The Effect of Therapeutic Horticulture on Depression and Kynurenine Pathways

Timea HITTER (BURU); Éva KÁLLAY; Loredana E. OLAR; Răzvan ŞTEFAN; Erzsebet BUTA; Silvia CHIOREAN; Maria CANTOR; Ionel PAPUC

doi:10.15835/nbha47311544

Authors

Timea HITTER (BURU) University of Agriculture Sciences and Veterinary Medicine, Faculty of Horticulture, 3-5 Mănăștur street, 400372, Cluj-Napoca (RO)
Éva KÁLLAY Babes Bolyai University, Faculty of Psychology and Educational Sciences, 1 Mihail Kogălniceanu street, 400084, Cluj-Napoca (RO)
Loredana E. OLAR University of Agriculture Sciences and Veterinary Medicine, Faculty of Veterinary Medicine, 3-5 Mănăștur street, 400372, Cluj-Napoca (RO)
Răzvan ŞTEFAN University of Agriculture Sciences and Veterinary Medicine, Faculty of Veterinary Medicine, 3-5 Mănăștur street, 400372, Cluj-Napoca (RO)
Erzsebet BUTA University of Agriculture Sciences and Veterinary Medicine, Faculty of Horticulture, 3-5 Mănăștur street, 400372, Cluj-Napoca (RO)
Silvia CHIOREAN University of Agriculture Sciences and Veterinary Medicine, Faculty of Horticulture, 3-5 Mănăștur street, 400372, Cluj-Napoca (RO)
Maria CANTOR University of Agriculture Sciences and Veterinary Medicine, Faculty of Horticulture, 3-5 Mănăștur street, 400372, Cluj-Napoca (RO)
Ionel PAPUC University of Agriculture Sciences and Veterinary Medicine, Faculty of Veterinary Medicine, 3-5 Mănăștur street, 400372, Cluj-Napoca (RO)

DOI:

https://doi.org/10.15835/nbha47311544

Keywords:

biomarker; gardening activities; mental health; nature-based interventions

Abstract

The article presents the results of a study conducted to assess change in depression severity, and modification in the kynurenine pathway at participants. Presently, depression is one of the most regularly encountered mental illnesses. Research based on experimental studies indicated the beneficial effects of activities conducted in nature are reducing self-reported anger, fatigue, anxiety, stress and depression. The present study was conducted by measuring depression on both the subjective (Beck Depression Inventory) and the objective (spectrophotometric analysis) levels, to obtain more relevant information regarding the real change in depression levels, during the therapeutic horticulture intervention. Consequently, depression is assessed with the BDI doubled the data by assessing the levels of kynurenine and kynurenic acid obtained from biological samples. Results indicate that the levels of depression measured with the BDI have significantly decreased after the Therapeutic Horticulture Sesions. An even better result regards the fact that the significance of this change was not only statistical, but also clinical. Analysing the kynurerine and kynurenic acid concentrations, differences were observed amongst subject during the research study.

References

Adevi AA, Mårtensson F (2013). Stress rehabilitation through garden therapy: the garden as a place in the recovery from stress. Urban Forestry and Urban Greening 12(2):230-237.

Albert PR (2015). Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience 40(4):219-221.

Aldwin CM (2007). Stress, coping, and development: an integrative perspective. UK Guilford, London.

Amstadter AB, Broman-Fulks J, Zinzow H, Ruggiero KJ, Cercone J (2009). Internet based interventions for traumatic stress-related mental health problems: a review and suggestions for future research. Clinical Psychology Review 29(5):410-420.

Amundson N (2006). Challenges for career interventions in changing contexts. International Journal for Educational and Vocational Guidance 6(1):3-14.

Anderson NB (2004). Encyclopedia of health and behavior. Vol. 1. Sage.

Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, de Graaf R, Vollebergh W, … Wittchen HU (2003). The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research 12(1):3-21.

Annerstedt M, Norman J, Boman M, Mattsson L, Grahn P, Währborg P (2010). Finding stress relief in a forest. Ecological Bulletins 53:33-42.

Annerstedt M, Währborg P (2011). Nature-assisted therapy: Systematic review of controlledand observational studies. Scandinavian Journal of Public Health 39(4):371-388.

Banyard VL, Edwards VJ, Kendall-Tackett KA (2009). Understanding the effects of extreme stress and of psychological harm. NY: Routledge, New York.

Bay-Richter C, Linderholm, KR, Lim CK, Samuelsson M, Träskman-Bendz L, Guillemin GJ, … Brundin L (2015). A role for inflammatory metabolites as modulators of the glutamate N -Methyl- D -Aspartate receptor in depression and suicidality. Brain Behavior and Immunity 43:110-17.

Beck AT, Steer R (1987). Manual for the Beck Depression Inventory. San Antonio, TX Psychological Corporation.

Bragg R, Atkins G (2016). A review of nature-based interventions for mental health care. Natural England Commissioned Reports, pp 204.

Bratman GN, Daily GC, Levy BJ, Gross JJ (2015). The benefits of nature experience: improved affect and cognition. Landscape and Urban Planning 138:41-50.

Brody DS, Khaliq AA, Thompson TL (1997). Patients’ perspectives on the management of emotional distress in primary care settings. Journal of General Internal Medicine 12(7):403-406.

Cohen J (1988). Statistical Power Analysis for the Behavioral Sciences. New York: Lawrence Erlbaum Associates.

Cooper Marcus C, Sachs NA (2014). Therapeutic landscapes: An evidence-based approach to designing healing gardens and restorative outdoor spaces. Vol. 1. John Wiley & Sons.

Cuijpers P, Smit F, van Straten A (2007). Psychological treatments of subthreshold depression: A meta-analytic review. Acta Psychiatrica Scandinavica 115(6):434-441.

Cunningham M, Rapee R, Lyneham H (2006). Feedback to a prototype self-help computer program for anxiety disorders in adolescents. Advances in Mental Health 5(3):216-224.

Dantzer, R, O’Connor JC, Lawson MA, Kelley KK (2011). Inflammation-associated depression: from serotonin to kynurenine. Psychoneuroendocrinology 36(3):426-436.

David D, Dobrean A (2012). Inventarul de depresie Beck-(BDI-II). Romanian Psychological Testing Services.

Falvo D (2005). Medical and psychosocial aspects of chronic illness and disability (3rd Ed.). Sudbury, MA: Jones and Bartlett.

Fujigaki H, Yamamoto Y, Saito K (2017). L-Tryptophan-Kynurenine pathway enzymes are therapeutic target for neuropsychiatric diseases: focus on cell type differences. Neuropharmacology 112:264-274.

Gabbay V, Liebes L, Katz Y, Liu S, Mendoza S, Babb JS, Klein RG, Gonen O (2010). The kynurenine pathway in adolescent depression: preliminary fi ndings from a proton MR spectroscopy study. Progress in Neuropsychopharmacology and Biological Psychiatry 34(1):37-44.

Ghanbari S, Jafari F, Bagheri N, Neamtolahi S, Shayanpour R (2015). Study of the effect of using purposeful activity (gardening) on depression of female resident in Golestan Dormitory of Ahvaz Jundishapur University of Medical Sciences. Journal of Rehabilitation Sciences and Research 2(1):8-11.

Gigliotti CM, Jarrott, SE, Yorgason J (2004). Harvesting health. Dementia 3(2):161-180.

Gonzalez MT, Hartig T, Patil GG, Martinsen EW, Kirkevold M (2009). Therapeutic horticulture in clinical depression: a prospective study. Research and Theory for Nursing Practice: An International Journal 23(4):312-328.

Gonzalez MT, Hartig T, Patil GG, Martinsen EW, Kirkevold M (2010). Therapeutic horticulture in clinical depression: a prospective study of active components. Journal of advanced Nursing 66(9):2002-2013.

Gonzalez MT, Hartig T, Patil GG, Martinsen EW, Kirkevold M (2011). A prospective study of existential issues in therapeutic horticulture for clinical depression. Issues in Mental Health Nursing 32(1):73-81.

Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, … Olesen J (2011). Cost of disorders of the brain in Europe 2010. European Neuropsychopharmacology 21(10):718-779.

Hartig T, Mitchell R, De Vries S, Frumkin H (2014). Nature and health. Annual Review of Public Health 35:207-228.

Hawkins JL, Thirlaway KJ. Backx K, Clayton DA (2011). Allotment gardening and other leisure activities for stress reduction and healthy aging. HortTechnology 21(5):577-585.

Hennings A, Schwarz MJ, Riemer S, Stapf TM, Selberdinger VB, Rief W (2013). Exercise affects symptom severity but not biological measures in depression and somatization–results on IL-6, neopterin, tryptophan, kynurenine and 5-HIAA. Psychiatry Research 210(3):925-933.

Hennings A, Schwarz MJ, Riemer S, Stapf TM, Selberdinger VB, Rief W (2013). Exercise Affects symptom severity but not biological measures in depression and somatization – results on il-6, neopterin, tryptophan, kynurenine and 5-HIAA. Psychiatry Research 210(3):925-933.

Hu LJ, Li XF, Hu JQ, Ni XJ, Lu HY, Wang JJ, Wen YG (2017). A simple HPLC–MS/MS method for determination of tryptophan, kynurenine and kynurenic acid in human serum and its potential for monitoring antidepressant therapy. Journal of Analytical Toxicology 41(1):37-44.

Kam MCY, Siu AMH (2010). Evaluation of a horticultural activity programme for persons with psychiatric illness. Hong Kong Journal of Occupational Therapy 20(2):80-86.

Kamioka H, Tsutani K, Yamada M, Park H, Okuizumi H, Honda T, … Mutohi Y (2014). Effectiveness of horticultural therapy: a systematic review of randomized controlled trials. Complementary Therapies in Medicine 22(5):930-943.

Kazantzis N, L’Abate L (2007). Handbook of homework assignments in psychotherapy: Research, practice, prevention. New York, NY, US: Springer.

Kendall-Tackett K (2009). Psychological trauma and physical health: A psychoneuroimmunology approach to etiology of negative health effects and possible interventions. Psychological Trauma: Theory, Research, Practice, and Policy 1(1):35-48.

Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, … Wang PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Jama 289(23):3095-3105.

Klein B, Mitchell J, Gilson K, Shandley K, Austin D, Kiropoulos L, … Cannard G (2009). A therapist-assisted internet-based CBT intervention for posttraumatic stress disorder: Preliminary results. Cognitive Behavior Therapy 38(2):121-131.

Krause D, Myint AM, Schuett C, Musil R, Dehning S, Husain MI, Müller N (2017). High kynurenine (a Tryptophan Metabolite) predicts remission in patients with major depression to add-on treatment with celecoxib. Frontiers in Psychiatry 8(16)1-7.

Lanius RA, Vermetten E, Pain C (2010). The impact of early life trauma on health and disease: The hidden epidemic. Cambridge, UK: Cambridge University Press.

Lee YH, Ro MR, Lee YS (2004). Effects of horticultural activities on anxiety reduction of female high school students. Acta Horticulturae 639:249-251.

Lesniak WG, Jyoti A, Mishra MK, Louissaint N, Romero R, Chugani DC, … Kannan RM (2013). Concurrent quantification of tryptophan and its major metabolites. Analytical Biochemistry 443(2):222-231.

Levenson JL (2006). Essentials of psychosomatic medicine. Arlington, VA: American Psychiatric Publishing.

Litz BT, Engel CC, Bryant RA, Papa A (2007). A randomized, controlled proof-of-concept trial of an internetbased, therapist-assisted self-management treatment for posttraumatic stress disorder. American Journal of Psychiatry 164(11):1676-1683.

Maes M, Galecki P. Verkerk R, Rief W (2011). Somatization, but not depression, is characterized by disorders in the tryptophan catabolite (TRYCAT) pathway, indicating increased indoleamine 2, 3-dioxygenase and lowered kynurenine aminotransferase activity. Neuro Endocrinology Letters 32(3):264-273.

Marsella AJ (1998). Urbanization, mental health, and social deviancy: a review of issues and research. American Psychologist 53(6):624-634.

Mathers CD, Loncar D (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3(11):442.

Min S, Hu JY, Kang JH, Kang HY (2014). The effects of horticultural therapy on the well-being and hope of women in rural Korea. Journal of Nursing and Care 3(06):1000214.

Myint AM, Bondy B, Baghai C, Eser D, Nothdurfter C, Schüle C, … Schwarz MJ (2013). Tryptophan metabolism and immunogenetics in major depression: a role for interferon-γ gene. Brain, Behaviour, and Immunity 31:128-133.

Myint YK, Verkerk R, Scharpé S, Steinbusch H, Leonard B (2007). Kynurenine pathway in major depression: evidence of impaired neuroprotection. Journal of Advanced Nursing 98(1-2):143-151.

National Institute for Clinical Excellence (NICE) (2002). Guidance on the use of computerized cognitive behavioral therapy for anxiety and depression. Technology Appraisal 51:1-38.

Nikkheslat N, Zunszain PA, Horowitz MA, Barbosa IG, Parker JA, Myint AM, … Pariante CM (2015). Insufficient glucocorticoid signaling and elevated inflammation in coronary heart disease patients with comorbid depression. Brain, Behavior, and Immunity 48:8-18.

Nolen-Hoeksema S (2003). Women who think too much. How to break free of overthinking and reclaim your life. London: Piatkus Books.

Ogyu K, Kubo K, Noda Y, Iwata Y, Tsugawa S (2018). Kynurenine pathway in depression: a systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews 90:16-25.

Patel V, Flisher AJ, Hetrick S, McGorry P (2007). Mental health of young people: A global public-health challenge. Lancet 369(9569):1302-1313.

Pennebaker JW, Chung CK (2011). Expressive writing: Connections to physical and mental health. Oxford Handbook of Health Psychology 417-437.

Pratt LA, Brody DJ, Qiuping G (2011). Antidepressant use in persons aged 12 and over: United States, 2005-2008. NCHS Data Brief 76:1-8.

Przeworski A, Newman MG (2006). Efficacy and utility of computer-assisted cognitive behavioral therapy for anxiety disorders. Clinical Psychologist 10(2):43-53.

Quak J, Doornbos B, Roest AM, Duivis HE, Vogelzangs N, Nolen WA, … De Jonge P (2014). Does tryptophan degradation along the kynurenine pathway mediate the association between pro-inflammatory immune activity and depressive symptoms? Psychoneuroendocrinology 45:202-210.

Raison CL, Dantzer R, Kelley KW, Lawson MA, Woolwine BJ, Vogt G, … Saito K (2010). CSF concentrations of brain tryptophan and kynurenines during immune stimulation with IFN-α: relationship to CNS immune responses and depression. Nature-Molecular Psychiatry 15(4):393-403.

Reus GZ, Jansen K, Titus S, Carvalho AF, Gabbay V, Quevedo J (2015). Kynurenine pathway dysfunction in the pathophysiology and treatment of depression: evidences from animal and human studies. Journal of Psychiatric Research 68:316-328.

Rodiek S (2002). Influence of an outdoor garden on mood and stress in older persons. Journal of Therapeutic Horticulture 13(1):13-21.

Roe J, Thompson C, Aspinall P, Brewer M, Duff E, Miller D, … Clow A (2013). Green space and stress: evidence from cortisol measures in deprived urban communities. International Journal of Environmental Research and Public Health 10(9):4086-4103.

Savitz J, Dantzer R, Meier TB, Wurfel BE, Victor TA, Mcintosh SA, … Drevets WC (2015). Activation of the kynurenine pathway is associated with striatal volume in major depressive disorder. Psychoneuroendocrinology 62:54-58.

Savitz J, Drevets WC, Smith CM, Victor TA, Wurfel BE, Bellgowan PS, Bodurka J, Teague TK, Dantzer R (2015). Putative neuroprotective and neurotoxic kynurenine pathway metabolites are associated with hippocampal and amygdalar volumes in subjects with major depressive disorder. Neuropsychopharmacology 40(2):463-471.

Savitz J, Drevets WC, Wurfel BE, Ford BN, Bellgowan PSF, Victor TA, … Dantzer R (2015). Reduction of Kynurenic acid to quinolinic acid ratio in both the depressed and remitted phases of major depressive disorder. Brain, Behavior, and Immunity 46:55-59.

Schwieler L, Larsson MK, Skogh E, Kegel ME, Orhan F, Sally A, … Engberg G (2015). Increased Levels of il-6 in the cerebrospinal fluid of patients with chronic schizophrenia - significance for activation of the kynurenine pathway. Journal of Psychiatry and Neuroscience 40(2):126-134.

Sempik J, Aldrige J, Becker S (2003). Social and therapeutic horticulture: evidence and messages from research. Leicestershire: Thrive and Centre for Child and Family Research, Loughborough University.

Sommerfeld AJ, Waliczek TM, Zajicek JM (2010). Growing minds: evaluating the effect of gardening on quality of life and physical activity level of older adults. HortTechnology 20(4):705-710.

Son KC, Um SJ, Kim SY. Song JE, Kwack HR (2004). Effect of horticultural therapy on the changes of self-esteem and sociality of individuals with chronic schizophrenia. Acta Horticulturae 639:185-191.

Song MJ, Kim MY, Sim IS, Kim WS (2010). Evaluation of horticultural therapy on the emotional improvement of depressed patients by using heart rate variability. Korean Journal of Horticultural Science and Technology 28(6):1066-1071.

Stepney PM, Davis PM (2005). Mental health, social inclusion and the green agenda: An evaluation of a land-based rehabilitation project designed to promote occupational access and inclusion of service users in North Somerset, UK. Social Work in Health Care 39(3-4):375-397.

Sublette ME, Galfalvy HC, Fuchs D, Lapidus M, Grunebaum MF, Oquendo MA, … Postolache TT (2011). Plasma kynurenine levels are elevated in suicide attempters with major depressive disorder. Brain, Behavior, and Immunity 25(6):1272-1278.

Ulrich RS (1993). Biophilia, biophobia, and natural landscapes. Washington DC: Island Press. The Biophilia Hypothesis 7:73-137.

van den Berg AE, Custers MHG (2011). Gardening promotes neuroendocrine and affective restoration from stress. Journal of Health Psychology 16(1):3-11.

van den Berg AE, van Winsum-Westra M, de Vries S, van Dillen SM (2010). Allotment gardening and health: a comparative survey among allotment gardeners and their neighbors without an allotment. Environmental Health 9(74):1-12.

Veen C, Mu A, Burgerhout KM, Schwarz MJ, Schütze G, Kushner SA, … Bergink V (2016). Tryptophan pathway alterations in the postpartum period and in acute postpartum psychosis and depression. Journal of Affective Disorders 189:298-305.

Vujcic M, Tomicevic-Dubljevic J, Grbic M, Lecic-Tosevski D, Vukovic O, Toskovic O (2017). Nature based solution for improving mental health and well-being in urban areas. Environmental Research 158:385-392.

Weddington WW (1983). Adherence by medical-surgical inpatients to recommendations for outpatient psychiatric treatment. Psychotherapy and Psychosomatics 39(4):225-235.

Weehuizen RM (2008). Mental capital. The economic significance of mental health. Maastricht: Universitaire Pers Maastricht.

WHO (2017). Depression and other common mental disorders - Global health estimates. Geneva: WHO Document Production Services.

Wichrowski M, Whiteson J, Haas F, Mola A, Rey MJ (2005). Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program. Journal of Cardiopulmonary Rehabilitation and Prevention 25(5):270-274.

Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, … Steinhausen HC (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology 21(9):655-679.

Wood CJ, Pretty J, Griffin M (2016). A case-control study of the health and well-being benefits of allotment gardening. Journal of Public Health 38(3):336-344.

Woolfolk RL, Lehrer PM, Allen LA (2007). Conceptual issues underlying stress management. In Lehrer PM, Woolfolk RL, Sime WE (Eds), Principles and practice of stress management. New York, NY: Guilford pp 3-15.

Wurfel BE, Drevets WC, Bliss SA, McMillin JR, Suzuki H, Ford BN, … Savitz JB (2017). Serum kynurenic acid is reduced in affective psychosis. Nature - Translational Psychiatry 7(5):1-8.

Young KD, Drevets WC, Dantzer R, Teague TK, Bodurka J, Savitz J (2016). Kynurenine pathway metabolites are associated with hippocampal activity during autobiographical memory recall in patients with depression. Brain, Behavior, and Immunity 56:335-342.

Zheng P, Chen JJ, Huang T, Wang MJ, Wang Y, Dong MX, … Xie P (2013). A novel urinary metabolite signature for diagnosing major depressive disorder. Journal of Proteome Research 12(12):5904-5911.