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Du Y, Dou Y, Wang M, Wang Y, Yan Y, Fan H, Fan N, Yang X, Ma X. Efficacy and acceptability of anti-inflammatory agents in major depressive disorder: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1407529. [PMID: 38863604 PMCID: PMC11165078 DOI: 10.3389/fpsyt.2024.1407529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024] Open
Abstract
Background Anti-inflammatory agents have emerged as a potential new therapy for major depressive disorder (MDD). In this meta-analysis, our aim was to evaluate the antidepressant effect of anti-inflammatory agents and compare their efficacy. Methods We conducted a comprehensive search across multiple databases, including PubMed, Embase, Web of Science, Cochrane Review, Cochrane Trial, and ClinicalTrials.gov, to identify eligible randomized clinical trials. The primary outcome measures of our meta-analysis were efficacy and acceptability, while the secondary outcome measures focused on remission rate and dropout rate due to adverse events. We used odds ratio (OR) and 95% confidence interval (95% CI) to present our results. Results A total of 48 studies were included in our analysis. In terms of efficacy, anti-inflammatory agents demonstrated a significant antidepressant effect compared to placebo (OR = 2.04, 95% CI: 1.41-2.97, p = 0.0002). Subgroup analyses revealed that anti-inflammatory agents also exhibited significant antidepressant effects in the adjunctive therapy subgroup (OR = 2.17, 95% CI: 1.39-3.37, p = 0.0006) and in MDD patients without treatment-resistant depression subgroup (OR = 2.33, 95% CI: 1.53-3.54, p < 0.0001). Based on the surface under the cumulative ranking curve (SUCRA) value of network meta-analysis, nonsteroidal anti-inflammatory drugs (NSAIDs) (SUCRA value = 81.6) demonstrated the highest acceptability among the included anti-inflammatory agents. Conclusion In summary, our meta-analysis demonstrates that anti-inflammatory agents have significant antidepressant effects and are well-accepted. Furthermore, adjunctive therapy with anti-inflammatory agents proved effective in treating MDD. Among the evaluated anti-inflammatory agents, NSAIDs exhibited the highest acceptability, although its efficacy is comparable to placebo. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=422004), identifier CRD42023422004.
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Affiliation(s)
| | | | | | | | | | | | | | - Xiao Yang
- Mental health center and laboratory of psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaohong Ma
- Mental health center and laboratory of psychiatry, West China Hospital of Sichuan University, Chengdu, China
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How does IL-6 change after combined treatment in MDD patients? A systematic review. Brain Behav Immun Health 2022; 27:100579. [PMID: 36624849 PMCID: PMC9822965 DOI: 10.1016/j.bbih.2022.100579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 12/26/2022] Open
Abstract
A growing amount of research suggests that inflammatory responses have a crucial role in the complex pathophysiology of Major Depressive Disorder (MDD), a disabling medical condition. The present review has two primary goals. Firstly, to highlight and summarize results from studies that investigated the changes of IL-6 in MDD patients before and after combined treatment. The second aim is to enlighten the need for further research on the difference in the concentration of the pro-inflammatory cytokines between MDD and Treatment-Resistant MDD. The protocol of this study was written using PRISMA, and it is registered at PROSPERO (identification: CRD42021289233). We searched the following bibliographic databases to identify potentially eligible articles without any time limit until September 2021: Pubmed, Web of Science, Scopus, PsycINFO. As they met the eligibility criteria, 14 articles were included in this systematic review. The selected studies assessed twelve different elements as an adjunction to the standard pharmacotherapy (ECT, Ketamine, CBT, NCT, Ketoprofene, Lithium, Celecoxib, Metformin tDCS, Pentoxifylline, ethyl-EPA, Zinc). Significant results were found in the studies that analyzed the impact of combined treatment with the adjunction of the following elements: ECT, Ketamine, CBT, NCT, Celecoxib, Metformin, and Pentoxifylline. Overall, this systematic review identifies several potentially beneficial combined treatments for MDD patients. Further evidence is needed to confirm the efficacy of reducing IL-6 levels in patients with Treatment-Resistant MDD.
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Is depression the missing link between inflammatory mediators and cancer? Pharmacol Ther 2022; 240:108293. [PMID: 36216210 DOI: 10.1016/j.pharmthera.2022.108293] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
Patients with cancer are at greater risk of developing depression in comparison to the general population and this is associated with serious adverse effects, such as poorer quality of life, worse prognosis and higher mortality. Although the relationship between depression and cancer is now well established, a common underlying pathophysiological mechanism between the two conditions is yet to be elucidated. Existing theories of depression, based on monoamine neurotransmitter system dysfunction, are insufficient as explanations of the disorder. Recent advances have implicated neuroinflammatory mechanisms in the etiology of depression and it has been demonstrated that inflammation at a peripheral level may be mirrored centrally in astrocytes and microglia serving to promote chronic levels of inflammation in the brain. Three major routes to depression in cancer in which proinflammatory mediators are implicated, seem likely. Activation of the kynurenine pathway involving cytokines, increases tryptophan catabolism, resulting in diminished levels of serotonin which is widely acknowledged as being the hallmark of depression. It also results in neurotoxic effects on brain regions thought to be involved in the evolution of major depression. Proinflammatory mediators also play a crucial role in impairing regulatory glucocorticoid mediated feedback of the hypothalamic-pituitary-adrenal axis, which is activated by stress and considered to be involved in both depression and cancer. The third route is via the glutamatergic pathway, whereby glutamate excitotoxicity may lead to depression associated with cancer. A better understanding of the mechanisms underlying these dysregulated and other newly emerging pathways may provide a rationale for therapeutic targeting, serving to improve the care of cancer patients.
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Du X, Zou S, Yue Y, Fang X, Wu Y, Wu S, Wang H, Li Z, Zhao X, Yin M, Ye G, Sun H, Gu X, Zhang X, Miao Z, Jin JW, Wu HE, Liu Y, Xu X. Peripheral Interleukin-18 is negatively correlated with abnormal brain activity in patients with depression: a resting-state fMRI study. BMC Psychiatry 2022; 22:531. [PMID: 35931995 PMCID: PMC9354267 DOI: 10.1186/s12888-022-04176-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Interleukin-18 (IL-18) may participate in the development of major depressive disorder, but the specific mechanism remains unclear. This study aimed to explore whether IL-18 correlates with areas of the brain associated with depression. METHODS Using a case-control design, 68 subjects (34 patients and 34 healthy controls) underwent clinical assessment, blood sampling, and resting-state functional Magnetic Resonance Imaging (fMRI). The total Hamilton depression-17 (HAMD-17) score was used to assess depression severity. Enzyme-linked immunosorbent assay (ELISA) was used to detect IL-18 levels. Rest-state fMRI was conducted to explore spontaneous brain activity. RESULTS The level of IL-18 was higher in patients with depression in comparison with healthy controls. IL-18 was negatively correlated with degree centrality of the left posterior cingulate gyrus in the depression patient group, but no correlation was found in the healthy control group. CONCLUSION This study suggests the involvement of IL-18 in the pathophysiological mechanism for depression and interference with brain activity.
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Affiliation(s)
- Xiangdong Du
- grid.452666.50000 0004 1762 8363Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004 China ,grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Siyun Zou
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Yan Yue
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China ,grid.263761.70000 0001 0198 0694Medical College of Soochow University, Suzhou, China
| | - Xiaojia Fang
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China ,grid.417303.20000 0000 9927 0537Xuzhou Medical University, Xuzhou, China
| | - Yuxuan Wu
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China ,grid.263761.70000 0001 0198 0694Medical College of Soochow University, Suzhou, China
| | - Siqi Wu
- grid.440734.00000 0001 0707 0296School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Haitao Wang
- grid.440734.00000 0001 0707 0296School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Zhe Li
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Xueli Zhao
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Ming Yin
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Gang Ye
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Hongyan Sun
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Xiaochu Gu
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Xiaobin Zhang
- grid.452825.c0000 0004 1764 2974Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004 China
| | - Zhigang Miao
- grid.452666.50000 0004 1762 8363Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Jeff Wang Jin
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Hanjing Emily Wu
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Yansong Liu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215004, China.
| | - Xingshun Xu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
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Use of Sertraline in Hemodialysis Patients. MEDICINA-LITHUANIA 2021; 57:medicina57090949. [PMID: 34577872 PMCID: PMC8470022 DOI: 10.3390/medicina57090949] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.
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Al-Hakeim HK, Twayej AJ, Al-Dujaili AH, Maes M. Plasma Indoleamine-2,3-Dioxygenase (IDO) is Increased in Drug-Naï ve Major Depressed Patients and Treatment with Sertraline and Ketoprofen Normalizes IDO in Association with Pro-Inflammatory and Immune- Regulatory Cytokines. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 19:44-54. [PMID: 31894751 DOI: 10.2174/1871527319666200102100307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/17/2019] [Accepted: 11/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Major Depression Disorder (MDD) is accompanied by an immune response characterized by increased levels of inflammatory and immune-regulatory cytokines and stimulation of indoleamine-2,3-dioxygenase (IDO). There is also evidence that anti-inflammatory drugs may have clinical efficacy in MDD. METHODS This study examined a) IDO in association with interferon (IFN)-γ, Interleukin (IL)-4 and Transforming Growth Factor (TGF)-β1 in 140 drug-naïve MDD patients and 40 normal controls; and b) the effects of an eight-week treatment of sertraline with or without ketoprofen (a nonsteroidal antiinflammatory drug) on the same biomarkers in 44 MDD patients. RESULTS Baseline IDO, IFN-γ, TGF-β1 and IL-4 were significantly higher in MDD patients as compared with controls. Treatment with sertraline with or without ketoprofen significantly reduced the baseline levels of all biomarkers to levels which were in the normal range (IDO, TGF-β1, and IL-4) or still somewhat higher than in controls (IFN-γ). Ketoprofen add-on had a significantly greater effect on IDO as compared with placebo. The reductions in IDO, IL-4, and TGF-β1 during treatment were significantly associated with those in the BDI-II. CONCLUSION MDD is accompanied by activated immune-inflammatory pathways (including IDO) and the Compensatory Immune-Regulatory System (CIRS). The clinical efficacy of antidepressant treatment may be ascribed at least in part to decrements in IDO and the immune-inflammatory response. These treatments also significantly reduce the more beneficial properties of T helper-2 and T regulatory (Treg) subsets. Future research should develop immune treatments that target the immune-inflammatory response in MDD while enhancing the CIRS.
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Affiliation(s)
| | - Ahmed Jasim Twayej
- Pathological Analysis Department, College of Health and Medical, Al-Kafeel University, Najaf, Iraq
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.,Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria.,IMPACT Research Center, Deakin University, Geelong, Australia
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In major depression, increased kappa and mu opioid receptor levels are associated with immune activation. Acta Neuropsychiatr 2020; 32:99-108. [PMID: 31753054 DOI: 10.1017/neu.2019.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study was carried out to delineate differences between major depressive disorder (MDD) and healthy controls in dynorphin and kappa opioid receptor (KOR) levels in association with changes in the β-endorphin - mu opioid receptor (MOR) and immune-inflammatory system. METHODS The present study examines dynorphin, KOR, β-endorphin, MOR, interleukin (IL)-6 and IL-10 in 60 drug-free male participants with MDD and 30 age-matched healthy males. RESULTS Serum dynorphin, KOR, β-endorphin and MOR are significantly higher in MDD as compared to controls. The increases in the dynorphin/KOR system and β-endorphin/MOR system are significantly intercorrelated and are both strongly associated with increased IL-6 and IL-10 levels. Dynorphin, β-endorphin, KOR and both cytokines showed a good diagnostic performance for MDD versus controls with a bootstrapped (n = 2000) area under the receiver operating curve of 0.972. The dynorphin/KOR system is significantly decreased in depression with comorbid nicotine dependence. CONCLUSION Our findings suggest that, in MDD, immune activation is associated with a simultaneous activation of dynorphin/KOR and β-endorphin/MOR signaling and that these opioid systems may participate in the pathophysiology of depression by (a) exerting immune-regulatory activities attenuating the primary immune response and (b) modulating reward responses and mood as well as emotional and behavioural responses to stress.
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Kajitani N, Iwata M, Miura A, Tsunetomi K, Yamanashi T, Matsuo R, Nishiguchi T, Fukuda S, Nagata M, Shibushita M, Yamauchi T, Pu S, Shirayama Y, Watanabe K, Kaneko K. Prefrontal cortex infusion of beta-hydroxybutyrate, an endogenous NLRP3 inflammasome inhibitor, produces antidepressant-like effects in a rodent model of depression. Neuropsychopharmacol Rep 2020; 40:157-165. [PMID: 32125791 PMCID: PMC7722664 DOI: 10.1002/npr2.12099] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
Aims Neuroinflammation is deeply related to the pathophysiology of depression. Beta‐hydroxybutyrate (BHB), which is an endogenous ketone body, exerts anti‐inflammatory effects, and peripheral administration of BHB induces antidepressant effects in an animal model of depression; however, it is unclear whether BHB specifically mediates these actions in the brain. Thus, we administered BHB directly into the brain in a rodent model of depression using a chronic unpredictable stress (CUS) paradigm. Methods BHB was continuously microinjected into the prefrontal cortex (PFC) using osmotic pumps for 21 days. Behavioral testing included the forced swim test (FST) and the open field test (OFT); the levels of pro‐inflammatory cytokines, such as interleukin 1β (IL‐1β) and tumor necrosis factor α (TNF‐α), were quantified in the PFC, and the concentration of corticosterone in blood serum was measured. Results BHB administration into the PFC significantly decreased immobility time in the FST, without significantly altering locomotor activity assessed in the OFT. Also, CUS significantly increased the levels of TNF‐α in the PFC and decreased serum corticosterone levels; these changes were attenuated by BHB administration. These findings suggest that a small amount of BHB administered into the PFC directly produces antidepressant effects, possibly through anti‐inflammatory mechanisms, and can improve hypothalamus‐pituitary‐adrenal axis responses. Conclusion BHB may be a novel therapeutic candidate for the treatment of depression based on the neuro‐inflammatory hypothesis, and the PFC is a region implicated in the antidepressant action of BHB. A small amount of beta‐hydroxybutyrate administered into the prefrontal cortex directly produces antidepressant effects, possibly through anti‐inflammatory mechanisms, and can improve hypothalamus‐pituitary‐adrenal axis responses.![]()
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Affiliation(s)
- Naofumi Kajitani
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaaki Iwata
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Akihiko Miura
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kyohei Tsunetomi
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takehiko Yamanashi
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryoichi Matsuo
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tsuyoshi Nishiguchi
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Saki Fukuda
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Mayu Nagata
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Midori Shibushita
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takahira Yamauchi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Shenghong Pu
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yukihiko Shirayama
- Department of Psychiatry, Teikyo University Chiba Medical Center, Ichihara, Japan
| | | | - Koichi Kaneko
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
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Twayej AJ, Al-Hakeim HK, Al-Dujaili AH, Maes M. Lowered zinc and copper levels in drug-naïve patients with major depression: Effects of antidepressants, ketoprofen and immune activation. World J Biol Psychiatry 2020; 21:127-138. [PMID: 31062629 DOI: 10.1080/15622975.2019.1612090] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: The aim of the present work is to examine the effects of treatment with sertraline with and without ketoprofen on serum levels of zinc and copper in association with immune-inflammatory biomarkers in drug-naïve major depressed patients.Methods: We measured serum zinc and copper, interleukin (IL)-1β, IL-4, IL-6, IL-18, interferon-γ, and transforming growth factor-β1 in 40 controls and 133 depressed patients. The clinical efficacy of the treatment was measured using the Beck Depression Inventory-II (BDI-II) at baseline and 8 weeks later.Results: We found significantly reduced serum zinc and copper in association with upregulation of all cytokines, indicating activation of the immune-inflammatory responses system (IRS) and the compensatory immune regulatory system (CIRS). Treatment with sertraline significantly increased zinc and decreased copper. During treatment, there was a significant inverse association between serum zinc and immune activation. The improvement in the BDI-II during treatment was significantly associated with increments in serum zinc coupled with attenuation of the IRS/CIRS.Conclusions: Lower zinc is a hallmark of depression, while increments in serum zinc and attenuation of the immune-inflammatory response during treatment appear to play a role in the clinical efficacy of sertraline.
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Affiliation(s)
- Ahmed Jasim Twayej
- Pathological Analysis Department, College of Health and Medical Techniques, Al-Kafeel University, Najaf, Iraq
| | | | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.,School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, Australia
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Al-Dujaili AH, Al-Hakeim HK, Twayej AJ, Maes M. Total and ionized calcium and magnesium are significantly lowered in drug-naïve depressed patients: effects of antidepressants and associations with immune activation. Metab Brain Dis 2019; 34:1493-1503. [PMID: 31292851 DOI: 10.1007/s11011-019-00458-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023]
Abstract
Major depressive disorder (MDD) is associated with alterations in calcium (Ca) and magnesium (Mg), as well as circulating pro- and anti-inflammatory cytokines. Anti-inflammatory drugs are commonly used as adjuvant treatments for MDD. However, no studies examined the effects of a combinatorial treatment with sertraline and ketoprofen, an anti-inflammatory drug, on Ca and Mg levels in MDD. The present study examined a) differences in both cations between drug-naïve MDD patients and controls, and b) the effects of sertraline and ketoprofen on Ca and Mg (both total and ionized). In the same patients, we also examined the associations between both cations and IL-1β, IL-4, IL-6, IL-18, IFN-γ, TGF-β1, zinc, and indoleamine 2,3-dioxygenase (IDO). Clinical improvement was assessed using the Beck Depression Inventory-II (BDI-II) at baseline and after follow up for 2 months. Serum Ca and Mg (total and ionized) were significantly lower in MDD patients as compared with controls, while treatment significantly increased calcium but decreased magnesium levels. There were significant and inverse correlations between the BDI-II scores from baseline to endpoint and Ca (both total and ionized), but not Mg, levels. The effects of calcium on the BDI-II score remained significant after considering the effects of zinc, IDO and an immune activation z unit-weighted composite score based on the sum of all cytokines. There was a significant and inverse association between this immune activation index and calcium levels from baseline to endpoint. In conclusion, lowered levels of both cations play a role in the pathophysiology of major depression. Antidepressant-induced increases in Ca are associated with clinical efficacy and attenuation of the immune response. The suppressant effect of antidepressants on Mg levels is probably a side effect of those drugs. New antidepressant treatments should be developed that increase the levels both Ca and Mg. Graphical abstract.
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Affiliation(s)
| | | | - Ahmed Jasim Twayej
- Pathological Analysis Department, College of Health and Medical, Al-Kafeel University, Najaf, Iraq
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
- IMPACT Strategic Research Center, Barwon Health, Deakin University, Geelong, VIC, Australia.
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