Changes in inflammation with treatment for bipolar II depression: Pilot trial data on differential effects of psychotherapy and medication

Q3 Medicine
Jess G. Fiedorowicz , Jill M. Cyranowski , Zhuangzhuang Liu , Holly A. Swartz
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引用次数: 5

Abstract

Objectives

Limited prospective data, mostly focused on bipolar I disorder, suggests that pro-inflammatory cytokines are elevated in abnormal mood states. We evaluated whether treatment normalizes peripheral markers of inflammation in bipolar II disorder.

Methods

Using data from a randomized clinical trial of Interpersonal and Social Rhythm Therapy (IPSRT) + quetiapine vs. IPSRT + placebo for bipolar II depression, we examined whether these treatments for bipolar II depression impact inflammatory cytokines and whether observed changes in cytokines are associated with changes in depressive symptomatology as measured by the Hamilton Rating Scale for Depression (HRSD-17).

Results

Cytokine values were available for 33 participants who completed baseline and 20-week follow-up visits. After excluding those with CRP values > = 10 mg/L, there were 27 patients available for analysis (IPSRT + quetiapine N = 10, IPSRT + placebo N = 17). Baseline measure of inflammation did not appear to moderate treatment response, nor was change in HRSD-17 score correlated with changes in cytokines. Those who received IPSRT + quetiapine had significantly greater increases in IL-6 (p = 0.02) and TNF-α (p = 0.04), even after adjusting for changes in body mass index, than the IPSRT alone group. Descriptively, the quetiapine group showed increases in pro-inflammatory and decreases in anti-inflammatory cytokines and the psychotherapy group showed reduced pro-inflammatory cytokines.

Conclusions

Despite both groups showing depression improvement, this small study suggests a more pro-inflammatory cytokine profile over time with quetiapine plus psychotherapy compared to psychotherapy alone. Elevated risk of cardiovascular morbidity and mortality among those with bipolar II disorder underscores the importance of delivering treatments that do not exacerbate these risk factors.

Abstract Image

治疗双相II型抑郁症时炎症的变化:心理治疗和药物治疗差异效果的初步试验数据
有限的前瞻性数据,主要集中在双相I型障碍,表明促炎细胞因子在异常情绪状态下升高。我们评估了治疗是否能使双相情感障碍患者的外周炎症标志物正常化。方法:利用人际与社会节律疗法(IPSRT) +喹硫平与IPSRT + 安慰剂治疗双相II型抑郁症的随机临床试验数据,我们研究了这些双相II型抑郁症治疗是否影响炎症细胞因子,以及观察到的细胞因子变化是否与汉密尔顿抑郁量表(HRSD-17)测量的抑郁症状变化相关。结果33名完成基线和20周随访的参与者均可获得细胞因子值。排除那些CRP值祝辞 =  10 mg / L,有27个病人可用于分析(IPSRT + 喹硫平N = 10,IPSRT + 安慰剂N = 17)。炎症的基线测量没有显示出适度的治疗反应,HRSD-17评分的变化也与细胞因子的变化无关。接受IPSRT + 喹硫平的患者IL-6 (p = 0.02)和TNF-α (p = 0.04)的增加显著高于单独接受IPSRT组,即使在调整了体重指数的变化后也是如此。描述性地,喹硫平组显示促炎细胞因子增加,抗炎细胞因子减少,心理治疗组显示促炎细胞因子减少。结论:尽管两组患者均表现出抑郁症状的改善,但这项小型研究表明,随着时间的推移,喹硫平加心理治疗比单独使用心理治疗有更多的促炎细胞因子。双相情感障碍患者心血管疾病发病率和死亡率的升高强调了提供不加剧这些危险因素的治疗的重要性。
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期刊介绍: Neurology, Psychiatry & Brain Research publishes original papers and reviews in biological psychiatry, brain research, neurology, neuropsychiatry, neuropsychoimmunology, psychopathology, psychotherapy. The journal has a focus on international and interdisciplinary basic research with clinical relevance. Translational research is particularly appreciated. Authors are allowed to submit their manuscript in their native language as supplemental data to the English version. Neurology, Psychiatry & Brain Research is related to the oldest German speaking journal in this field, the Centralblatt fur Nervenheilkunde, Psychiatrie und gerichtliche Psychopathologie, founded in 1878. The tradition and idea of previous famous editors (Alois Alzheimer and Kurt Schneider among others) was continued in modernized form with Neurology, Psychiatry & Brain Research. Centralblatt was a journal of broad scope and relevance, now Neurology, Psychiatry & Brain Research represents a journal with translational and interdisciplinary perspective, focusing on clinically oriented research in psychiatry, neurology and neighboring fields of neurosciences and psychology/psychotherapy with a preference for biologically oriented research including basic research. Preference is given for papers from newly emerging fields, like clinical psychoimmunology/neuroimmunology, and ideas.
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