Coahuila (Mexico)
*
Correspondence concerning this article should be addressed to Cecilia Esparza González. Universidad Autónoma de Coahuila. 25280 Saltillo (Mexico). E-mail: sceciliaesparza@gmail.com

Abstract

Depressive symptoms are diagnosed by physicians using scales but their pathophysiology is unclear. Low serotonin (5–HT) levels play an important role in depression, and the 5–HT transporter (5–HTT) is an important regulator of plasma serotonin levels and reuptake. Additionally, the 5–HTT gene-linked polymorphic region (5–HTTLPR) is associated with depression. The aim was to clarify the roles of plasma serotonin levels in plasma and the 5HTTPLR polymorphism in depressive symptoms in older adults. A total of 84 older adult participants were evaluated. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale of 20 items (CESD–20). The plasma serotonin levels were determined by ELISA, and the 5–HTTLPR genotype was analyzed by PCR. Depressive symptoms were present in 39.3% (N = 33) of the participants. The median plasma serotonin level was 204.34 ng/mL (SD = 93.88). A significant correlation was found between the CESD–20 scale and plasma serotonin levels (r = –.256; p = .019). Low serotonin levels were associated with the presence of depressive symptoms (p = .001). The 5–HTTLPR analysis showed that of the 84 older adults, 35.7% had the SS genotype, 10.7% had the LL genotype, and 53.6% were heterozygous. The 5–HTTLPR polymorphism was not associated with depressive symptoms (p = .587) and plasma serotonin levels (p = 0.391). Depressive symptoms correlate with low serotonin levels in plasma, but not with the 5–HTTLPR polymorphism in older Mexican adults.

Type
Research Article
Copyright
© Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of Interest: None

Funding Statement: This study was supported by IMSS funding project number FIS/IMSS/PROT/G13/1242 awarded to O. S-C.

References

Aguilera-Guzmán, R. M., García, M. S. C., & García, F. J. (2004). Características psicométricas de la CES-D en una muestra de adolescentes rurales mexicanos de zonas con alta tradición migratoria. Salud mental, 27(6), 5766.Google Scholar
Aleksovski, B., Neceva, V., Vujović, V., Manusheva, N., Rendevski, V., Novotni, A., Filipce, A., Spasovska, A., Sofijanova, A., Aleksovski, V., & Gjorgoski, I. (2018). SSRI-reduced platelet reactivity in non-responding patients with life-long Recurrent Depressive Disorder: Detection and involved mechanisms. Thrombosis Research, 165, 2432. https://doi.org/10.1016/j.thromres.2018.03.006CrossRefGoogle ScholarPubMed
Alghadir, A. H., Gabr, S. A., & Al-Eisa, E. (2016). Effects of physical activity on trace elements and depression related biomarkers in children and adolescents. Biological Trace Element Research, 172(2), 299306. https://doi.org/10.1007/s12011-015-0601-3CrossRefGoogle ScholarPubMed
Amador, M. H. B., & McDonald, M. D. (2018). The serotonin transporter and nonselective transporters are involved in peripheral serotonin uptake in the Gulf toadfish, Opsanus beta. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 315(6), R1154R1166. https://doi.org/10.1152/ajpregu.00137.2018CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2015). Depressive disorders: DSM–5® selections. American Psychiatric Pub.Google Scholar
Amor Andrés, P. J., Holgado-Tello, F. P., Lasa-Aristu, A., Domínguez-Sánchez, F. J., & Delgado Egido, B. (2015). Estructura factorial de la Escala de Balance Afectivo en población normativa [Factorial structure of the Affect Balance Scale in a normative population]. Clínica y Salud, 26(2), 7380. http://doi.org/10.1016/j.clysa.2015.03.001CrossRefGoogle Scholar
Bamalan, O. A., & Al Khalili, Y. (2020, October 3). Physiology, serotonin. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK545168/Google Scholar
Bojorquez, I., & Snyder, N. (2009). Psychometric characteristics of the Center for Epidemiological Studies - Sepression Scale (CES-D), the 10- and 20-item versions, in women from a rural area in Mexico. Salud Mental, 32, 299307.Google Scholar
Escobar Bravo, M. A., Botigué Satorra, T., Jürschik Giménez, P., Nuin Orrio, C., & Blanco Blanco, J. (2013). Sintomatología depresiva en ancianos. La influencia del género [Depressive symptoms in elderly women. The influence of gender]. Revista Española de Geriatría y Gerontología, 48(2), 5964. http://doi.org/10.1016/j.regg.2012.07.003CrossRefGoogle Scholar
Brummett, B. H., Boyle, S. H., Siegler, I. C., Kuhn, C. M., Ashley-Koch, A., Jonassaint, C. R., Züchner, S., Collins, A., & Williams, R. B. (2008). Effects of environmental stress and gender on associations among symptoms of depression and the serotonin transporter gene linked polymorphic region (5–HTTLPR). Behavior Genetics, 38(1), 3443. https://doi.org/10.1007/s10519-007-9172-1CrossRefGoogle Scholar
Burke, A. D., Goldfarb, D., Bollam, P., & Khokher, S. (2019). Diagnosing and treating depression in patients with Alzheimer’s disease. Neurology and Therapy, 8, 325350. https://doi.org/10.1007/s40120-019-00148-5CrossRefGoogle ScholarPubMed
Carayanni, V., Stylianopoulou, C., Koulierakis, G., Babatsikou, F., & Koutis, C. (2012). Sex differences in depression among older adults: Are older women more vulnerable than men in social risk factors? The case of open care centers for older people in Greece. European Journal of Ageing, 9(2), 177186. https://doi.org/10.1007/s10433-012-0216-xCrossRefGoogle Scholar
Cha, M. Y., & Hong, H. S. (2015). Effect and path analysis of laughter therapy on serotonin, depression and quality of life in middle-aged women. Journal of Korean Academy of Nursing, 45(2), 221230. https://doi.org/10.4040/jkan.2015.45.2.221CrossRefGoogle ScholarPubMed
Christensen, K. S., Oernboel, E., Nielsen, M. G., & Bech, P. (2019). Diagnosing depression in primary care: A Rasch analysis of the major depression inventory. Scandinavian Journal of Primary Health Care, 37(1), 105112. https://doi.org/10.1080/02813432.2019.1568703CrossRefGoogle ScholarPubMed
Collier, D. A., Stöber, G., Li, T., Heils, A., Catalano, M., Di Bella, D., Arranz, M. J., Murray, R. M., Vallada, H. P., Bengel, D., Müller, C. R., Roberts, G. W., Smeraldi, E., Kirov, G., Sham, P., & Lesch, K. P. (1996). A novel functional polymorphism within the promoter of the serotonin transporter gene: Possible role in susceptibility to affective disorders. Molecular Psychiatry, 1(6), 453460.Google ScholarPubMed
Culverhouse, R. C., Saccone, N. L., Horton, A. C., Ma, Y., Anstey, K. J., Banaschewski, T., Burmeister, M., Cohen-Woods, S., Etain, B., Fisher, H. L., Goldman, N., Guillaume, S., Horwood, J., Juhasz, G., Lester, K. J., Mandelli, L., Middeldorp, C. M., Olié, E., Villafuerte, S., … Bierut, L. J. (2018). Collaborative meta-analysis finds no evidence of a strong interaction between stress and 5–HTTLPR genotype contributing to the development of depression. Molecular Psychiatry, 23(1), 133142. https://doi.org/10.1038/mp.2017.44CrossRefGoogle Scholar
Evans, I. E. M., Llewellyn, D. J., Matthews, F. E., Woods, R. T., Brayne, C., Clare, L., & CFAS-Wales Research Team. (2019). Living alone and cognitive function in later life. Archives of Gerontology and Geriatrics, 81, 222233. https://doi.org/10.1016/j.archger.2018.12.014CrossRefGoogle ScholarPubMed
Gao, Z., Yuan, H., Sun, M., Wang, Z., He, Y., & Liu, D. (2014). The association of serotonin transporter gene polymorphism and geriatric depression: A meta-analysis. Neuroscience Letters, 578, 148152. https://doi.org/10.1016/j.neulet.2014.06.046CrossRefGoogle ScholarPubMed
Ghaheri, M., Kahrizi, D., Yari, K., Babaie, A., Suthar, R. S., & Kazemi, E. (2016). A comparative evaluation of four DNA extraction protocols from whole blood sample. Cellular and Molecular Biology (Noisy-le-Grand, France), 62(3), 120124. http://doi.org/10.14715/cmb/2016.62.3.20Google ScholarPubMed
Girgus, J. S., Yang, K., & Ferri, C. V. (2017). The gender difference in depression: Are elderly women at greater risk for depression than elderly men? Geriatrics, 2(4), Article 35. https://doi.org/10.3390/geriatrics2040035CrossRefGoogle ScholarPubMed
Giurgiuca, A., Schipor, S., Caragheorgheopol, A., Crasan, A., Postolache, E., Tudose, C., Prelipceanu, D., & Cozman, D. (2016). Platelet serotonin as biomarker for assessing suicidal behavior in patients with Bipolar I disorder. Acta Endocrinologica (Bucharest), 12(3), 275281. http://doi.org/10.4183/aeb.2016.275CrossRefGoogle ScholarPubMed
González, P., Nuñez, A., Merz, E., Brintz, C., Weitzman, O., Navas, E. L., Camacho, A., Buelna, C., Wassertheil-Smoller, S., Perreira, K., Isasi, C. R., Choca, J., Talavera, G. A., & Gallo, L. C. (2017). Measurement properties of the Center for Epidemiologic Studies Depression Scale (CES–D 10): Findings from HCHS/SOL. Psychological Assessment, 29(4), 372381. http://doi.org/10.1037/pas0000330CrossRefGoogle Scholar
Grzesiak, M., Beszłej, J. A., Waszczuk, E., Szechiński, M., Szewczuk-Bogusławska, M., Frydecka, D., Dobosz, T., Jonkisz, A., Lebioda, A., & Małodobra, M., & Mulak, A. (2017). Serotonin-related gene variants in patients with irritable bowel syndrome and depressive or anxiety disorders. Gastroenterology Research and Practice, 2017, Article 4290430. https://doi.org/10.1155/2017/4290430CrossRefGoogle ScholarPubMed
Holck, A., Wolkowitz, O. M., Mellon, S. H., Reus, V. I., Nelson, J. C., Westrin, Å., & Lindqvist, D. (2019). Plasma serotonin levels are associated with antidepressant response to SSRIs. Journal of Affective Disorders, 250, 6570. https://doi.org/10.1016/j.jad.2019.02.063CrossRefGoogle ScholarPubMed
Hu, J., Zhou, B., Li, Y., Deng, Y., He, Q., Ye, J., & Ning, Y. (2019). The interaction between estradiol change and the serotonin transporter gene (5–HTTLPR) polymorphism is associated with postpartum depressive symptoms. Psychiatric Genetics, 29(4), 97102. http://doi.org/10.1097/YPG.0000000000000222CrossRefGoogle ScholarPubMed
Iga, J.-I., Watanabe, S., Numata, S., Umehara, H., Nishi, A., Kinoshita, M., Inoshita, M., Shimodera, S., Fujita, H., & Ohmori, T. (2016). Association study of polymorphism in the serotonin transporter gene promoter, methylation profiles, and expression in patients with major depressive disorder. Human Psychopharmacology: Clinical and Experimental, 31(3), 193199. https://doi.org/10.1002/hup.2527CrossRefGoogle ScholarPubMed
Jayasingam, S., Omar, S., Mustamil, N. M., Hashim, R. C., & Bakar, R. A. (2020). “Depression a silent killer", supporting and sustaining well-being in the workplace: Insights from a developing economy. Emerald Publishing Limited (pp. 13–62). https://doi.org/10.1108/978-1-83982-692-420201003CrossRefGoogle Scholar
Jesulola, E., Micalos, P., & Baguley, I. J. (2018). Understanding the pathophysiology of depression: From monoamines to the neurogenesis hypothesis model-are we there yet? Behavioural Brain Research, 341, 7990. https://doi.org/10.1016/j.bbr.2017.12.025CrossRefGoogle ScholarPubMed
Kao, W.-T., Chang, C.-L., & Lung, F.-W. (2018). 5–HTT mRNA level as a potential biomarker of treatment response in patients with major depression in a clinical trial. Journal of Affective Disorders, 238, 597608. https://doi.org/10.1016/j.jad.2018.06.035CrossRefGoogle ScholarPubMed
Kvam, S., Kleppe, C. L., Nordhus, I. H., & Hovland, A. (2016). Exercise as a treatment for depression: A meta-analysis. Journal of Affective Disorders, 202, 6786. https://doi.org/10.1016/j.jad.2016.03.063CrossRefGoogle ScholarPubMed
Lewis, C. P., Camsari, D. D., Sonmez, A. I., Nandakumar, A. L., Gresbrink, M. A., Daskalakis, Z. J., & Croarkin, P. E. (2019). Preliminary evidence of an association between increased cortical inhibition and reduced suicidal ideation in adolescents treated for major depression. Journal of Affective Disorders, 244, 2124. https://doi.org/10.1016/j.jad.2018.09.079CrossRefGoogle ScholarPubMed
Malakouti, S. K., Pachana, N. A., Naji, B., Kahani, S., & Saeedkhani, M. (2015). Reliability, validity and factor structure of the CES-D in Iranian elderly. Asian Journal of Psychiatry, 18, 8690. http://doi.org/10.1016/j.ajp.2015.08.007CrossRefGoogle ScholarPubMed
Mammadova-Bach, E., Mauler, M., Braun, A., & Duerschmied, D. (2018). Autocrine and paracrine regulatory functions of platelet serotonin. Platelets, 29(6), 541548. http://doi.org/10.1080/09537104.2018.1478072CrossRefGoogle ScholarPubMed
Manjarrez-Gutiérrez, G., & Hernández-Rodríguez, J. (2016). Clinical and basic studies on diabetes and brain serotonin. International Journal Endocrinology and Metabolic Disorders, 2, Article 2. http://doi.org/10.16966/2380-548X.123Google Scholar
McCauley, J. L., Olson, L. M., Dowd, M., Amin, T., Steele, A., Blakely, R. D., Folstein, S. E., Haines, J. L., & Sutcliffe, J. S. (2004). Linkage and association analysis at the serotonin transporter (SLC6A4) locus in a rigid‐compulsive subset of autism. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 127(1), 104112. https://doi.org/10.1002/ajmg.b.20151CrossRefGoogle Scholar
McLaren, S. (2018). The relationship between living alone, sense of belonging, and depressive symptoms among older men: The moderating role of sexual orientation. Aging & Mental Health, 24, 103109. http://doi.org/10.1080/13607863.2018.1531373CrossRefGoogle ScholarPubMed
Meguid, N. A., Gebril, O. H., & Khalil, R. O. (2015). A study of blood serotonin and serotonin transporter promoter variant (5–HTTLPR) polymorphism in Egyptian autistic children. Advanced Biomedical Research, 4, Article 94. http://doi.org/10.4103/2277-9175.156658Google ScholarPubMed
Nguyen, T. T. H., Roussin, A., Rousseau, V., Montastruc, J.-L., & Montastruc, F. (2018). Role of serotonin transporter in antidepressant-induced diabetes mellitus: A pharmaco epidemiological–pharmacodynamic study in VigiBase®. Drug Safety, 41(11), 10871096. https://doi.org/10.1007/s40264-018-0693-8CrossRefGoogle Scholar
Panagioti, M., Bower, P., Kontopantelis, E., Lovell, K., Gilbody, S., Waheed, W., Dickens, C., Archer, J., Simon, S., Ell, K., Huffman, J. C., Richards, D. A., van der Feltz-Cornelis, C., Adler, D. A., Bruce, M., Buszewicz, M., Cole, M. G., Davidson, K. W., de Jonge, P., … Coventry, P. A. (2016). Association between chronic physical conditions and the effectiveness of collaborative care for depression: An individual participant data meta-analysis. JAMA Psychiatry, 73(9), 978989. http://doi.org/10.1001/jamapsychiatry.2016.1794CrossRefGoogle ScholarPubMed
Park, B.-K., Kim, Y. R., Kim, Y. H., Yang, C., Seo, C.-S., Jung, I. C., Jang, I.-K., Kim, S.-H., & Lee, M. Y. (2018). Antidepressant-like effects of Gyejibokryeong-hwan in a mouse model of reserpine-induced depression. BioMed Research International, 2018, Article 5845491. https://doi.org/10.1155/2018/5845491CrossRefGoogle Scholar
Paul-Savoie, E., Potvin, S., Daigle, K., Normand, E., Corbin, J.-F., Gagnon, R., & Marchand, S. (2011). A deficit in peripheral serotonin levels in major depressive disorder but not in chronic widespread pain. The Clinical Journal of Pain, 27(6), 529534. http://doi.org/10.1097/AJP.0b013e31820dfedeCrossRefGoogle ScholarPubMed
Paykel, E. S., Cooper, Z., Ramana, R., & Hayhurst, H. (1996). Life events, social support and marital relationships in the outcome of severe depression. Psychological Medicine, 26(1), 121133. https://doi.org/10.1017/S0033291700033766CrossRefGoogle ScholarPubMed
Pehrson, A. L., Leiser, S. C., Gulinello, M., Dale, E., Li, Y., Waller, J. A., & Sanchez, C. (2015). Treatment of cognitive dysfunction in major depressive disorder—a review of the preclinical evidence for efficacy of selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors and the multimodal-acting antidepressant vortioxetine. European Journal of Pharmacology, 753, 1931. https://doi.org/10.1016/j.ejphar.2014.07.044CrossRefGoogle ScholarPubMed
Pérez-Olmos, I., Bustamante, D., & Ibáñez-Pinilla, M. (2016). Polimorfismo del gen del transportador de serotonina (5–HTT) y trastorno de depresión mayor en pacientes en Bogotá, Colombia [Serotonin transporter gene (5–HTT) polymorphism and major depressive disorder in patients in Bogota, Colombia]. Biomédica, 36(2), 285294. http://doi.org/10.7705/biomedica.v36i3.3014CrossRefGoogle Scholar
Prabhakar, V., Gupta, D., Kanade, P., & Radhakrishnan, M. (2015). Diabetes-associated depression: The serotonergic system as a novel multifunctional target. Indian Journal of Pharmacology, 47(1), 410. https://doi.org/10.4103/0253-7613.150305Google ScholarPubMed
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385401. https://doi.org/10.1177/014662167700100306CrossRefGoogle Scholar
Radloff, L. S., & Locke, B. Z. (1986). The community mental health assessment survey and the CES-D Scale. In Weissman, M. M., Myers, J. K., & Ross, C. E. (Eds). Community surveys of psychiatric disorders (pp. 177189). Rutgers University Press.Google Scholar
Rief, W., Bleichhardt, G., Dannehl, K., Euteneuer, F., & Wambach, K. (2018). Comparing the efficacy of CBASP with two versions of CBT for depression in a routine care center: A randomized clinical trial. Psychotherapy and Psychosomatics, 87(3), 164178. http://doi.org/10.1159/000487893CrossRefGoogle Scholar
Roppolo, M., Mulasso, A., Gobbens, R. J., Mosso, C. O., & Rabaglietti, E. (2015). A comparison between uni-and multidimensional frailty measures: Prevalence, functional status, and relationships with disability. Clinical Interventions in Aging, 10, 16691678. http://doi.org/10.2147/CIA.S92328Google ScholarPubMed
Runde, M. (2013). Statistical methods for detecting genotype-phenotype association in the presence of environmental covariates [Master’s thesis, Institutt for Matematiske fag]. CORE. https://core.ac.uk/download/pdf/52106326Google Scholar
Saldanha, D., Kumar, N., Ryali, V. S. S. R., Srivastava, K., & Pawar, A. A. (2009). Serum serotonin abnormality in depression. Medical Journal Armed Forces India, 65(2), 108112. https://doi.org/10.1016/S0377-1237(09)80120-2CrossRefGoogle ScholarPubMed
Sarkar, S., Kattimani, S., Premarajan, K. C., & Roy, G. (2017). Impact of attendance in a daycare centre on depression among elderly in rural Puducherry: A pre-& post-intervention study. The Indian Journal of Medical Research, 146 (Suppl. 2), 6876. http://doi.org/10.4103/ijmr.IJMR_857_15CrossRefGoogle Scholar
Sarmiento-Hernández, E. I., Ulloa-Flores, R. E., Camarena-Medellín, B., Sanabrais-Jiménez, M. A., Aguilar-García, A., & Hernández-Muñoz, S. (2019). Association between 5–HTTLPR polymorphism, suicide attempt and comorbidity in Mexican adolescents with major depressive disorder. Actas Españolas de Psiquiatría, 47(1), 16.Google ScholarPubMed
Spreux-Varoquaux, O., Gailledreau, J., Vanier, B., Bothua, D., Plas, J., Chevalier, J.-F., Advenier, C., Pays, M., & Brion, S. (1996). Initial increase of plasma serotonin: A biological predictor for the antidepressant response to clomipramine? Biological Psychiatry, 40(6), 465473. https://doi.org/10.1016/0006-3223(95)00449-1CrossRefGoogle ScholarPubMed
Tong, Q., Zhang, L., Yuan, Y., Jiang, S., Zhang, R., Xu, Q., Ding, J., Li, D., Zhou, X., & Zhang, K. (2015). Reduced plasma serotonin and 5-hydroxyindoleacetic acid levels in Parkinson’s disease are associated with nonmotor symptoms. Parkinsonism & Related Disorders, 21(8), 882887. https://doi.org/10.1016/j.parkreldis.2015.05.016CrossRefGoogle ScholarPubMed
Van Dam, N. T., & Earleywine, M. (2011). Validation of the Center for Epidemiologic Studies Depression Scale—Revised (CESD-R): Pragmatic depression assessment in the general population. Psychiatry Research, 186(1), 128132. https://doi.org/10.1016/j.psychres.2010.08.018CrossRefGoogle Scholar
World Health Organization. (2017). Mental health. [cited 29 Agosto 2029]. https://www.who.int/mental_health/world-mental-health-day/2017/en/Google Scholar
Xie, R., Xie, H., Krewski, D., & He, G. (2018). Plasma concentrations of neurotransmitters and postpartum depression. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 43(3), 274281. http://doi.org/10.11817/j.issn.1672-7347.2018.03.007Google ScholarPubMed
Zhu, J., Klein‐Fedyshin, M., & Stevenson, J. M. (2017). Serotonin transporter gene polymorphisms and selective serotonin reuptake inhibitor tolerability: Review of pharmacogenetic evidence. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 37(9), 10891104. https://doi.org/10.1002/phar.1978CrossRefGoogle ScholarPubMed
Zimmer, P., Stritt, C., Bloch, W., Schmidt, F. P., Hübner, S. T., Binnebößel, S., Schenk, A., & Oberste, M. (2016). The effects of different aerobic exercise intensities on serum serotonin concentrations and their association with Stroop task performance: A randomized controlled trial. European Journal of Applied Physiology, 116(10), 20252034. http://doi.org/10.1007/s00421-016-3456-1CrossRefGoogle ScholarPubMed