A Prospective Hospital-based Study on C-reactive Protein As a Response Predictor of Antidepressant Treatment in Drug Naïve Patients with Major Depressive Disorder

Overview

Journal Indian J Psychiatry

Specialty Psychiatry

Date 2023 Jun 16

PMID 37325099

Authors

Didakamiwan Khonglah

Arghya Pal

Nitu Mallik

Debes Ray

Malay Ghosal

Rudraprasad Acharya

Affiliations

Soon will be listed here.

Abstract

Background: C-reactive protein (CRP) is an acute phase reactant that is implicated in the pathogenesis of major depressive disorder (MDD), due to its role in the execution of various important neurological events, including neurogenesis, mediation of neural plasticity, and synaptic transmission.

Aims: This study was conducted to determine the relationship between the level of CRP to remission rates after antidepressant therapy.

Methods: Fifty patients of first episode MDD with no past history of antidepressant exposure and other medical comorbidity were recruited after obtaining consent for Escitalopram therapy. The CRP levels of the patients were evaluated on the day of recruitment and depressive symptoms were monitored using Montgomery-Asberg Depression Rating Scale at weeks 0, 3, 6, and 12. The patients with low (≤10 mg/l) and high (>10 mg/l) CRP levels were compared for time taken to achieve remission using Kaplan-Meier survival analysis.

Results: The Kaplan-Meier survival analysis showed a significantly higher proportion of patients with low CRP levels attained remission than patients with higher CRP levels (Log-rank = 7.594; dF = 1; = 0.006). The age, compliance to pharmacotherapy, and disability did not significantly affect the remission rates of the patients.

Conclusion: Our study confirms that higher levels of CRP can lead to poorer remission rates in patients with MDD after antidepressant therapy and can predict treatment resistance.

Citing Articles

Research on treatment-related aspects of depression from India in the preceding decade (2014-2023): An updated systematic review.

Jaiswal A, Umesh S, Goyal N Indian J Psychiatry. 2024; 65(11):1112-1121.

PMID: 38249143 PMC: 10795667. DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_810_23.

References

Williams J, Kobak K . Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA). Br J Psychiatry. 2008; 192(1):52-8. DOI: 10.1192/bjp.bp.106.032532. View

Wiedlocha M, Marcinowicz P, Krupa R, Janoska-Jazdzik M, Janus M, Debowska W . Effect of antidepressant treatment on peripheral inflammation markers - A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2017; 80(Pt C):217-226. DOI: 10.1016/j.pnpbp.2017.04.026. View

Milenkovic V, Stanton E, Nothdurfter C, Rupprecht R, Wetzel C . The Role of Chemokines in the Pathophysiology of Major Depressive Disorder. Int J Mol Sci. 2019; 20(9). PMC: 6539240. DOI: 10.3390/ijms20092283. View

Uher R, Tansey K, Dew T, Maier W, Mors O, Hauser J . An inflammatory biomarker as a differential predictor of outcome of depression treatment with escitalopram and nortriptyline. Am J Psychiatry. 2014; 171(12):1278-86. DOI: 10.1176/appi.ajp.2014.14010094. View

Khandaker G, Pearson R, Zammit S, Lewis G, Jones P . Association of serum interleukin 6 and C-reactive protein in childhood with depression and psychosis in young adult life: a population-based longitudinal study. JAMA Psychiatry. 2014; 71(10):1121-8. PMC: 4561502. DOI: 10.1001/jamapsychiatry.2014.1332. View

Khera A, McGuire D, Murphy S, Stanek H, Das S, Vongpatanasin W . Race and gender differences in C-reactive protein levels. J Am Coll Cardiol. 2005; 46(3):464-9. DOI: 10.1016/j.jacc.2005.04.051. View

Strawbridge R, Arnone D, Danese A, Papadopoulos A, Herane Vives A, Cleare A . Inflammation and clinical response to treatment in depression: A meta-analysis. Eur Neuropsychopharmacol. 2015; 25(10):1532-43. DOI: 10.1016/j.euroneuro.2015.06.007. View

Bruno G, Fornengo P, Novelli G, Panero F, Perotto M, Segre O . C-reactive protein and 5-year survival in type 2 diabetes: the Casale Monferrato Study. Diabetes. 2008; 58(4):926-33. PMC: 2661603. DOI: 10.2337/db08-0900. View

Kamath D, Xavier D, Sigamani A, Pais P . High sensitivity C-reactive protein (hsCRP) & cardiovascular disease: An Indian perspective. Indian J Med Res. 2015; 142(3):261-8. PMC: 4669860. DOI: 10.4103/0971-5916.166582. View

10.

Hawley C, Gale T, Sivakumaran T . Defining remission by cut off score on the MADRS: selecting the optimal value. J Affect Disord. 2002; 72(2):177-84. DOI: 10.1016/s0165-0327(01)00451-7. View

11.

Zhang J, Yue Y, Thapa A, Fang J, Zhao S, Shi W . Baseline serum C-reactive protein levels may predict antidepressant treatment responses in patients with major depressive disorder. J Affect Disord. 2019; 250:432-438. DOI: 10.1016/j.jad.2019.03.001. View

12.

Jha M, Minhajuddin A, Gadad B, Greer T, Grannemann B, Soyombo A . Can C-reactive protein inform antidepressant medication selection in depressed outpatients? Findings from the CO-MED trial. Psychoneuroendocrinology. 2017; 78:105-113. PMC: 6080717. DOI: 10.1016/j.psyneuen.2017.01.023. View

13.

OBrien S, Scully P, Fitzgerald P, Scott L, Dinan T . Plasma cytokine profiles in depressed patients who fail to respond to selective serotonin reuptake inhibitor therapy. J Psychiatr Res. 2006; 41(3-4):326-31. DOI: 10.1016/j.jpsychires.2006.05.013. View

14.

Wium-Andersen M, Orsted D, Nielsen S, Nordestgaard B . Elevated C-reactive protein levels, psychological distress, and depression in 73, 131 individuals. JAMA Psychiatry. 2012; 70(2):176-84. DOI: 10.1001/2013.jamapsychiatry.102. View

15.

Orsolini L, Pompili S, Tempia Valenta S, Salvi V, Volpe U . C-Reactive Protein as a Biomarker for Major Depressive Disorder?. Int J Mol Sci. 2022; 23(3). PMC: 8836046. DOI: 10.3390/ijms23031616. View

16.

Ridker P, Buring J, Cook N, Rifai N . C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003; 107(3):391-7. DOI: 10.1161/01.cir.0000055014.62083.05. View

17.

Wang J, Wu X, Lai W, Long E, Zhang X, Li W . Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open. 2017; 7(8):e017173. PMC: 5640125. DOI: 10.1136/bmjopen-2017-017173. View

18.

Mosiolek A, Pieta A, Jakima S, Zborowska N, Mosiolek J, Szulc A . Effects of Antidepressant Treatment on Peripheral Biomarkers in Patients with Major Depressive Disorder (MDD). J Clin Med. 2021; 10(8). PMC: 8071355. DOI: 10.3390/jcm10081706. View

19.

Kuo D, Tran M, Shah A, Matorin A . Depression and the Suicidal Patient. Emerg Med Clin North Am. 2015; 33(4):765-78. DOI: 10.1016/j.emc.2015.07.005. View

20.

Gautam S, Jain A, Gautam M, Vahia V, Grover S . Clinical Practice Guidelines for the management of Depression. Indian J Psychiatry. 2017; 59(Suppl 1):S34-S50. PMC: 5310101. DOI: 10.4103/0019-5545.196973. View