Antidepresan tedavi başlanan major depresyon hastalarında inflamatuar parametrelerdeki değişikliklerin tedavi yanıtı ile ilişkisi

Year 2021, , 118 - 125, 30.08.2021

Abdullah Burak Uygur , Şeyda Çankaya

https://doi.org/10.30565/medalanya.880254

Abstract

Amaç: Depresyonda meydana gelen sitokinler, stres hormonları ve C reaktif protein gibi inflamatuvar parametrelerin değişimi, depresyonun patofizyolojisinin anlaşılması ve yeni tedavi yaklaşımlarının geliştirilmesi açısından önem taşımaktadır. Bu çalışmanın temel amacı, major depresyon hastalarında antidepresan tedavi öncesi ve sonrasında inflamatuvar belirteçlerde nasıl bir değişiklik olduğunu tespit etmek ve antidepresan tedavi türünün bu değişiklikler üzerindeki etkisini belirlemektir.

Yöntem: Tek merkezli, retrospektif olarak gerçekleştirilen çalışmada, Alanya Alaaddin Keykubat Üniversitesi Eğitim ve Araştırma Hastanesi psikiyatri polikliniğinde son beş yıla ait geriye dönük incelenen kayıtlara göre, Majör Depresif Bozukluk (MDB) tanısı konulup, ilk kez tekli antidepresan tedavisine başlanan ve en az 6-8 hafta antidepresan tedavi kullanmış, tedavi öncesi ve sonrası Hamilton Depresyon Derecelendirme Ölçeği (HDDÖ), tam kan sayımı, C reaktif protein, kortizol değerlerine ulaşılabilen hastalar çalışmanın örneklemini oluşturmuştur.

Bulgular: Çalışmamızda, antidepresan tedavi sonrası, HDDÖ puanları Majör Depresyonlu hastalarda tedavi öncesine göre anlamlı olarak azalırken (p<0,001), inflamatuar parametrelerdeki değişiklikler ile tedaviye yanıt arasında anlamlı bir ilişki belirlenmemiştir (p>0,05). Bu durum, tedavide kullanılan antidepresan ilaç türünden bağımsızdır (SSRI tedavi grubunda p>0,05, SNRI tedavi grubunda p>0,05). Ayrıca depresyon puanlarındaki azalmanın da, antidepresan ilaç türü (SSRI-SNRI) ile ilişkili olmadığı belirlenmiştir (SSRI tedavi grubunda, p=0,001, SNRI tedavi grubunda, p=0,005).

Sonuç: Çalışmamızda, MDB’de inflamatuar hipotezi destekleyecek sonuçlar belirlenmemiştir. Depresyonun patofizyolojisinin oldukça karmaşık olduğu düşünüldüğünde, inflamasyon ve depresyon arasındaki bağlantıyı açıklamak için yalnızca bir grup kan testinin yeterli olmayabileceği düşünülebilir. Çalışmamızdaki tüm sınırlılıklar göz önünde bulundurulduğunda, gelecekte daha kapsamlı kan, BOS testleri ile beraber beyin yolaklarına ilişkin nörogörüntüleme parametrelerini de içeren prospektif çalışmalar, MDB’de inflamatuar hipotezi kanıtlamak için daha etkili sonuçlar sağlayabilir. 

Keywords

major depresif bozukluk, inflamasyon, inflamatuar parametreler, antidepresan tedavi, tedavi yanıtı

The relationship between the changes in inflammatory parameters and response to treatment in major depression patients starting antidepressant treatment

Abstract

Aim: Changes in inflammatory parameters such as cytokines, stress hormones and C reactive protein that occur in depression, are important in understanding the pathophysiology of depression and developing new treatment approaches. The main purpose of this study was to determine the changes in inflammatory markers in patients with major depression, before and after antidepressant treatment, as well as to determine the effect of antidepressant treatment types on these changes.

Methods: This study was a single center, retrospective study. According to the retrospective records of the last five years in the psychiatry outpatient clinic of Alanya Alaaddin Keykubat University Training and Research Hospital, the patients diagnosed with Major Depressive Disorder (MDD), started on single antidepressant treatment for the first time and who used antidepressant treatment for at least 6-8 weeks, were included in the study. Patients whose Hamilton Depression Rating Scale (HDRS), complete blood count, C reactive protein and cortisol values were reached from the system during MDD treatment, constituted the sample of the study.

Results: In the present study, after the antidepressant treatment, while HDRS scores decreased significantly in patients with Major Depression compared to before treatment (p<0,001), no significant correlation was found between the changes in inflammatory parameters and the response to treatment (p>0,05). This condition was independent of the type of antidepressant used in the treatment (p>0,05 in the SSRI treatment group, p>0,05 in the SNRI treatment group). In addition, it was observed that the decrease in depression scores was not associated with the type of antidepressant (p=0,001, in the SSRI treatment group, p=0,005, in the SNRI treatment group).

Conclusion: Results to support the inflammatory hypothesis in Major Depressive Disorder were not conclusive in this study. Considering that the pathophysiology of depression is quite complex, it could be argued that a single group of blood tests may not be sufficient to explain the link between inflammation and depression. Considering all the limitations of the study, a future a prospective study to prove the inflammatory hypothesis in MDD, including the detailed blood, BOS tests, along with more comprehensive neuroimaging parameters on the brain pathways, might provide more effective results.  

Keywords

major depressive disorder, inflammation, inflammatory parameters, antidepressant treatment, antidepressant type, treatment response

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