Clinical phenotypes of depressed patients with evidence of inflammation and somatic symptoms.
Creators: name: Foley, Eimear
name: Parkinson, Joel T
name: Kappelmann, Nils
name: Khandaker, Golam
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021

description: Whether depressed patients with evidence of inflammation are more appropriate candidates for immunotherapies is being tested in several clinical trials, which are selecting patients based on elevated C-reactive protein (CRP) and inflammation-related symptoms. However, studies of the clinical and phenotypic profile of depressed patients with elevated CRP are relatively scarce. We have investigated detailed clinical characteristics of 84 depressed patients, grouped as those with (CRP≥3 mg/L) and without (CRP&lt;3 mg/L) inflammation. All patients met the International Classification of Diseases 10th Revision criteria for current depressive episode and had somatic symptoms of depression. We report that depressed patients with inflammation are more likely to be older (P=0.04), have higher body mass index (P&lt;0.01), and be on non-selective serotonin reuptake inhibitor anti-depressants (P=0.04). After adjusting for potential confounders, the inflammation group had higher depression severity (adjusted mean difference, 8.82; 95% CI, 3.91-13.72), somatic symptoms (adjusted mean difference, 3.25; 95% CI, 1.58-4.92), state anxiety (adjusted mean difference, 9.25; 95% CI, 3.82-14.67), perceived stress (adjusted mean difference, 4.58; 95% CI, 1.98-7.18), and fatigue (adjusted mean difference, 9.71; 95% CI, 3.09-6.33), but not anhedonia. The inflamed group also had poorer quality of life (adjusted mean difference, -0.18; 95% CI, -0.32-0.05). At individual depressive symptom level, the inflammation group had increased guilty feelings (adjusted odds ratio [OR], 7.28; 95% CI, 2.09-31.17), pessimism (adjusted OR, 5.38; 95% CI, 1.53-22.73), concentration difficulties (adjusted OR, 4.56; 95% CI, 1.32-19.02), and indecisiveness (adjusted OR, 4.21; 95% CI, 1.15-18.54). Our findings highlight the clinical features associated with inflammation in depressed patients with somatic symptoms, including poor quality of life, supporting the need for intervention targeting this group. These results could also aid patient and outcome selection in future clinical trials testing immunotherapies in depression. Replication of these findings in larger samples is required.
description: This work was funded by a Wellcome Trust fellowship to GMK (grant code: 201486/Z/16/Z). GMK also acknowledges funding support from Cambridgeshire and Peterborough NHS Foundation Trust R&amp;D Department (Grant code: G101481), the BMA Foundation (J Moulton grant 2019); the MQ: Transforming Mental Health (grant code: MQDS17/40); and the Medical Research Council UK (grant codes: MC_PC_17213 and MR/S037675/1). The BMA Foundation J Moulton grant supports ÉMF and the MRC grant MC_PC_17213 supports JTP. NK is supported by the International Max Planck Research School of Translational Psychiatry (IMPRS-TP). The funding sources had no role in study design; collection, analysis, and interpretation of data; writing of the report; and the decision to submit the paper for publication.