Effects of SSRIs on inflammatory markers in patients with major depressive disorder:: a systematic review and meta-analysis

Hou, Ruihua, Wang, Lina, Wang, Ruzhan, Qiao, Dongdong and Baldwin, David (2017) Effects of SSRIs on inflammatory markers in patients with major depressive disorder:: a systematic review and meta-analysis. Summer Meeting of the British Association for Psychopharmacology, , Harrogate, United Kingdom. 23 - 26 Jul 2017. p. 55 .

Abstract

Introduction: Peripheral levels of inflammatory markers are elevated in major depressive disorder (MDD).Selective serotonin reuptake inhibitors (SSRIs) affect levels of inflammatory markers in patients withMDD, but studies have reported inconsistent findings. This systematic review and meta-analysis aims toinvestigate the effects of SSRIs treatment on peripheral levels of a range of inflammatory markers in MDDpatients. Methods: Systematic literature search (Pubmed, Web of Science, Embase, Cochrane) for trialspublished before November 2016 were conducted. Studies were included if they used SSRI monotherapyand peripheral levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, andinterferon (IFN)-γ were measured before and after treatment in patients with MDD. Meta-analysis wasconducted using Comprehensive Meta-analysis (version 2). Effect sizes were calculated using biascorrected standardized mean difference (Hedges’ g) between pre- and post-treatment. Sub-group analysesand publication bias estimates were undertaken; sensitivity analyses were performed using differentestimated pre- and post-treatment correlations and after removing poor quality studies. Results: Sixteeneligible studies including 570 MDD patients were included in the meta-analysis: 10 studies for IL-6; 7 forTNF-α; 5 for IL-1β, IL-4 and IL-10; 4 for IL-2; and 3 for IFN-γ. The pooled effect estimate indicates SSRI treatment decreased levels of pro-inflammatory markers IL-6 (Hedges’ g, -0.428; 95%CI, -0.699 to -0.158;I2=84.867) and IL-1β (Hedges’ g=-0.873; 95%CI, -1.702 to -0.043; I2=94.237), and anti-inflammatory markerIL-10 (Hedges’ g=-0.535; 95%CI, -0.987 to -0.084; I2=84.369). There were no significant treatment effects onlevels of IL-2, IL-4, TNF-α, or IFN-γ. There was a high level of heterogeneity between studies. Sub-group analyses on studies involving IL-6 indicated the high heterogeneity was not explained by age, gender, sample size, drug dosage, study duration or study design. No evidence of publication bias was found. Sensitivity analyses indicated the robustness of the primary analyses. Conclusions: High heterogeneity between studies limits interpretation, but meta-analysis indicates moderate immunoregulatory effects of SSRIs treatment for MDD, which suggests SSRIs may owe some of their therapeutic effect to their anti-inflammatory properties

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Contributors

Author: Ruihua Hou

Author: David Baldwin

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