How treatment affects peripheral inflammatory markers in mood disorders:: A systematic review

Wijayaweera, Sahan S. and Hou, Ruihua (2018) How treatment affects peripheral inflammatory markers in mood disorders:: A systematic review. Summer meeting of British association of psychopharmacology, , London, United Kingdom. 22 - 25 Jul 2018. p. 86 .

Record type: Conference or Workshop Item (Other)

Abstract

Introduction: Targeting inflammation as a means of improving outcome in mood disorders has been a growing area of interest in research. Studies have demonstrated that non steroidal anti-Inflammatory drugs and Cyclo-oxygenase 2 inhibitors reduce inflammatory levels and improve outcome in mood disorders. The aim of our review was to assess current evidence from randomised controlled trials (RCT) investigating how pharmacological or psychological interventions affect peripheral inflammatory marker levels and clinical outcomes in patients with mood disorders. Methods: We performed a systematic search of literature using the following databases: EMBASE, Pubmed, COCHRANE, Web of Science and OVID, published before28th February 2018 and supplemented with manual searches. We used combinations of following search terms: Randomized Control Trial, C-reactive protein, cytokine, biomarker, depression, bipolar disorder, posttraumatic disorder, anxiety disorders and their variants. Screening, data extraction and quality assessment were conducted. Primary outcome measures were pre and post treatment levels of peripheral inflammatory cytokines and assessment of depression using rating scales. Results: Five RCTs were identified for qualitative review: four studies were Major Depressive Disorder and one was Bipolar Disorder. Probiotic supplements(n=40) significantly reduced high-sensitivity-C-Reactive Protein (hs-CRP) levels (p=0.03) and Beck Depression Inventory (BDI) scores (p=0.001). Infliximab (n=60) demonstrated reduction in Hamilton Scale for Depression(HAM-D) with a baseline hs-CRP > 5mg/L, while with baseline hs-CRP < 5mg/L placebo demonstrated reduction in HAM-D. In terms of HAM-D scores, there were no overall difference between two groups. In treatment responders baseline hs-CRP level was significantly reduced in Infliximab treated group compared to placebo. In the Vitamin D study (n=40) both groups had low Vitamin D at baseline. In the Vitamin Dgroup BDI was reduced significantly (p=0.04). Reduction of hs-CRP levels were not significant (p=0.80).Narrative Cognitive Therapy (NCT) and Cognitive Behaviour Therapy (CBT) Hamilton Depression Rating Scale (HDRS) scores were reduced significantly(p=<0.001) while CBT significantly reduced TNF α (p=0.05)and IL-6 (p=0.042). The Bipolar II Depression study assessed Memantine as an adjunct to Valproic Acid (n =214). TNF α levels were significantly lower in the Memantine treated group (p=0.013). HDRS (p=0.739) and Young Mania Rating Scale (p=0.972) failed to significantly improve between the groups. Conclusions: Data from eligible RCTs suggest neuroinflammatory pathway may underlie the beneficial effects of treatment in mood disorders, especially in Depression and sub-groups of individuals with high level of inflammation at baseline. Diversity of treatments and small sample sizes limited interpretation of the current review. Larger prospective studies are warranted.

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