Effects of fluoxetine and escitalopram on C-reactive protein in patients of depression

Abstract

Objective:To study the anti-inflammatory activity of fluoxetine and escitalopram in newly diagnosed patients of depression and also to evaluate the association between depression and inflammation.Materials and Methods:Ninety-eight newly diagnosed patients of depression were recruited as cases. From these, 48 had started treatment with fluoxetine (20 mg/day) and 50 had started treatment with escitalopram (20 mg/day). After 2 months of treatment of these patients, Hamilton rating scale for depression (HRSD scale), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count were measured and compared to their respective baseline values before starting treatment. One hundred healthy volunteers were recruited as controls and their baseline of CRP, ESR and WBC count were measured and compared with their respective baseline values of cases. Severity of depression was measured by HRSD scale and anti-inflammatory activity was measured by reduction CRP, ESR and WBC count.Results:On baseline comparison between cases and controls, there were significant increases in the levels of CRP (P = 0.014), ESR (P = 0.023) and WBC count (P = 0.020) in cases. In fluoxetine (20 mg/day) treatment group, there was a significant reduction in the levels of CRP (P = 0.046), ESR (P = 0.043) and WBC count (P = 0.021) after 2 months of treatment but no significant reduction in HRSD scale (P = 0.190). Similarly, in escitalopram treatment group, there was a significant reduction in CRP (P = 0.041), ESR (P = 0.030) and WBC count (P = 0.017) after 2 months of treatment but no significant reduction in HRSD scale (P = 0.169).Conclusion:In newly diagnosed patients of depression, inflammatory markers such as CRP, ESR and WBC count were significantly raised and Selective serotonin reuptake inhibitors SSRIs such as fluoxetine and escitalopram reduced them independent of their antidepressant effect. So, SSRIs have some anti-inflammatory activity independent of their antidepressant action.

Escitalopram Ameliorates Cardiomyopathy in Type 2 Diabetic Rats via Modulation of Receptor for Advanced Glycation End Products and Its Downstream Signaling Cascades

“…Besides its antioxidant effect, escitalopram attenuated HFFD/ STZ-induced cardiac inflammation and fibrosis where it significantly reduced NF-κB p65, TNF-α and TGF-β1 contents in cardiac tissues of HFFD/STZ diabetic rats. The present results confirm the anti-inflammatory and anti-fibrotic actions of escitalopram that have been documented in both experimental and clinical studies (Bah et al, 2011;Chavda et al, 2011;van Noort et al, 2014;Ibrahim et al, 2019). The aforementioned antioxidant activity of escitalopram, observed herein, might contribute to the inhibition of NF-κB p65 with the subsequent reduction of TNF-α and TGF-β1 contents.…”

Inflammation and depression: combined use of selective serotonin reuptake inhibitors and NSAIDs or paracetamol and psychiatric outcomes

“… 2010 ; Chavda et al. 2011 ), probably due to Cyclooxygenase-2 (COX-2) inhibition (Taler et al. 2007 ; Knights et al.…”

Mirtazapine Treatment of a Severe Depressive Episode and Resolution of Elevated Inflammatory Markers

“…The anti-inflammatory properties of SSRIs have been documented [6, 9, 10], although the extent to which these correlate with the effects of these drugs on depressive symptoms remains uncertain. Response to antidepressant treatment using mirtazapine, however, has been shown to correlate with significant effects on inflammatory cytokines in a double-blind placebo controlled study of patients with depression postmyocardial infarction [7].…”

“…There is growing evidence that not only tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) but also newer noradrenergic and specific serotonergic antidepressants (NaSSAs) such as mirtazapine may modulate the inflammatory response as part of their mode of action [5]. Reduction in the levels of inflammatory markers such as CRP, the Erythrocyte Sedimentation Rate (ESR), and White Cell Count (WCC) has been observed in direct response to SSRI treatment, although it remains unclear how this relates to the therapeutic effect of antidepressants [6]. …”