Clinical data from 154 patients with (TN) revealed that longer disease duration and greater trigeminal branch involvement are associated with higher scores of depression, anxiety, and insomnia.
Longer disease duration and more extensive involvement of trigeminal branches correlate with increased severity of mental health symptoms.
analysis suggests that certain mental disorders, such as depression and anxiety, may increase the risk of developing TN.
Conversely, conditions like autism and schizophrenia are associated with a reduced risk of TN.
Trigeminal Neuralgia (TN) itself is linked to an increased risk of subsequent anxiety, depression, and insomnia.
Simplified
BACKGROUND: Clinical observational evidence suggests a close association between (TN) and Mental disorders (MDs). However, the causal relationship between the two remains unclear. This study aims to observe and analyse the associations between depression, anxiety, insomnia, and TN through clinical research. It also employs (MR) analysis to verify the potential genetic correlation between TN and various mental disorders. offering new insights for the diagnosis, prevention, and intervention strategies for TN.
METHODS: In the cohort study section, clinical data were collected from 154 patients with TN, all of whom were excluded from preoperative use of psychotropic drugs such as carbamazepine. The PHQ-9, GAD-7, and ISI scales were used to assess preoperative symptoms of depression, anxiety, and insomnia. Multivariable linear regression models were used to identify factors associated with questionnaire scores, with model performance evaluated by adjusted R², AIC, BIC, and p-values. Patients with significant positive symptoms preoperatively were followed up one-year after surgery, and non-parametric tests were employed to examine changes in mental disorder symptoms after pain relief. In MR analysis section, the main MR analysis methods include Inverse Variance Weighted (IVW), MR Egger, Weighted Median, Simple Mode, and Weighted Mode. The Benjamini-Hochberg (BH) method was used to adjust the p -values and control the false discovery rate (FDR). Subsequent sensitivity analyses involved Cochran's Q test, MR-Egger regression intercept, MR-pleiotropy residual sum and outlier test (MR-PRESSO).
RESULTS: Multiple linear regression analyses revealed that longer disease duration and greater involvement of trigeminal branches were consistently associated with higher PHQ-9, GAD-7, and ISI scores, while demographic factors and baseline BNI scores showed no significant predictive value. MR analysis indicated that autism (OR = 0.697, 95% CI [0.494-0.982], P = 0.039), schizophrenia (OR = 0.910, 95% CI [0.831-0.997], P = 0.042), and ADHD combined with OCD (OR = 0.175, 95% CI [0.044-0.693], P = 0.013) reduced the risk of TN. Conversely, bipolar disorder (OR = 1.249, 95% CI [1.016-1.535], P = 0.034), depression (OR = 2.375, 95% CI [1.043-5.409], P = 0.039), anxiety (OR = 1.174, 95% CI [1.008-1.368], P = 0.039), and insomnia (OR = 2.036, 95% CI [1.074-3.861], P = 0.029)increased the risk of TN. TN also elevated the risk of anxiety (OR = 1.43, 95% CI [1.04-1.96], P = 0.034), depression (OR = 1.00305, 95% CI [1.00036-1.00549], P = 0.013), and insomnia (OR = 1.00918, 95% CI [1.00236-1.01605], P = 0.008).
CONCLUSIONS: Longer disease duration and broader trigeminal nerve involvement were independently associated with increased severity of depressive, anxiety, and insomnia symptoms, highlighting the importance of early clinical intervention in patients with TN. And results of MR analysis provide evidence supporting a causal relationship between MDs and TN. In contrast to the traditional view that pain causes mood changes such as anxiety and depression, a variety of MDs such as anxiety, depression, and insomnia also alter the risk of developing TN.
Key numbers
2.375
Increase in Depression Risk
Odds Ratio for depression in relation to risk
10.89
Postoperative Decrease in Depression Scores
Mean difference in PHQ-9 scores post-surgery
82 of 154
Prevalence of Insomnia Symptoms
Number of patients with significant insomnia symptoms preoperatively
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Declarations. Ethics approval and consent to participate: This study was conducted as a retrospective analysis of clinical data, and informed consent was obtained from all participants. All personal information was anonymized to ensure the confidentiality and privacy of the participants. The study was approved by the Institutional Review Board (IRB) of China-Japan Friendship Hospital, Beijing, China, and was performed in accordance with the ethical standards of the Declaration of Helsinki. Mendelian randomization analysis utilizes summary data from various publicly available large-scale GWASs and does not include any individual-specific information. Patient consent was previously obtained in the original studies; therefore, this study does not require new patient consent. The GWASs also received ethical approval from the respective ethics review boards. Consent for publication: All the authors of this study have read and approved the final manuscript. They consent to the publication of the research findings in The Journal of Headache and Pain. Competing interests: The authors declare no competing interests.
