Probable Autoimmune Depression in a Patient With Multiple Sclerosis and Antineuronal Antibodies

Abstract

Background: In a subgroup of patients with mood disorders, clear-cut organic disorders are responsible for depressive symptoms (e.g., autoimmune diseases such as multiple sclerosis or systemic lupus erythematosus). In these cases, an organic affective disorder can be diagnosed. Case Presentation: The authors present the case of a 59-year-old male patient who developed a severe depressive episode over approximately 6 months and was, therefore, admitted to the hospital. In retrospect, he reported that, at age 39, he suffered from selflimiting sensory disturbances and muscle weakness in both legs. The current magnetic resonance imaging of his brain showed several conspicuous FLAIR-hyperintense supratentorial white matter lesions compatible with chronic inflammatory brain disease. Imaging of the spinal axis revealed no clear spinal lesions. Cerebrospinal fluid (CSF) analyses showed CSF-specific oligoclonal bands. Therefore, multiple sclerosis was diagnosed. Further CSF analyses, using tissue-based assays with indirect immunofluorescence on unfixed murine brain tissue, revealed a (peri-)nuclear signal and a strong neuritic signal of many neurons, especially on granule cells in the cerebellum, hippocampus, and olfactory bulb, as well as in the corpus callosum. Additionally, antinuclear antibody (ANA) titers of 1:12,800 and a lymphopenia were detected in blood tests. Further system clarification showed no suspicion of rheumatic or oncological disease. Anti-inflammatory treatment led to rapid and sustained improvement. Conclusion: The present patient suffered from a probable "autoimmune depression" in the context of newly diagnosed multiple sclerosis with typical MRI and CSF pathologies, alongside mild concomitant latent systemic autoimmune process (with high-titer ANAs and lymphopenia) and unknown antineuronal antibodies. The case report illustrates that a

Current Knowledge of the Antidepressant Activity of Chemical Compounds from Crocus sativus L.

“…The major depressive disorder has a neuroprogressive nature [ 23 , 24 ] with accelerated cellular aging [ 25 , 26 , 27 , 28 , 29 ], and a higher risk of co-morbid somatic age-related diseases [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Neuroprogression recognised at the clinical, structural, and biochemical levels in the major depressive disorder includes stage-related neurodegeneration, cell death, reduced neurogenesis, reduced neuronal plasticity, and increased autoimmune responses [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Depression in its endogenous form accompanies many organic diseases (including infectious diseases), as well as being related to disease processes or treatment (e.g., pharmacologically induced immune-related depression).…”