Creatine kinase levels in patients with bipolar disorder: depressive, manic, and euthymic phases

Abstract

Objective: Bipolar disorder is a severe, recurrent, and often chronic psychiatric illness associated with significant functional impairment, morbidity, and mortality. Creatine kinase is an important enzyme, particularly for cells with high and fluctuating energy requirements, such as neurons, and is a potential marker of brain injury. The aim of the present study was to compare serum creatine kinase levels between bipolar disorder patients, in the various phases (depressive, manic, and euthymic), and healthy volunteers. Method: Forty-eight bipolar patients were recruited: 18 in the euthymic phase; 17 in the manic phase; and 13 in the depressive phase. The control group comprised 41 healthy volunteers. The phases of bipolar disorder were defined as follows: euthymic-not meeting the DSM-IV criteria for a mood episode and scoring < 8 on the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS); manic-scoring < 7 on the HDRS and > 7 on the YMRS; depressive-scoring > 7 on the HDRS and < 7 on the YMRS. Patients in mixed phases were excluded. Blood samples were collected from all participants. Results: Creatine kinase levels were higher in the manic patients than in the controls. However, we observed no significant difference between euthymic and depressive patients in terms of the creatine kinase level. Conclusion: Our results suggest that the clinical differences among the depressive, manic, and euthymic phases of bipolar disorder are paralleled by contrasting levels of creatine kinase. However, further studies are needed in order to understand the state-dependent differences observed in serum creatine kinase activity. Descriptors

Proteomic investigation of the prefrontal cortex in the rat clomipramine model of depression

“…The literature related to association between CKB levels and depression is controversial in some aspects. The increase in the level of CKB in the serum of non-psychotic major depression patients had been revealed previously in comparison with other types of depression syndromes [42], and in the serum of bipolar disorder patients in manic phase [43]. The activity of this protein was also increased in the PFC of rats after chronic treatment with the antidepressant paroxetine [44].…”

Depressive symptoms of female nursing staff working in stressful environments and their association with serum creatine kinase and lactate dehydrogenase – a preliminary study

“…In humans, depression is often comorbid with other chronic diseases and can worsen their associated health outcomes [4]. Previous studies have suggested that the activities of serum enzymes such as creatine kinase (CK) are potentially involved in several types of depression [5,6]. Segal et al investigated the total activity of serum CK in various forms of depression, including major depression with or without psychotic symptoms, bipolar depression, and schizoaffective depression [5].…”

“…Their results showed that serum CK activity in nonpsychotic major depression was significantly higher than that in all other forms of depression. Additionally, Feier and colleagues reported that the serum CK activity of bipolar depression patients was higher than that of healthy control subjects and depressed patients [6]. CK is an enzyme that catalyzes the reversible phosphorylation of ATP and creatine to ADP and phosphocreatine, and it plays an important role in the regulation and maintenance of cellular energy metabolism [7,8].…”

“…Several previous studies have suggested that serum enzymes related to muscle origin, such as CK or LDH, appear to be associated with psychiatric illnesses, including mania, depression, and bipolar disorder [5,6,14,15]. In particular, mania appears to induce the release of CK and LDH from skeletal muscle, occasionally at unusually high levels, and these enzymes are presumably released from skeletal muscle in association with agitation, muscle tension, or blood stasis and local tissue hypoxia consequent to hypoactivity [14].…”

“…In bipolar disorder, Segal et al have also shown that CK activity was higher in the manic phase than in the depressive phase, suggesting that clinical differences between the manic and depressive states are supported by contrasting levels of CK [15]. Additionally, Feier et al have similarly shown that serum CK activity in the manic phase was higher than that in the depressive phase of bipolar disorder and that it was also higher than activity in healthy volunteer controls [6]. In the present study, the depressive symptoms evaluated by CES-D were also negatively correlated not only with the serum enzyme activities of muscle-related CK and LDH, but also with the protein levels of serum CK-MM, even in physiological healthy nursing staff working in conditions that produced work-related stress.…”