Inflammation and remission in older patients with depression treated with electroconvulsive therapy; findings from the MODECT study✰

Angela Carlier, Johanna G. Berkhof, Maarten Rozing, F. Bouckaert, Pascal Sienaert, Piet Eikelenboom, Robert Veerhuis, Mathieu Vandenbulcke, Johannes Berkhof, M. L. Stek, Didi Rhebergen, Eric van Exel, Annemiek Dols

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)509-516
Number of pages8
JournalJournal of Affective Disorders
Volume256
Early online date1 Jul 2019
DOIs
Publication statusPublished - 1 Sep 2019

Cite this

Carlier, Angela ; Berkhof, Johanna G. ; Rozing, Maarten ; Bouckaert, F. ; Sienaert, Pascal ; Eikelenboom, Piet ; Veerhuis, Robert ; Vandenbulcke, Mathieu ; Berkhof, Johannes ; Stek, M. L. ; Rhebergen, Didi ; Exel, Eric van ; Dols, Annemiek. / Inflammation and remission in older patients with depression treated with electroconvulsive therapy; findings from the MODECT study✰. In: Journal of Affective Disorders. 2019 ; Vol. 256. pp. 509-516.
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title = "Inflammation and remission in older patients with depression treated with electroconvulsive therapy; findings from the MODECT study✰",
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 {\AA}sberg 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.",
keywords = "Depression, Electroconvulsive therapy (ECT), IL-6, CRP, IL-10, Low-grade inflammation",
author = "Angela Carlier and Berkhof, {Johanna G.} and Maarten Rozing and F. Bouckaert and Pascal Sienaert and Piet Eikelenboom and Robert Veerhuis and Mathieu Vandenbulcke and Johannes Berkhof and Stek, {M. L.} and Didi Rhebergen and Exel, {Eric van} and Annemiek Dols",
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Inflammation and remission in older patients with depression treated with electroconvulsive therapy; findings from the MODECT study✰. / Carlier, Angela; Berkhof, Johanna G.; Rozing, Maarten; Bouckaert, F.; Sienaert, Pascal; Eikelenboom, Piet; Veerhuis, Robert; Vandenbulcke, Mathieu; Berkhof, Johannes; Stek, M. L.; Rhebergen, Didi; Exel, Eric van; Dols, Annemiek.

In: Journal of Affective Disorders, Vol. 256, 01.09.2019, p. 509-516.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Inflammation and remission in older patients with depression treated with electroconvulsive therapy; findings from the MODECT study✰

AU - Carlier, Angela

AU - Berkhof, Johanna G.

AU - Rozing, Maarten

AU - Bouckaert, F.

AU - Sienaert, Pascal

AU - Eikelenboom, Piet

AU - Veerhuis, Robert

AU - Vandenbulcke, Mathieu

AU - Berkhof, Johannes

AU - Stek, M. L.

AU - Rhebergen, Didi

AU - Exel, Eric van

AU - Dols, Annemiek

N1 - Copyright © 2019. Published by Elsevier B.V.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - 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.

AB - 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.

KW - Depression

KW - Electroconvulsive therapy (ECT)

KW - IL-6, CRP, IL-10

KW - Low-grade inflammation

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U2 - 10.1016/j.jad.2019.06.040

DO - 10.1016/j.jad.2019.06.040

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JO - Journal of Affective Disorders

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