A Placebo-Controlled Randomized Trial of the Effects of Escitalopram on Depressive Symptoms and Immune Function in People With HIV

IF 4 Q2 NEUROSCIENCES

Biological psychiatry global open science Pub Date : 2026-01-01 Epub Date: 2025-10-10 DOI:10.1016/j.bpsgos.2025.100627

Dwight L. Evans , Sergei Spitsin , Kevin G. Lynch , Chelsea D. Voytek , Menvekeh G. Daramay , Elizabeth A. Hembree , Danielle Fiore , Robert Gross , J. Cobb Scott , Steven D. Douglas , Michael E. Thase

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Abstract

Background

This study was a randomized controlled trial investigating the effects of a selective serotonin reuptake inhibitor (SSRI) and improvement in depressive symptoms on innate immunity and inflammation in people with HIV (PWH).

Methods

The mean 17-item Hamilton Depression Rating Scale (HAMD-17) score at baseline was 19.1 for the sample (N = 108). Eligible participants were randomized to 10 weeks of double-blind therapy with either SSRI (escitalopram) or placebo. All participants concurrently received computer-assisted cognitive behavioral therapy (CCBT). Peripheral blood was obtained from each participant at baseline and at weeks 2, 4, and 10, and intracellular interferon gamma (IFN-γ) in natural killer (NK) cells, lytic units per 10⁷ NK cells (LUNKs), interleukin 6 (IL-6), and C-reactive protein (CRP) were measured.

Results

Participants showed substantial reduction in depressive symptoms during study with final HAMD-17 score of 8.00 (average decrease of 11.0 units). However, there was no statistically significant effect of treatment, whether viewed as a group × time interaction (F_1,166 = 0.00, p = .976) or as a main effect for group (F_1,667 = 0.50, p = .479). There were no statistically significant differences between the groups on the immune parameters over time. There was little evidence that the magnitude of symptom improvement was associated with changes in immune measures.

Conclusions

Our study did not demonstrate superiority of treatment with SSRI+CCBT versus placebo+CCBT. Patients in both arms showed improvement of depression symptoms, which did not correlate with changes in immune markers. We found no evidence of decreased inflammation (IL-6, CRP) or immune restoration (LUNKs or intracellular IFN-γ) following treatment with CCBT with or without active escitalopram. While antidepressant treatment is indicated for PWH with depression, we observed no evidence of direct immunologic benefits.

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艾司西酞普兰对HIV感染者抑郁症状和免疫功能影响的安慰剂对照随机试验

本研究是一项随机对照试验，旨在研究选择性血清素再摄取抑制剂（SSRI）和抑郁症状的改善对HIV （PWH）患者先天免疫和炎症的影响。方法样本（108例）17项汉密尔顿抑郁评定量表（HAMD-17）基线平均得分为19.1分。符合条件的参与者被随机分配到SSRI（艾司西酞普兰）或安慰剂的10周双盲治疗。所有参与者同时接受计算机辅助认知行为治疗（CCBT）。在基线和第2周、第4周和第10周采集每位参与者的外周血，并测量自然杀伤（NK）细胞中的细胞内干扰素γ (IFN-γ)、每107个NK细胞（LUNKs）的溶解单位、白细胞介素6 （IL-6）和c反应蛋白（CRP）。结果受试者抑郁症状明显减轻，最终HAMD-17评分为8.00分（平均下降11.0分）。然而，无论是作为组间交互作用（f1166 = 0.00, p = .976）还是作为组内主要作用（f1667 = 0.50, p = .479），治疗均无统计学显著影响。各组间免疫参数随时间变化无统计学差异。几乎没有证据表明症状改善的程度与免疫措施的改变有关。结论我们的研究并未证明SSRI+CCBT治疗优于安慰剂+CCBT治疗。两组患者均表现出抑郁症状的改善，这与免疫标记物的变化无关。我们没有发现在CCBT治疗后炎症（IL-6， CRP）或免疫恢复（lunk或细胞内IFN-γ）减少的证据。虽然抗抑郁治疗适用于伴有抑郁症的PWH，但我们没有观察到直接免疫益处的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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