Exploration of 27 plasma immune markers: a cross-sectional comparison of 64 old psychiatric inpatients having unipolar major depression and 18 non-depressed old persons

Abstract

BackgroundThe prevalence of major depression (MD) according to population studies is the same for old (65 years and older) and younger adults. In contrast, an elevated proportion of old MD patients are hospitalized compared to younger adults with MD, indicating a need to expand the characteristics of old inpatients with MD. To illustrate this point, the association between inflammation and MD in old psychiatric inpatients is sparsely investigated even though an association between inflammation and treatment resistance among younger adults with MD has been reported. In this study, we aimed to explore the plasma concentrations of 27 immune markers in old inpatients with MD, and our purpose was to expand the understanding of inflammatory mechanisms in these patients.MethodsPrior to electroconvulsive treatment of MD, we compared 64 inpatients with unipolar MD (mean age 75.2 years) and 18 non-depressed controls (mean age 78.0 years). Symptoms characterizing MD were assessed by the Hamilton Rating Scale of Depression (HRSD)-17, and the immune markers from peripheral blood plasma were analysed using multiplex assay technology. For statistical analysis of data, we used the independent samples median test, independent samples t-test, χ2-test, receiver operating characteristic curve analyses, stepwise discriminant analysis, and multivariate linear regression.ResultsTwenty-two immune markers representing pro- and anti-inflammatory, adaptive and trophic signalling had higher concentrations in the inpatients compared to the controls. Only the four immune markers IL-1β, IL-5, IL-10 and IL-15 had concentrations below the lower detection limit in a considerable portion (above 20%) of the patient cases. A combination of the concentration in plasma of TNF, vascular endothelial growth factor (VEGF), IL-1β, IL-7 and monocyte chemotactic protein (MCP)-1, correctly classified 98.4% of the depressed patients and 83.3% of the non-depressed controls. Plasma concentration of TNF and VEGF were associated with the HRSD-17 scores (p = 0.017 and 0.005, respectively).ConclusionsOur results indicate that several inflammatory mechanisms may be highly activated in old psychiatric inpatients with MD, and indicate that immune markers may contribute to a more comprehensive understanding of MD in old persons.Trial registrationNCT01559324 ClinicalTrials.gov.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0836-x) contains supplementary material, which is available to authorized users.

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“…Elevated levels of IL‐6 and TNF‐α are also commonly found in the serum of patients with major depressive disorder (MDD) . Systemically increased C‐reactive protein (CRP) and IL‐1β have been reported in depressed patients, while IL‐8 and IL‐17 have shown high specificity and high sensitivity, respectively, for depression in elderly subjects .…”

“…Elevated levels of IL‐6 and TNF‐α are also commonly found in the serum of patients with major depressive disorder (MDD) . Systemically increased C‐reactive protein (CRP) and IL‐1β have been reported in depressed patients, while IL‐8 and IL‐17 have shown high specificity and high sensitivity, respectively, for depression in elderly subjects . However, a meta‐analysis published in 2015 that included 58 studies involving MDD patients and a meta‐analysis published in 2016 that included 30 studies involving MDD patients showed no significant changes in systemic IL‐1β .…”

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“…Depression and schizophrenia seem to dominate this research, both disorders repeatedly demonstrating elevated levels of pro-inflammatory cytokines such as IL-1β, IL-2, IL-6, and TNF [ 1 – 3 ]. Though some of these studies include elderly patients [ 4 – 6 ], most studies have been conducted on younger adults. Thus, there is a paucity of studies on elderly psychiatric patients and particularly elderly psychiatric in-patients.…”

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“…Although rectal temperatures predicted and thus could serve as surrogate markers for brain temperatures in SIV-infected monkeys under the conditions we studied, brain temperatures do not always correlate with peripheral temperature measures. 32,33 Thus, brain temperature can be a useful independent measure and could be informative in other brain disorders, including in major depression, which is associated with inflammation, [50][51][52] as well as in addiction disorders, 32,53,54 psychotic disorders, [55][56][57] seizure disorders, 58 and stroke. 59,60…”