Dominique Endres1, Evgeniy Perlov2, Rick Dersch3, Annette Baumgartner3, Tilman Hottenrott3, Benjamin Berger3, Oliver Stich3, Ludger Tebartz van Elst2. 1. Section for Experimental Neuropsychiatry, Department for Psychiatry & Psychotherapy, Medical Center - University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany. Electronic address: dominique.endres@uniklinik-freiburg.de. 2. Section for Experimental Neuropsychiatry, Department for Psychiatry & Psychotherapy, Medical Center - University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany. 3. Department for Neurology, Medical Center - University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
Abstract
BACKGROUND: Depression is the most prevalent psychiatric disease. In addition to primary, idiopathic depression, there are multiple secondary organic forms. However, distinguishing the two can be difficult, information about cerebrospinal fluid (CSF) basic findings in patients with depressive syndromes is sparse. Therefore, we investigated CSF alterations in so far the largest sample of patients with depressive syndromes. We hypothesized that increased prevalence of CSF pleocytosis, blood-brain-barrier (BBB) dysfunction, and oligoclonal bands (OCBs) would be observed as possible markers of underlying immunological processes. METHODS: From January 2006 until October 2013, we performed CSF basic diagnostics in 125 patients with depressive syndromes. We also performed serum and CSF autoantibody measurements, cerebral magnetic resonance imaging (cMRI) and electroencephalography (EEG). RESULTS: Four % of the patients displayed increased CSF white blood cell counts (WBC), 46.4% had increased protein concentrations, and 19.4% had pathological albumin quotients. OCBs in the CSF were detected in 6.5%. Overall, CSF basic diagnostics were abnormal in 56%. Including instrument-based diagnostics, we found alterations in 80.8% of patients. Suicidal tendencies correlated with an increased WBC count (r=0.276, p=0.002). LIMITATIONS: In this open, uncontrolled study, we investigated mainly CSF samples of depressive patients with signs of organic features. Therefore, the study cohort is not representative of idiopathic depression. CONCLUSIONS: The main findings of this study are the high rates of pathological (although mainly unspecific) CSF findings. We discuss the findings regarding possible immunological mechanisms and the vascular depression hypothesis. If these findings are associated with low-level inflammation of the central nervous system, new treatment alternatives could be considered. More and better controlled research is necessary.
BACKGROUND:Depression is the most prevalent psychiatric disease. In addition to primary, idiopathic depression, there are multiple secondary organic forms. However, distinguishing the two can be difficult, information about cerebrospinal fluid (CSF) basic findings in patients with depressive syndromes is sparse. Therefore, we investigated CSF alterations in so far the largest sample of patients with depressive syndromes. We hypothesized that increased prevalence of CSF pleocytosis, blood-brain-barrier (BBB) dysfunction, and oligoclonal bands (OCBs) would be observed as possible markers of underlying immunological processes. METHODS: From January 2006 until October 2013, we performed CSF basic diagnostics in 125 patients with depressive syndromes. We also performed serum and CSF autoantibody measurements, cerebral magnetic resonance imaging (cMRI) and electroencephalography (EEG). RESULTS: Four % of the patients displayed increased CSF white blood cell counts (WBC), 46.4% had increased protein concentrations, and 19.4% had pathological albumin quotients. OCBs in the CSF were detected in 6.5%. Overall, CSF basic diagnostics were abnormal in 56%. Including instrument-based diagnostics, we found alterations in 80.8% of patients. Suicidal tendencies correlated with an increased WBC count (r=0.276, p=0.002). LIMITATIONS: In this open, uncontrolled study, we investigated mainly CSF samples of depressivepatients with signs of organic features. Therefore, the study cohort is not representative of idiopathic depression. CONCLUSIONS: The main findings of this study are the high rates of pathological (although mainly unspecific) CSF findings. We discuss the findings regarding possible immunological mechanisms and the vascular depression hypothesis. If these findings are associated with low-level inflammation of the central nervous system, new treatment alternatives could be considered. More and better controlled research is necessary.
Authors: Sarah A Keaton; Zachary B Madaj; Patrick Heilman; LeAnn Smart; Jamie Grit; Robert Gibbons; Teodor T Postolache; Kimberly Roaten; Eric D Achtyes; Lena Brundin Journal: J Affect Disord Date: 2019-01-03 Impact factor: 4.839
Authors: Dominique Endres; Sebastian Rauer; Nils Venhoff; Patrick Süß; Rick Dersch; Kimon Runge; Bernd L Fiebich; Kathrin Nickel; Miriam Matysik; Simon Maier; Katharina Domschke; Karl Egger; Harald Prüss; Ludger Tebartz van Elst Journal: Front Psychiatry Date: 2020-08-13 Impact factor: 4.157
Authors: Dominique Endres; Rick Dersch; Tilman Hottenrott; Evgeniy Perlov; Simon Maier; Dietrich van Calker; Benedikt Hochstuhl; Nils Venhoff; Oliver Stich; Ludger Tebartz van Elst Journal: Front Psychiatry Date: 2016-12-08 Impact factor: 4.157
Authors: M B Schou; S G Sæther; O K Drange; E Brenner; J Crespi; L Eikenes; M S Mykland; C Pintzka; A K Håberg; T Sand; A Vaaler; D Kondziella Journal: Sci Rep Date: 2019-12-31 Impact factor: 4.379