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. 2013 Oct 22;3(10):e314.
doi: 10.1038/tp.2013.87.

The association between immune activation and manic symptoms in patients with a depressive disorder

K Becking  1 , L Boschloo, N Vogelzangs, B C M Haarman, R Riemersma-van der Lek, B W J H Penninx, R A Schoevers
Affiliations

The association between immune activation and manic symptoms in patients with a depressive disorder

K Becking et al. Transl Psychiatry. .

Abstract

Although recent studies have shown that immunological processes play an important role in the pathophysiology of mood disorders, immune activation may only be present in specific subgroups of patients. Our study aimed to examine whether immune activation was associated with (a) the presence of manic symptoms and (b) the onset of manic symptoms during 2 years of follow-up in depressed patients. Patients with a depressive disorder at baseline (N=957) and healthy controls (N=430) were selected from the Netherlands Study of Depression and Anxiety. Assessments included lifetime manic symptoms at baseline and two-year follow up, as well as C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) at baseline. Within depressed patients, immune activation was not related to the presence or absence of lifetime manic symptoms at baseline. However, CRP levels were strongly elevated in depressed men who developed manic symptoms compared with those who did not develop manic symptoms over 2 years (P<0.001, Cohen's d=0.89). IL-6 and TNF-α were also higher in depressed men with an onset of manic symptoms, but this association was not significant. However, we found that the onset of manic symptoms was particularly high in men with multiple elevated levels of inflammatory markers. Depressed men who developed manic symptoms during follow-up had increased immunological activity (especially CRP) compared with depressed men who did not develop manic symptoms. Further research should explore whether a treatment approach focusing on inflammatory processes may be more effective in this specific subgroup of depressed patients.

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Figures

Figure 1
Figure 1
Flow-chart for the cross-sectional and prospective analyses.
Figure 2
Figure 2
Shape of relation between inflammatory markers and linear relationship between the number of highest quartiles and onset of manic symptoms in men. Q1–Q4: quartiles of inflammatory markers. P-values in figure are the overall P-values based on χ2-tests.
See this image and copyright information in PMC

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