A Psychological Intervention Reduces Inflammatory Markers by Alleviating Depressive Symptoms: Secondary Analysis of a Randomized Controlled Trial

Abstract

Objective Depression and inflammation are common among cancer patients. Data suggest that inflammation can contribute to depressive symptoms, while the converse remains untested. We experimentally test whether a psychological intervention reduces depression-related symptoms and markers of inflammation among cancer patients, and further, we test one mechanism for the intervention effects. Methods As part of a randomized clinical trial, newly diagnosed breast cancer patients (N=45) with clinically significant depressive symptoms were evaluated and randomized to Psychological Intervention with assessment or Assessment only study arms. The intervention spanned 12 months, with assessments at baseline, 4, 8, and 12, months. Mixed effects modeling tested the hypothesis that the intervention reduced self reported depressive symptoms (Center for Epidemiological Studies Depression scale, Profile of Mood States Depression and Fatigue subscales, and SF-36 Bodily Pain subscale) and immune cell numbers that are elevated in the presence of inflammation (white blood cell [WBC] count, neutrophil count, and helper:suppressor ratio). Mediation analyses tested whether change in depressive symptoms, pain, or fatigue predicted change in WBC count, neutrophil count, or the helper:suppressor ratio. Results The intervention significantly reduced depressive symptoms, pain, fatigue, and inflammation markers. Moreover, the intervention effect on inflammation was mediated by its effect on depressive symptoms. Conclusions This is the first experiment to test whether psychological treatment effective in reducing depressive symptoms would also reduce indicators of inflammation. Data show that the intervention directly reduced depressive symptoms and indirectly reduced inflammation. Psychological treatment may effectively treat depressive symptoms, pain, and fatigue among cancer patients.

Associação entre depressão, níveis de dor e falta de apoio social em pacientes internados em enfermarias de clínica médica

“…Além disso, vem sendo demonstrado que o tratamento da depressão pode, além de reduzir os sintomas depressivos, levar a uma redução de marcadores inflamatórios. 7 É possível que, por meio do estudo das vias de ativação de imunidade mediada por células e outros mecanismos que estimulam a manutenção de processos inflamatórios possam ser gerados dados que ajudem a elucidar a alta associação entre dor, depressão e diversas doenças sistêmicas 5 . Contudo, apesar das novas vias que vêm sendo propostas, não se pode esquecer da importância de um bom manejo clínico desses pacientes, que envolve aspectos do correto tratamento da dor, da relação médico-paciente e da rede de apoio social.…”

“…Em pacientes com artrite reumatoide, a depressão e a inflamação (medida por meio da dosagem da proteína C reativa) têm correlação entre si, mas influenciam a dor de forma independente 6 . De maneira semelhante, em pacientes com câncer de mama, o tratamento da depressão foi efetivo para reduzir os indicadores de inflamação 7 . Contudo, ainda existem poucos estudos no Brasil sobre a interface da depressão com a dor e outros aspectos psicossociais.…”

Psychoneuroimmunology of Early-Life Stress: The Hidden Wounds of Childhood Trauma?

“…Third, non-pharmacological strategies with anti-inflammatory properties, physical exercise, and anti-depressant medications, can buffer the effects of earlylife stress on brain and behavioral outcomes in animal models (Harrison and Baune, 2014). Similarly, psychosocial interventions with anti-inflammatory properties, such as psychotherapy and mindful meditation (Black and Slavich, 2016;Koh et al, 2008;Pace et al, 2013;Thornton et al, 2009), might be beneficial in the aftermath of trauma exposure (Macmillan et al, 2009).…”

Psychologists partnering with obstetricians and gynecologists: Meeting the need for patient-centered models of women’s health care delivery.

“…H. Miller et al, 2009;Raison, Capuron, & Miller, 2006). Several studies now suggest it may be possible to reduce inflammation using behavioral interventions such as mindfulness-based stress reduction (Witek-Janusek et al, 2008), cognitive-behavioral therapy (Zautra et al, 2008), and other psychological interventions (Thornton, Andersen, Schuler, & Carson, 2009). Thus, the psychologist may be able to facilitate change that reduces risk for inflammation and its health consequences among women.…”