What is the clinical evidence from this study?

Study design: Cohort. Population: Depressive symptoms (n=656). Intervention: Elevated inflammatory biomarkers (IL-6) vs. Lower levels of inflammatory biomarkers. Primary outcome: Persistence of depressive symptoms over 5 years (CES-D score ≥16 at baseline and follow-up) (OR 2.44, 95% CI 1.09-5.45, p=0.030).

April 15, 2015Open Access

Low-grade inflammation predicts persistence of depressive symptoms

Resultado clave

Higher baseline levels of the inflammatory biomarker IL-6 were significantly associated with the persistence of depressive symptoms over 5 years (OR 2.44) in older adults.

Diseño del estudio

Tipo

Cohort (n=656)

Multicéntrico

PICO estructurado

Do higher baseline levels of inflammatory biomarkers predict the persistence of depressive symptoms over 5 years in older adults?

Población

656 older adults (mean age 73 years) from the Rotterdam Study, free of antidepressant medications, followed for 5 years to assess the association between inflammatory biomarkers and depressive symptoms.

Exposición

Baseline serum levels of inflammatory biomarkers (IL-6, alpha-1-antichymotrypsin, and C-reactive protein)

Comparador

Lower baseline levels of inflammatory biomarkers

Resultado

Depressive symptoms at 5-year follow-up and persistence of depressive symptoms over 5 years (defined as CES-D score ≥16 at baseline and follow-up)patient reported

Elevated baseline levels of IL-6 and CRP predict the persistence of depressive symptoms over 5 years in older adults, suggesting a role for low-grade inflammation in chronic depression.

Resultado numérico

Odds Ratio: 2.44 (95% CI 1.09–5.45)

valor p: p=0.030

Limitaciones

Restricted to an older population, limiting generalizability to younger individuals.
Exclusion of participants on antidepressants may limit generalizability to patients with more severe clinical depression.
Lack of repeated measures of inflammatory cytokines prevented analysis of long-term exposure to high levels of inflammatory markers.

Resumen

RATIONALE: Evidence suggests that depression is cross-sectionally and longitudinally associated with activation of inflammatory response system. A few studies, however, have investigated the longitudinal relationship between raised inflammatory biomarkers and persistence of depressive symptoms. We examined the temporal relationship between serum levels of inflammatory biomarkers and persistence of depressive symptoms among older participants. METHODS: Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptoms at baseline and at 5-year follow-up in 656 participants (233 men, 423 women) aged >60 years of the Rotterdam Study. Markers of inflammation interleukin (IL)-6, alpha-1-antichymotrypsin (ACT) and C-reactive protein (CRP) were assessed at baseline, and all participants taking antidepressant medications were excluded from the analysis. RESULTS: No cross-sectional association was found between IL-6, ACT and CRP with depressive symptoms at baseline. However, higher levels of IL-6 and CRP predicted depressive symptoms at 5-year follow-up. Adjustment for confounding variables had no impact on the observed associations. Similarly, a positive association was found between baseline levels of IL-6 (OR = 2.44, p = 0.030) and CRP (OR = 1.81, p = 0.052) and persistence of depressive symptoms over 5 years. CONCLUSION: Our data suggest that dysregulation of the inflammatory response system is associated with a more severe form of depression more likely to re-occur.

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