Positive Health Online

Abstract

BOT and COLLEAGUES, Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands studied the relationship between pre-treatment markers of inflammation and treatment response in patients with coronary heart disease (CHD) and major depression.

Background

Treatment-resistant depression has recently emerged as a marker of increased risk for morbidity and mortality in patients with coronary heart disease (CHD). Studies in depressed patients without CHD suggest that elevated markers of inflammation predict poor response to treatment. This may help to explain the increased risk of cardiac events associated with depression.

Methodology

This was a planned, secondary analysis of a clinical trial in which 122 patients with CHD and comorbid major depression were randomly assigned to 50 mg of sertraline plus 2 g/day omega-3 fatty acids or to 50 mg of sertraline plus 2 g/day corn oil placebo capsules for ten weeks. Depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II). Blood samples were collected at baseline to determine levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumour necrosis factor alpha (TNF-alpha). The primary outcome was the post-treatment BDI-II depression score.

Results

Baseline levels of hs-CRP, IL-6, and TNF-alpha were not associated with the 10-week post-treatment depression score (P=.89, P=.88, and P=.31, respectively). Treatment responders (>50% reduction from baseline BDI-II score) did not differ from non-responders in either baseline hs-CRP, IL-6, or TNF-alpha (P=.83, P=.93, and P=.24, respectively). Similarly, depression remitters (BDI-II <=8 at post-treatment) did not differ from non-remitters on the three baseline inflammation markers.

Conclusion

These findings do not support the hypothesis that elevated baseline inflammatory markers predict poor response to sertraline in patients with CHD and major depression. The explanation for the increased risk of cardiac events associated with poor response to depression treatment remains unclear.

References

Bot M, Carney RM, Freedland KE, Rubin EH, Rich MW, Steinmeyer BC and Mann DL. Inflammation and treatment response to sertraline in patients with coronary heart disease and comorbid major depression. Source Journal of Psychosomatic Research. 71(1):13-7. Jul 2011. Other ID Source: NLM. NIHMS256934 [Available on 07/01/12] Source: NLM. PMC3115530 [Available on 07/01/12]