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Treatment-resistant depression and peripheral C-reactive protein

Treatment-resistant depression and peripheral C-reactive protein
Treatment-resistant depression and peripheral C-reactive protein
Background
C-reactive protein (CRP) is a candidate biomarker for major depressive disorder (MDD), but it is unclear how peripheral CRP levels relate to the heterogeneous clinical phenotypes of the disorder.

Aim
To explore CRP in MDD and its phenotypic associations.

Method
We recruited 102 treatment-resistant patients with MDD currently experiencing depression, 48 treatment-responsive patients with MDD not currently experiencing depression, 48 patients with depression who were not receiving medication and 54 healthy volunteers. High-sensitivity CRP in peripheral venous blood, body mass index (BMI) and questionnaire assessments of depression, anxiety and childhood trauma were measured. Group differences in CRP were estimated, and partial least squares (PLS) analysis explored the relationships between CRP and specific clinical phenotypes.

Results
Compared with healthy volunteers, BMI-corrected CRP was significantly elevated in the treatment-resistant group (P = 0.007; Cohen's d = 0.47); but not significantly so in the treatment-responsive (d = 0.29) and untreated (d = 0.18) groups. PLS yielded an optimal two-factor solution that accounted for 34.7% of variation in clinical measures and for 36.0% of variation in CRP. Clinical phenotypes most strongly associated with CRP and heavily weighted on the first PLS component were vegetative depressive symptoms, BMI, state anxiety and feeling unloved as a child or wishing for a different childhood.

Conclusions
CRP was elevated in patients with MDD, and more so in treatment-resistant patients. Other phenotypes associated with elevated CRP included childhood adversity and specific depressive and anxious symptoms. We suggest that patients with MDD stratified for proinflammatory biomarkers, like CRP, have a distinctive clinical profile that might be responsive to second-line treatment with anti-inflammatory drugs.
0007-1250
11-19
Chamberlain, Samuel R.
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Cavanagh, Jonathan
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De Boer, Peter
ce595446-bf0b-454c-bf71-07569568d14e
Mondelli, Valeria
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Jones, Declan N.c.
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Drevets, Wayne C.
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Cowen, Philip J.
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Harrison, Neil A.
f0c50f7d-c5a9-4ed6-a19b-e1696bbbfd30
Pointon, Linda
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Pariante, Carmine M.
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Bullmore, Edward T.
f2fa4f13-15e7-4d71-a4ca-f66d291a31a8
Chamberlain, Samuel R.
8a0e09e6-f51f-4039-9287-88debe8d8b6f
Cavanagh, Jonathan
1cda6988-26ba-4848-a73a-b79b3737ced4
De Boer, Peter
ce595446-bf0b-454c-bf71-07569568d14e
Mondelli, Valeria
6c44e128-c000-4e2d-a232-399c23c390ca
Jones, Declan N.c.
3bb83c7a-f294-43ab-94c0-3271b9fe0eb7
Drevets, Wayne C.
5f791326-89f0-4778-a92a-882f1f6a55d2
Cowen, Philip J.
93afecb5-6a05-4c3a-b6e6-3ddd73859893
Harrison, Neil A.
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Pointon, Linda
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Pariante, Carmine M.
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Bullmore, Edward T.
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Chamberlain, Samuel R., Cavanagh, Jonathan, De Boer, Peter, Mondelli, Valeria, Jones, Declan N.c., Drevets, Wayne C., Cowen, Philip J., Harrison, Neil A., Pointon, Linda, Pariante, Carmine M. and Bullmore, Edward T. (2019) Treatment-resistant depression and peripheral C-reactive protein. British Journal of Psychiatry, 214 (1), 11-19. (doi:10.1192/bjp.2018.66).

Record type: Article

Abstract

Background
C-reactive protein (CRP) is a candidate biomarker for major depressive disorder (MDD), but it is unclear how peripheral CRP levels relate to the heterogeneous clinical phenotypes of the disorder.

Aim
To explore CRP in MDD and its phenotypic associations.

Method
We recruited 102 treatment-resistant patients with MDD currently experiencing depression, 48 treatment-responsive patients with MDD not currently experiencing depression, 48 patients with depression who were not receiving medication and 54 healthy volunteers. High-sensitivity CRP in peripheral venous blood, body mass index (BMI) and questionnaire assessments of depression, anxiety and childhood trauma were measured. Group differences in CRP were estimated, and partial least squares (PLS) analysis explored the relationships between CRP and specific clinical phenotypes.

Results
Compared with healthy volunteers, BMI-corrected CRP was significantly elevated in the treatment-resistant group (P = 0.007; Cohen's d = 0.47); but not significantly so in the treatment-responsive (d = 0.29) and untreated (d = 0.18) groups. PLS yielded an optimal two-factor solution that accounted for 34.7% of variation in clinical measures and for 36.0% of variation in CRP. Clinical phenotypes most strongly associated with CRP and heavily weighted on the first PLS component were vegetative depressive symptoms, BMI, state anxiety and feeling unloved as a child or wishing for a different childhood.

Conclusions
CRP was elevated in patients with MDD, and more so in treatment-resistant patients. Other phenotypes associated with elevated CRP included childhood adversity and specific depressive and anxious symptoms. We suggest that patients with MDD stratified for proinflammatory biomarkers, like CRP, have a distinctive clinical profile that might be responsive to second-line treatment with anti-inflammatory drugs.

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More information

Accepted/In Press date: 4 March 2018
e-pub ahead of print date: 16 May 2018
Published date: 1 January 2019

Identifiers

Local EPrints ID: 443456
URI: http://eprints.soton.ac.uk/id/eprint/443456
ISSN: 0007-1250
PURE UUID: c9bf2845-70cb-43b9-9603-59ddfaa7328d
ORCID for Samuel R. Chamberlain: ORCID iD orcid.org/0000-0001-7014-8121

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Date deposited: 26 Aug 2020 16:34
Last modified: 28 Apr 2022 02:30

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Contributors

Author: Samuel R. Chamberlain ORCID iD
Author: Jonathan Cavanagh
Author: Peter De Boer
Author: Valeria Mondelli
Author: Declan N.c. Jones
Author: Wayne C. Drevets
Author: Philip J. Cowen
Author: Neil A. Harrison
Author: Linda Pointon
Author: Carmine M. Pariante
Author: Edward T. Bullmore

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