Depression in patients with mastocytosis: prevalence, features and effects of masitinib therapy

Abstract

Depression in patients with mastocytosis is often reported but its prevalence and characteristics are not precisely described. In addition, the impact of therapies targeting mast cells proliferation, differentiation and degranulation on psychic symptoms of depression have never been investigated. Our objective was to determine the prevalence and to describe features of depression in a large cohort of mastocytosis patients (n = 288) and to investigate the therapeutic impact of the protein kinase inhibitor masitinib in depression symptoms. The description of depression was based on the analysis of a database with Hamilton scores using Principal Component Analysis (PCA). Efficacy of masitinib therapy was evaluated using non parametric Wilcoxon test for paired data within a three months period (n = 35). Our results show that patients with indolent mastocytosis present an elevated prevalence of depression (64%). Depression was moderate in 56% but severe in 8% of cases. Core symptoms (such as psychic anxiety, depressed mood, work and interests) characterized depression in mastocytosis patients. Masitinib therapy was associated with significant improvement (67% of the cases) of overall depression, with 75% of recovery cases. Global Quality of Life slightly improved after masitinib therapy and did not predicted depression improvement. In conclusion, depression is very frequent in mastocytosis patients and masitinib therapy is associated with the reduction its psychic experiences. We conclude that depression in mastocytosis may originate from processes related to mast cells activation. Masitinib could therefore be a useful treatment for mastocytosis patients with depression and anxiety symptoms.

Figure 1. Symptoms of depression from the Ham-D17 in non depressed, mild-moderate and severe depressed patients with mastocytosis.

Chi square test was performed to compare groups item by item. Severe depression was characterized by a huge prevalence of impairment in work and activities (97%), depressed mood (95%), somatic anxiety (83%), guilt (61%) and genital symptoms (56%). Mild-moderate depression was characterized by a higher prevalence of late insomnia (22%), agitation (37%), psychic anxiety (44%) and hypochondriasis (34%).

Figure 2. Depression improvement following masitinib therapy.

A. Mean total score in depression reduced significantly at the end of the trial (p = .0001); pre-mean Ham-D17 = 11.23 (S.D. = 6.8); post-mean Ham-D17 = 6.97 (S.D. = 6.9). B. Mean score in sleep disturbances dimension reduced significantly at the end of the trial (p = .0112); pre-mean Ham-D17 = 1.57 (S.D. = 1.5); post-mean Ham-D17 = 1.00 (S.D. = 1.3). C. Mean score in anxious depression dimension reduced significantly at the end of the trial (p = .0004); pre-mean Ham-D17 = 5.83 (S.D. = 4.0); post-mean Ham-D17 = 3.77 (S.D. = 3.9). + Exclusion of this patient from the analysis did not change the results. * (p≤0.05); ** (p≤0.0005); *** (p≤0.0001).