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The association between immune activation and manic symptoms in patients with a depressive disorder.

Becking K, Boschloo L, Vogelzangs N, Haarman BC, Riemersma-van der Lek R, Penninx BW, Schoevers RA - Transl Psychiatry (2013)

Bottom Line: Although recent studies have shown that immunological processes play an important role in the pathophysiology of mood disorders, immune activation may only be present in specific subgroups of patients.Patients with a depressive disorder at baseline (N=957) and healthy controls (N=430) were selected from the Netherlands Study of Depression and Anxiety.Further research should explore whether a treatment approach focusing on inflammatory processes may be more effective in this specific subgroup of depressed patients.

View Article: PubMed Central - PubMed

Affiliation: Interdisciplinary Center of Psychopathology and Emotion Regulation (ICPE)/University Center Psychiatry (UCP), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

ABSTRACT
Although recent studies have shown that immunological processes play an important role in the pathophysiology of mood disorders, immune activation may only be present in specific subgroups of patients. Our study aimed to examine whether immune activation was associated with (a) the presence of manic symptoms and (b) the onset of manic symptoms during 2 years of follow-up in depressed patients. Patients with a depressive disorder at baseline (N=957) and healthy controls (N=430) were selected from the Netherlands Study of Depression and Anxiety. Assessments included lifetime manic symptoms at baseline and two-year follow up, as well as C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) at baseline. Within depressed patients, immune activation was not related to the presence or absence of lifetime manic symptoms at baseline. However, CRP levels were strongly elevated in depressed men who developed manic symptoms compared with those who did not develop manic symptoms over 2 years (P<0.001, Cohen's d=0.89). IL-6 and TNF-α were also higher in depressed men with an onset of manic symptoms, but this association was not significant. However, we found that the onset of manic symptoms was particularly high in men with multiple elevated levels of inflammatory markers. Depressed men who developed manic symptoms during follow-up had increased immunological activity (especially CRP) compared with depressed men who did not develop manic symptoms. Further research should explore whether a treatment approach focusing on inflammatory processes may be more effective in this specific subgroup of depressed patients.

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Shape of relation between inflammatory markers and linear relationship between the number of highest quartiles and onset of manic symptoms in men. Q1–Q4: quartiles of inflammatory markers. P-values in figure are the overall P-values based on χ2-tests.
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fig2: Shape of relation between inflammatory markers and linear relationship between the number of highest quartiles and onset of manic symptoms in men. Q1–Q4: quartiles of inflammatory markers. P-values in figure are the overall P-values based on χ2-tests.

Mentions: The shapes of the prospective associations were illustrated with graphs plotting the onset of manic symptoms across groups with increasing levels (quartiles) of inflammatory markers (see Figure 2). A non-linear association was found for CRP, as the percentage of patients with an onset of manic symptoms was only increased in patients in the highest quartile of CRP, which was significantly higher than in the three groups with lower levels of CRP (Q4 vs Q1: P=0.002; Q4 vs Q2: P=0.013; Q4 vs Q3: P=0.003). Although the associations of IL-6 and TNF-α were not significant, the onset of manic symptoms was higher in depressed men with higher levels of these markers. This could indicate that these markers, in addition to CRP, may contribute to the onset of manic symptoms. This was also demonstrated by the last graph in Figure 2, showing that the onset of manic symptoms gradually increased with the number of inflammatory markers in the highest quartiles (range: 0–3).


The association between immune activation and manic symptoms in patients with a depressive disorder.

Becking K, Boschloo L, Vogelzangs N, Haarman BC, Riemersma-van der Lek R, Penninx BW, Schoevers RA - Transl Psychiatry (2013)

Shape of relation between inflammatory markers and linear relationship between the number of highest quartiles and onset of manic symptoms in men. Q1–Q4: quartiles of inflammatory markers. P-values in figure are the overall P-values based on χ2-tests.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3818012&req=5

fig2: Shape of relation between inflammatory markers and linear relationship between the number of highest quartiles and onset of manic symptoms in men. Q1–Q4: quartiles of inflammatory markers. P-values in figure are the overall P-values based on χ2-tests.
Mentions: The shapes of the prospective associations were illustrated with graphs plotting the onset of manic symptoms across groups with increasing levels (quartiles) of inflammatory markers (see Figure 2). A non-linear association was found for CRP, as the percentage of patients with an onset of manic symptoms was only increased in patients in the highest quartile of CRP, which was significantly higher than in the three groups with lower levels of CRP (Q4 vs Q1: P=0.002; Q4 vs Q2: P=0.013; Q4 vs Q3: P=0.003). Although the associations of IL-6 and TNF-α were not significant, the onset of manic symptoms was higher in depressed men with higher levels of these markers. This could indicate that these markers, in addition to CRP, may contribute to the onset of manic symptoms. This was also demonstrated by the last graph in Figure 2, showing that the onset of manic symptoms gradually increased with the number of inflammatory markers in the highest quartiles (range: 0–3).

Bottom Line: Although recent studies have shown that immunological processes play an important role in the pathophysiology of mood disorders, immune activation may only be present in specific subgroups of patients.Patients with a depressive disorder at baseline (N=957) and healthy controls (N=430) were selected from the Netherlands Study of Depression and Anxiety.Further research should explore whether a treatment approach focusing on inflammatory processes may be more effective in this specific subgroup of depressed patients.

View Article: PubMed Central - PubMed

Affiliation: Interdisciplinary Center of Psychopathology and Emotion Regulation (ICPE)/University Center Psychiatry (UCP), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

ABSTRACT
Although recent studies have shown that immunological processes play an important role in the pathophysiology of mood disorders, immune activation may only be present in specific subgroups of patients. Our study aimed to examine whether immune activation was associated with (a) the presence of manic symptoms and (b) the onset of manic symptoms during 2 years of follow-up in depressed patients. Patients with a depressive disorder at baseline (N=957) and healthy controls (N=430) were selected from the Netherlands Study of Depression and Anxiety. Assessments included lifetime manic symptoms at baseline and two-year follow up, as well as C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) at baseline. Within depressed patients, immune activation was not related to the presence or absence of lifetime manic symptoms at baseline. However, CRP levels were strongly elevated in depressed men who developed manic symptoms compared with those who did not develop manic symptoms over 2 years (P<0.001, Cohen's d=0.89). IL-6 and TNF-α were also higher in depressed men with an onset of manic symptoms, but this association was not significant. However, we found that the onset of manic symptoms was particularly high in men with multiple elevated levels of inflammatory markers. Depressed men who developed manic symptoms during follow-up had increased immunological activity (especially CRP) compared with depressed men who did not develop manic symptoms. Further research should explore whether a treatment approach focusing on inflammatory processes may be more effective in this specific subgroup of depressed patients.

Show MeSH
Related in: MedlinePlus