Angela Carlier1, Johanna G Berkhof2, Maarten Rozing3, Filip Bouckaert4, Pascal Sienaert5, Piet Eikelenboom2, Robert Veerhuis6, Mathieu Vandenbulcke7, Johannes Berkhof8, Max L Stek9, Didi Rhebergen9, Annemiek Dols9, Eric van Exel9. 1. GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands. Electronic address: a.carlier@ggzingeest.nl. 2. GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands. 3. Section of General Practice, Department of Public Health, University of Copenhagen. 4. KU Leuven, University Psychiatric Centre KU Leuven, department of Old Age Psychiatry, Leuven/Kortenberg, Belgium; KU Leuven, University Psychiatric Centre KU Leuven, Academic Center for ECT and Neuromodulation, Leuven/Kortenberg, Belgium. 5. KU Leuven, University Psychiatric Centre KU Leuven, Academic Center for ECT and Neuromodulation, Leuven/Kortenberg, Belgium. 6. Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Chemistry department, the Netherlands. 7. KU Leuven, University Psychiatric Centre KU Leuven, department of Old Age Psychiatry, Leuven/Kortenberg, Belgium. 8. Amsterdam UMC, Vrije Universiteit Amsterdam, department of Epidemiology & Biostatistics, the Netherlands. 9. GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute and NCA Neuroscience Amsterdam, the Netherlands.
Abstract
BACKGROUND: Compelling evidence links elevated levels of C-reactive protein (CRP) and other inflammatory markers to poor treatment outcome of antidepressant medication. Little is known about the contribution of low-grade inflammation to treatment response to electroconvulsive therapy (ECT) in severely depressed patients. METHOD: Associations between serum levels of CRP, interleukin-6, interleukin-10, and tumour necrosis factor-α as well as remission of depression, time to remission, and speed of decline of depressive symptoms were examined in 95 older (mean age: 73.1 years) depressed patients treated with ECT. RESULTS: Moderately elevated levels of CRP at baseline (3 to 10 mg/L), but no other inflammatory markers, were associated with higher remission rates. In patients with moderately elevated CRP levels, the odds ratio for remission was 3.62 (95% confidence interval [CI], 1.09-11.97; p = 0.04). Time to remission was shorter in those with moderately elevated CRP levels (p = 0.05). Speed of decline was higher in patients with moderately elevated CRP levels as compared with those with low CRP levels (decline of 3.2 Montgomery Åsberg Depression Rating Scale points per administration vs. 2.3 points per administration, p = 0.03). LIMITATIONS: Because of the observational design, residual confounding through other lifestyle or demographic factors cannot be ruled out. CONCLUSIONS: Although earlier studies showed that low-grade inflammation contributes to poor treatment response in those treated with antidepressants, our study provides clues that low-grade inflammation does not have such a detrimental effect on the treatment response to ECT. This is underscored by our finding that moderately elevated CRP levels were associated with increased remission rates in depressed patients treated with ECT. Replication studies are warranted.
BACKGROUND: Compelling evidence links elevated levels of C-reactive protein (CRP) and other inflammatory markers to poor treatment outcome of antidepressant medication. Little is known about the contribution of low-grade inflammation to treatment response to electroconvulsive therapy (ECT) in severely depressedpatients. METHOD: Associations between serum levels of CRP, interleukin-6, interleukin-10, and tumour necrosis factor-α as well as remission of depression, time to remission, and speed of decline of depressive symptoms were examined in 95 older (mean age: 73.1 years) depressedpatients treated with ECT. RESULTS: Moderately elevated levels of CRP at baseline (3 to 10 mg/L), but no other inflammatory markers, were associated with higher remission rates. In patients with moderately elevated CRP levels, the odds ratio for remission was 3.62 (95% confidence interval [CI], 1.09-11.97; p = 0.04). Time to remission was shorter in those with moderately elevated CRP levels (p = 0.05). Speed of decline was higher in patients with moderately elevated CRP levels as compared with those with low CRP levels (decline of 3.2 Montgomery Åsberg Depression Rating Scale points per administration vs. 2.3 points per administration, p = 0.03). LIMITATIONS: Because of the observational design, residual confounding through other lifestyle or demographic factors cannot be ruled out. CONCLUSIONS: Although earlier studies showed that low-grade inflammation contributes to poor treatment response in those treated with antidepressants, our study provides clues that low-grade inflammation does not have such a detrimental effect on the treatment response to ECT. This is underscored by our finding that moderately elevated CRP levels were associated with increased remission rates in depressedpatients treated with ECT. Replication studies are warranted.
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