Influenza Vaccine as a Novel Experimental Model of the Behavioral Immune Response in Depression

Study Overview
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Brief Summary
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The purpose of this study is to determine differences between the immune responses in healthy and depressed people. Participants will receive the influenza vaccine and their responses will be monitored. This study will recruit 15 healthy and 60 depressed participants.

Detailed Description
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The purpose of this study is to determine differences between the immune responses in healthy and depressed people. Specifically subjects are provided a mild immune stimulus, an influenza vaccine, and their responses are monitored. The goals are to determine whether patients with depression experience a temporary worsening of mood in response to the stimulus and whether this is associated with measurable differences in the cytokine response to the vaccine. Additionally, patients with depression may be less likely to mount a successful antibody response to vaccination as healthy people based on circumstantial evidence, and this study will assess whether this the case. This study aims to recruit a sample of 15 healthy and 60 depressed participants. The 15 healthy participants will be age and gender matched to the first 15 depressed participants recruited. Three more sets of age and gender matched depressed subjects will be recruited. This will result in 15 sets of quintuplets (4 depressed and one healthy), that are matched by age and gender. The study consists of four visits. The first visit is the baseline assessment where participants will receive the influenza vaccine. Participants will then return 1, 3 and 28 days after receiving the vaccine to assess their responses.

Official Title
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Influenza Vaccine as a Novel Experimental Model of the Behavioral Immune Response in Depression

Conditions
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Depression, Healthy

Intervention / Treatment
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* Biological: Influenza Vaccine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inclusion Criteria for all subjects Adults age 18-60 Able to provide written informed consent directly, without use of a proxy Able to speak and write in English sufficiently to undergo consent and to complete self reports Inclusion Criteria for depressed subjects Currently meets criteria for a Depressive Episode and a diagnosis of MDD according Mini International Neuropsychiatric Interview (MINI) Depressive severity of ≥ 12 on the Quick Inventory of Depression Symptomatology, Clinician Rated (QIDS-C), corresponding to more than mild depression severity, but <21, indicating not severe Inclusion Criteria for healthy Subjects No lifetime Axis I diagnosis on the MINI QIDS-SR score <6 indicating no depression CRP at screening of <1mg/L. Exclusion Criteria: Exclusion Criteria for all subjects Active, unstable, or serious medical illness (e.g. requiring urgent out-patient or higher level of care) as determined by history and lab examination at screening. For example, subjects with untreated cardiovascular disease (blood pressure above 140/80 on repeated measurements, history of cardiac event without medical follow up) or untreated diabetes (based on symptoms and elevated fasting blood sugar at screening) will be excluded. Taking medications that have a significant effect on the immune system. This includes daily Non-steroidal Anti-inflammatory medications (NSAIDs). As needed NSAIDs will not be exclusionary but subjects will be asked to refrain from NSAID usage for 48 hours prior to the vaccination visit and through the day 3 visit. Has received the influenza vaccine for the current season or within the last 12 months Infection with fever or otherwise clinically significant in the last two weeks. Subjects with elevated white blood cell count at screening will also be excluded. Current and within the last 3 months meeting criteria for tobacco use disorder. Previous severe adverse event associated with IIV History of allergy to any component of the IIV History of Guillain-Barre Syndrome Pregnancy Otherwise judged unable to comply with study procedures or unsafe to participate by study clinician Exclusion Criteria for Depressed Subjects Life-time history of mania, hypomania, or psychosis on the MINI Meets or has met criteria for substance abuse or dependence in the last 6 months (3 months for nicotine) Meets or has met criteria for any eating disorder in the last 6 months Baseline suicidal ideation above passive defined as thoughts of death or dying (e.g. wish for natural death) without thoughts of active methods (e.g. overdose) or intent to die, as determined using the Concise Health Risk Tracking Scale (CHRT) (assessment interval the last week) and clinician interview. No Exclusion Criteria for Healthy Subjects

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Both healthy and depressed arms will receive the influenza vaccine.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Depression Subjects: Influenza Vaccine<br>Subjects will receive a quadrivalent inactivated influenza vaccine, for the appropriate season/year of enrollment. The vaccine will be administered by the PI or similarly trained clinician, into the deltoid muscle as directed | Biological: Influenza Vaccine<br>* The appropriate quadrivalent influenza vaccine for the give year will be given to subjects.<br>* Other names: flu vaccine;|
| Active Comparator: Healthy Subjects: Influenza Vaccine<br>Subjects will receive a quadrivalent inactivated influenza vaccine, for the appropriate season/year of enrollment. The vaccine will be administered by the PI or similarly trained clinician, into the deltoid muscle as directed | Biological: Influenza Vaccine<br>* The appropriate quadrivalent influenza vaccine for the give year will be given to subjects.<br>* Other names: flu vaccine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Positive and Negative Affect Schedules Score | We will compute change in scores on the PANAS-x subscales between baseline and day 1. Self reported assessment that contains both positive and negative words and phrases that describe different feelings and emotions. Subjects read each item and mark the appropriate answer for how they feel right now as they fill out the form. Possible answers and the associated score are: (1) Not at all, (2) A little, (3) Moderately, (4) Quite a bit, (5) Extremely. To rate, responses to items in each scale are summed. The scales in the PANAS are listed below with the number of items in that scale in parentheses followed by the total range of the scale. General Dimensions Negative Affect (10) 10-50 General Dimensions of Positive Affect (10) 10-50 Negative Emotion Fear (6) 6-30 Hostility (6): 6-30 Guilt (6): 6-30 Sadness (5) 5- 25 Positive Emotion Joviality (8) 8-40 Self-Assurance (6) 6-30 Attentiveness (4) 4-20 Other Affective States Shyness (4) 4-20 Fatigue (4) 4-20 Serenity (3) 3-15 | 1 Day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Cytokine Concentration (pg/mL) | We will compute differences in cytokine (IFN- α, IFN-y, IL-6, IL1-β and TNF-α) values for each subject between baseline and day 1 and days 1 and 3. Using OLS regression we will compute regressions between hypothesis appropriate time points using baseline CRP, QIDS, PANAS score and BMI as covariates. | 3 Days | 
| Difference in PGE4/LipoxinA4 Ratio | After determining the difference in the PGE4/LipoxinA4 ratio between days 1 and 3, we will perform a similar regression. | 3 Days | 
| Tryptophan Metabolites | We will calculate difference between baseline and day 1 in the KYN/TRP and KYNA/QUIN ratios and us them in regression models as above, correcting for two tests. | 1 Day | 
| HPA Axis | To test the hypothesis that ACTH/cortisol affects peak inflammatory cytokine levels in MDD, we will use similar OLS regression models including HPA-axis response as a covariate and examining its interaction with cytokines as the dependent variables. | 3 Days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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depression, Major Depressive Disorder, depressive