Supplementary Files
Keywords
Escitalopram
Major Depressive Disorder
Remission
Treatment-resistance
How to Cite
Abstract
Abstract
Objective: C-reactive protein (CRP) is an indicator of the inflammatory process in the body, and is associated with the pathogenesis of depression through its purported effect on neurotransmitter function in the brain. Current research aims to study the relationship between the levels of CRP and the rate of remission of major depressive disorder with first-line antidepressant therapy.
Methods: This hospital-based prospective study included thirty patients by purposive sampling technique. Patients with first-episode MDD with no history of antidepressant exposure and other medical comorbidity were recruited for pharmacotherapy with escitalopram, a first-line antidepressant. Patients taking antidepressants, anti-inflammatory medicines, having co-morbid conditions or other psychiatric conditions were excluded. The baseline CRP levels were measured and depressive symptoms were evaluated using the Hamilton Rating Scale for Depression (HRSD) at weeks 0, 6 and 12. The patients with low (≤5 mg/l) and high (>5 mg/l) CRP levels were compared for remission rates at week 12 using Kaplan–Meier survival analysis.
Results: Amongst the 30 cases, 11(36.7%) were males and 19(63.3%) were female patients. The mean age was 35.95±7.85 years. Both groups were matched concerning age, gender, BMI and baseline HRSD score (p>0.05). As per Kaplan–Meier survival analysis, a significantly higher proportion of patients had remission of MDD at the 12th week having CRP levels ≤5 mg/l than the patients with CRP levels >5 mg/dl (p=0.002).
Conclusion: This research concluded that after an adequate trial with a standard antidepressant, higher levels of CRP could lead to poorer remission rates in MDD subjects and could represent a sub-group of patients with treatment resistance.
References
Gutiérrez-Rojas L, Porras-Segovia A, Dunne H, Andrade-González N, Cervilla JA. Prevalence and correlates of major depressive disorder: a systematic review. Braz J Psychiatry 2020; 42: 657-72. DOI: 10.1590/1516-4446-2020-0650.
Beurel E, Toups M, Nemeroff CB. The bidirectional relationship of depression and inflammation: double trouble. Neuron 2020; 107: 234-256. doi: 10.1016/j.neuron.2020.06.002.
Pitsillou E, Bresnehan SM, Kagarakis EA, Wijoyo SJ, Liang J, Hung A, Karagiannis TC. The cellular and molecular basis of major depressive disorder: towards a unified model for understanding clinical depression. Mol Biol Rep 2020; 47: 753-70. doi: 10.1007/s11033-019-05129-3.
Więdłocha M, Marcinowicz P, Krupa R, Janoska-Jaździk M, Janus M, Dębowska W, Mosiołek A, Waszkiewicz N, Szulc A. Effect of antidepressant treatment on peripheral inflammation markers–A meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018 Jan 3;80:217-26.
Köhler CA, Freitas TH, Stubbs B, Maes M, Solmi M, Veronese N, de Andrade NQ, Morris G, Fernandes BS, Brunoni AR, Herrmann N. Peripheral alterations in cytokine and chemokine levels after antidepressant drug treatment for major depressive disorder: systematic review and meta-analysis. Molecular neurobiology. 2018 May;55:4195-206.
Osimo EF, Baxter LJ, Lewis G, Jones PB, Khandaker GM. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychological medicine. 2019; 49: 1958-70. DOI: 10.1017/S0033291719001454.
Wium-Andersen MK, Ørsted DD, Nielsen SF, Nordestgaard BG. Elevated C-reactive protein levels, psychological distress, and depression in 73, 131 individuals. JAMA Psychiatry 2013; 70: 176-84. doi: 10.1001/2013.jamapsychiatry.102.
Orsolini L, Pompili S, Valenta ST, Salvi V, Volpe U. C-Reactive Protein as a biomarker for major depressive disorder? International journal of molecular sciences.2022; 23: 1616. DOI: 10.3390/ijms23031616.
Zhang J, Yue Y, Thapa A, Fang J, Zhao S, Shi W, Yang Z, Li Y, Yuan Y. Baseline serum C-reactive protein levels may predict antidepressant treatment responses in patients with major depressive disorder. Journal of affective disorders. 2019 May 1;250:432-8.DOI: 10.1016/j.jad.2019.03.001.
Jha MK, Minhajuddin A, Gadad BS, Greer T, Grannemann B, Soyombo A, Mayes TL, Rush AJ, Trivedi MH. Can C-reactive protein inform antidepressant medication selection in depressed outpatients? Findings from the CO-MED trial. Psychoneuroendocrinology. 2017 Apr 1;78:105-13.
Carboni L, McCarthy DJ, Delafont B, Filosi M, Ivanchenko E, Ratti E, Learned SM, Alexander R, Domenici E. Biomarkers for response in major depression: comparing paroxetine and venlafaxine from two randomised placebo-controlled clinical studies. Translational psychiatry. 2019 Aug 2;9(1):182.
Chang HH, Lee IH, Gean PW, Lee SY, Chi MH, Yang YK, Lu RB, Chen PS. Treatment response and cognitive impairment in major depression: association with C-reactive protein. Brain, behavior, and immunity. 2012 Jan 1;26(1):90-5. DOI: 10.1016/j.bbi.2011.07.239.
Haroon E, Daguanno AW, Woolwine BJ, Goldsmith DR, Baer WM, Wommack EC, Felger JC, Miller AH. Antidepressant treatment resistance is associated with increased inflammatory markers in patients with major depressive disorder. Psychoneuroendocrinology. 2018 Sep 1;95:43-9..
Eller T, Vasar V, Shlik J, Maron E. Pro-inflammatory cytokines and treatment response to escitalopram in major depressive disorder. Prog Neuro-psychopharmacol Biol Psychiatry 2008; 32: 445–50. DOI: 10.1016/j.pnpbp.2007.09.015.
Liu JJ, Wei YB, Strawbridge R, Bao Y, Chang S, Shi L, Que J, Gadad BS, Trivedi MH, Kelsoe JR, Lu L. Peripheral cytokine levels and response to antidepressant treatment in depression: a systematic review and meta-analysis. Molecular psychiatry. 2020 Feb;25(2):339-50. DOI: 10.1038/s41380-019-0474-5
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