Inflammation and remission in older patients with depression treated with electroconvulsive therapy; findings from the MODECT study
Adult
Aged
Antidepressive Agents
/ therapeutic use
Biomarkers
C-Reactive Protein
Depressive Disorder, Major
/ drug therapy
Disease Progression
Electroconvulsive Therapy
Female
Humans
Inflammation
/ blood
Interleukin-10
/ blood
Interleukin-6
/ blood
Male
Middle Aged
Treatment Outcome
Tumor Necrosis Factor-alpha
/ blood
Depression
Electroconvulsive therapy (ECT)
IL-6, CRP, IL-10
Low-grade inflammation
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
01 09 2019
01 09 2019
Historique:
received:
12
02
2019
revised:
07
05
2019
accepted:
30
06
2019
pubmed:
7
7
2019
medline:
4
6
2020
entrez:
7
7
2019
Statut:
ppublish
Résumé
Compelling evidence links elevated levels of C-reactive protein (CRP) and other inflammatory markers to poor treatment outcome of antidepressant medication. Little is known about the contribution of low-grade inflammation to treatment response to electroconvulsive therapy (ECT) in severely depressed patients. Associations between serum levels of CRP, interleukin-6, interleukin-10, and tumour necrosis factor-α as well as remission of depression, time to remission, and speed of decline of depressive symptoms were examined in 95 older (mean age: 73.1 years) depressed patients treated with ECT. Moderately elevated levels of CRP at baseline (3 to 10 mg/L), but no other inflammatory markers, were associated with higher remission rates. In patients with moderately elevated CRP levels, the odds ratio for remission was 3.62 (95% confidence interval [CI], 1.09-11.97; p = 0.04). Time to remission was shorter in those with moderately elevated CRP levels (p = 0.05). Speed of decline was higher in patients with moderately elevated CRP levels as compared with those with low CRP levels (decline of 3.2 Montgomery Åsberg Depression Rating Scale points per administration vs. 2.3 points per administration, p = 0.03). Because of the observational design, residual confounding through other lifestyle or demographic factors cannot be ruled out. Although earlier studies showed that low-grade inflammation contributes to poor treatment response in those treated with antidepressants, our study provides clues that low-grade inflammation does not have such a detrimental effect on the treatment response to ECT. This is underscored by our finding that moderately elevated CRP levels were associated with increased remission rates in depressed patients treated with ECT. Replication studies are warranted.
Sections du résumé
BACKGROUND
Compelling evidence links elevated levels of C-reactive protein (CRP) and other inflammatory markers to poor treatment outcome of antidepressant medication. Little is known about the contribution of low-grade inflammation to treatment response to electroconvulsive therapy (ECT) in severely depressed patients.
METHOD
Associations between serum levels of CRP, interleukin-6, interleukin-10, and tumour necrosis factor-α as well as remission of depression, time to remission, and speed of decline of depressive symptoms were examined in 95 older (mean age: 73.1 years) depressed patients treated with ECT.
RESULTS
Moderately elevated levels of CRP at baseline (3 to 10 mg/L), but no other inflammatory markers, were associated with higher remission rates. In patients with moderately elevated CRP levels, the odds ratio for remission was 3.62 (95% confidence interval [CI], 1.09-11.97; p = 0.04). Time to remission was shorter in those with moderately elevated CRP levels (p = 0.05). Speed of decline was higher in patients with moderately elevated CRP levels as compared with those with low CRP levels (decline of 3.2 Montgomery Åsberg Depression Rating Scale points per administration vs. 2.3 points per administration, p = 0.03).
LIMITATIONS
Because of the observational design, residual confounding through other lifestyle or demographic factors cannot be ruled out.
CONCLUSIONS
Although earlier studies showed that low-grade inflammation contributes to poor treatment response in those treated with antidepressants, our study provides clues that low-grade inflammation does not have such a detrimental effect on the treatment response to ECT. This is underscored by our finding that moderately elevated CRP levels were associated with increased remission rates in depressed patients treated with ECT. Replication studies are warranted.
Identifiants
pubmed: 31279250
pii: S0165-0327(19)30215-0
doi: 10.1016/j.jad.2019.06.040
pii:
doi:
Substances chimiques
Antidepressive Agents
0
Biomarkers
0
IL10 protein, human
0
Interleukin-6
0
TNF protein, human
0
Tumor Necrosis Factor-alpha
0
Interleukin-10
130068-27-8
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
509-516Informations de copyright
Copyright © 2019. Published by Elsevier B.V.