The association of tumor necrosis factor alpha levels with Depression symptoms in Systemic lupus erythematosus patients

Abstract

Background Effects of the cytokine system, in which of tumor necrosis factor alpha (TNF-α) is a part, on serotonin metabolism as well as on the hypothalamic-pituitary-adrenal (HPA)-axis, may induce changes in the structure and function of the brain, possibly leading to the development of depression in SLE patients. For this purpose, we aimed to assess serum TNF-α levels in SLE patients, and to explore its possible relationship with depression among these patients.Methods: 60 SLE adult patients were enrolled in this study and further subdivided into two equal groups (30 with active SLE and 30 with inactive SLE) using SLEDAI score, in addition to 30 age and sex matched healthy controls. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to provide broad coverage of psychiatric diagnoses was done for all subjects, and severity of depression was assessed using Beck depression Inventory. TNF-α levels were measured using ELISA technique. Results: Depression was identified in 63.3% of active SLE group, 40% in the inactive SLE group and 16.7% in the control group with p value <0.001. TNF-α levels were higher significantly in the active group versus inactive group and control p value <0.001.In the multivariate analysis, sera TNF-α levels were independently associated with depressive symptoms odds ratio = 1.004, 95% CI = 1.001 to 1.006, p-value =0.020). Conclusions: Depression was more prevalent among SLE patients with active disease. Serum TNF-α was the only independent predictor of depression in SLE patients.