A DGReview of :"Treatment
of Depression Is Associated With Suppression of Nonspecific and Antigen-Specific
T H 1 Responses in Multiple Sclerosis"
07/16/2001
Depression is linked with interferon
gamma (IFN-gamma) production in patients with multiple sclerosis (MS).
Treatment of depression is associated with a reduction in non-specific
and antigen-specific IFN-gamma production.
"These novel findings suggest that
treating depression may be an important disease-modifying component in
the treatment and management of relapse-remitting MS," explain researchers
from the University of California, San Francisco.
"Depression is associated with increased
IFN-gamma production, and IFN-gamma production can be down-regulated by
treating depression."
Investigators add that the observed
relationship between IFN-production, depression and treatment of depression
may have "particular salience for MS patients as IFN-gamma has been implicated
as a major factor in the pathophysiology of this disease."
Researchers conducted a randomised,
comparative outcome trial that included three 16-week treatments for depression.
Three treatment programs included
both behavioural and pharmacological treatments: individual cognitive behavioural
therapy designed to improve coping skills, group psychotherapy designed
to provide social support and psycho-pharmacological therapy based on the
antidepressant, sertraline.
Of 14 MS patients with major depressive
disorder who participated, 10 (71 percent) were women. Average age was
47.4 years. Mean time since MS diagnosis was 11.3 years. Mean Expanded
Disability Status Range was 3.6.
Participants were assessed at baseline,
week eight and at the end of treatment. Variability in immune assays was
controlled for using eight non-depressed, healthy subjects enrolled at
the same time as MS patients were enrolled.
Investigators used the Beck Depression
Inventory to assess depression. They also measured IFN-gamma production
by peripheral blood mononuclear cells.
"Over the course of treatment for
depression, decreases in levels of depression were associated with decreases
in levels of IFN-gamma production" among the MS patients, the researchers
report.
There were no changes in IFN-gamma
production or in depression among the healthy controls.
"Although the manipulation of depression
through treatment supports the argument that depression can cause changes
in IFN-gamma production, these findings do not rule out the possibility
that IFN-gamma production can cause depression," investigators note.
"It has been suggested that immune
dysregulation in MS may cause depression, and the increased incidence of
depression during disease exacerbation is consistent with this argument.
"Thus the present findings might
better be interpreted as supporting the notion that the relationship between
immune dysregulation and depression in MS is dynamic and reciprocal."
Archives of Neurology, 2001; 58:
1081-1086. "Treatment
of Depression Is Associated With Suppression of Nonspecific and Antigen-Specific
T H 1 Responses in Multiple Sclerosis"
Archives of Neurology
By Elda Hauschildt