ImpairedIn VivoImmune Responses in Patients with Melancholia

Abstract

Previous attempts to establish a relationship between impaired cell-mediated immunity (CMI) and major mood disorders have been limited by a failure to explore the relevance of depressive subcategories or to assess CMI by in vivo methods. In this case-control study CMI was assessed in 57 patients with major depression (31 with melancholic, 26 with non-melancholic disorders), and in age- and sex-matched controls by both in vitro and in vivo immunological techniques. Compared with control subjects and patients with non-melancholic depression, patients with melancholia demonstrated reduced in vivo CMI as assessed by delayed-type hypersensitivity (DTH) skin responses. Although increasing age, severity of depression, hospital admission for treatment, and reported weight loss are correlates of melancholia, none of these factors alone, or in combination, accounted for the differences in DTH responses observed between the two depressive subtypes. These data suggest that impaired CMI in vivo may be limited to those with melancholic disorders. At this stage the factors which account for this effect are unclear.

Biological differences between melancholic and nonmelancholic depression subtyped by the CORE measure

“…Most studies examining biological differences (including inflammatory markers) in melancholic patients have made comparisons with symptom-defined groups with nonmelancholic depression, atypical depression, or nondepressive controls 9–11,18,27,29–32,34,35,68. Such studies have generally reported hypercortisolemia and other hypothalamic-pituitary-adrenal axis changes in melancholic patients11,18,32,34,69 but contradictory or less robust results in relation to inflammatory markers.…”

Influences of Distress and Alcohol Consumption on the Development of a Delayed-Type Hypersensitivity Skin Test Response

“…This test comprises a convenient plastic applicator with 7 ubiquitous antigens (tetanus, diphtheria, streptococcus, tuberculin, candida, trichophyton, and proteus) and a glycerine control preloaded in eight tined heads (7). A decline in immune function, associated with severe (melancholic) depression (8,9), wintering in the Antarctic (10), and perceived distress (11), has been demonstrated using this apparatus.…”

Lymphocyte Subsets Associated With Major Depression and Dysthymia

“…Such effects were particularly marked in depressed patients exhibiting melancholia (21,24), and at least some of the immune changes (altered lymphocyte proliferation) were independent of age, sleep disturbances, menopausal status, or prior treatment with benzodiazepines (7,24], Moreover, the reduced NK cell activity associated with major depression may be abrogated with symptom remission (25). It is unlikely that the immunosuppression seen among inpatients was due to institutionalization (21,26) because the reduced NK cytotoxicity was not evident in hospitalized schizophrenic patients (27,28).…”