Inflammatory and Metabolic Dysregulation and the 2-Year Course of Depressive Disorders in Antidepressant Users

Abstract

Scarce evidence suggests that inflammatory and metabolic dysregulation predicts poor response to antidepressants, which could result in worse depression outcome. This study prospectively examined whether inflammatory and metabolic dysregulation predicted the 2-year course of depressive disorders among antidepressant users. Data were from the Netherlands Study of Depression and Anxiety, including 315 persons (18-65 years) with a current depressive disorder (major depressive disorder, dysthymia) at baseline according to the DSM-IV criteria and using antidepressants. Inflammatory (C-reactive protein, interleukin-6 (IL-6), tumor-necrosis factor-a) and metabolic (waist circumference, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, fasting glucose) factors were measured at baseline. Primary outcome for course of depression was indicated by whether or not a DSM-IV depressive disorder diagnosis was still/ again present at 2-year follow-up, indicating chronicity of depression. Elevated IL-6, low HDL cholesterol, hypertriglyceridemia, and hyperglycemia were associated with chronicity of depression in antidepressant users. Persons showing X4 inflammatory or metabolic dysregulations had a 1.90 increased odds of depression chronicity (95% CI ¼ 1.12-3.23). Among persons who recently (ie, at most 3 months) started antidepressant medication (N ¼ 103), having X4 dysregulations was associated with a 6.85 increased odds of depression chronicity (95% CI ¼ 1.95-24.06). In conclusion, inflammatory and metabolic dysregulations were found to predict a more chronic course of depressive disorders among patients using antidepressants. This could suggest that inflammatory and metabolic dysregulation worsens depression course owing to reduced antidepressant treatment response and that alternative intervention treatments may be needed for depressed persons with inflammatory and metabolic dysregulation.

Association of treatment response with obesity and other metabolic risk factors in adults with depressive disorders: Results from a National Depression Cohort study in Korea (the CRESCEND study)

“…The results from this study were also in accordance with a report by Vogelzangs et al (Vogelzangs et al, 2014). They prospectively examined whether inflammatory and metabolic dysregulation predicted outcomes in 315 patients with depressive disorders receiving antidepressant treatment for 2 years.…”

“…Because visceral adiposity is associated with insulin resistance, dyslipidemia, and systemic inflammation (Lee and Pratley, 2005), the lower predictive power of BMI for visceral adiposity in men could mask the effect of obesity and allow observation of only the effect of metabolic condition on insufficient treatment response. Moreover, Asian men possess a greater amount of visceral adipose tissue than do women at the same level of BMI and are therefore more likely to experience related inflammation (Vogelzangs et al, 2014).…”

“…In a separate study, Vogelzangs et al (Vogelzangs et al, 2014) followed patients with depressive disorders (MDD and dysthymia) who were in antidepressant treatment for 2 years and measured baseline values of metabolic and inflammatory factors. The study found that the co-occurrence of four or more metabolic/inflammatory dysregulations in an individual with depressive disorders negatively affected the clinical course and treatment outcome.…”

N-acetylcysteine as add-on to antidepressant medication in therapy refractory major depressive disorder patients with increased inflammatory activity: study protocol of a double-blind randomized placebo-controlled trial

“…Although an earlier study by Berk et al failed to demonstrate overall significant beneficial effects of NAC supplementation to regular antidepressant treatment at 12-week end point [10], a secondary analysis suggested a positive effect of NAC in patients with more severe depression. In contrast to the present study inflammatory activity was not specifically assessed in the study by Berk et al [10] but work from our own group has shown that increased inflammatory activity is related to non-response in depressed patients treated with antidepressants [7]. By sharpening the inclusion criteria in the present study, we expect to reduce heterogeneity of the patient sample, diminish possible confounding effects by other medications and develop a tailored intervention for patients with mood disorder with inflammatory dysregulation who have do not respond to regular phases of antidepressant treatment.…”

Anti-depression Medication Taking And Risk Of Metabolic Syndrome Among US Citizens Aged 60+ Years: An Across-sectional Analysis Of The NHANES 2007-2008

“…However, seniors are often with large degree of medical co-morbidity, especially vascular diseases, or with much unfavorable profile of inflammatory and metabolic dysregulations, which may contribute to the development of depression in late life [5][6][7][8][9][10]; while antidepressants use are often associated with weight gain and metabolic abnormalities [11][12][13]. As drug therapy is often selected as a primary mode of management in depression and the antidepressants now rank as the most frequently dispensed prescription medication in the US [14], the risk for metabolic syndrome (MS) among seniors is particularly a concern.…”