Journal article

Publication year: 2020

Journal: Frontiers in Psychiatry

Volume number: 11

ISSN: 1664-0640

Open access status: Gold

DOI Link: https://doi.org/10.3389/fpsyt.2020.571636

Publisher: Frontiers Media

Abstract: 

Objective: In experimental settings, systemically elevated inflammation markers interfere with major depression treatment. In German healthcare, compulsory national health insurance covers treatment of a wide variety of depressive disorders, if it follows evidence-based medicine guidelines combining recommended therapies. To date, little is known about the relevance of immune system cytokine production with regard to real-world clinical care for patients with moderate depression.

Methods: Seventy three patients with moderate depression subjected to multimodal psychotherapeutic inpatient therapy (mPT) following a psychodynamic concept at a German university hospital were included. As a primary outcome, mPT success, evidenced by delta HADS "depression," was analyzed according to tumor necrosis factor alpha (TNF alpha) production by peripheral blood mononuclear cells (PBMC) after phytohemagglutinin (PHA) challenge at baseline. Secondary outcomes addressed the inflammatory response and mental health comparing high and low TNF alpha-producers.

Results: First, higher PBMC TNF alpha production at baseline predicted a better mPT-outcome (R-2 0.162, p = 0.014). Second, patients with high TNF alpha (hTNF) at baseline produced significantly more acute inflammatory cytokines [interleukin (IL)1 beta, IL6), TH1/TH2 cytokines [interferon gamma (IFN gamma), IL4] as well as eotaxin and IL2 compared to low TNF alpha producers (lTNF) (Cohen's ds between -0.532 and -1.013). Demographic data, diagnosis subtype-distribution, medication, systemic inflammation markers [C-reactive protein (CRP), high mobility group box 1 (HMGB1), leptin], anxiety and depression (HADS) did not differ. From baseline to mPT-discharge, HADS "depression" decreased in both hTNF (11.31 to 5.47, p = 0.001, d = 1.184) and lTNF patients (11.50-7.92, p = 0.001, d = -0.765), while PBMC cytokine production decreased significantly in hTNF (Cohen's ds between -0.304 and -0.345) with a significant group by time interaction for TH1/TH2 ratio. At the end of therapy, comparison of TNF groups revealed significantly lower depression-scores in hTNF compared to lTNF patients (5.47 compared to 7.92, p = 0.035, d = 0.504).

Conclusions: Our study demonstrates successful treatment of depression in a clinical care setting using multimodal psychotherapy based on a psychodynamic concept following guideline recommendation. The greatest improvement in patient depression was linked to the highest production of TNF alpha by PBMCs at baseline. Our study contributes to the definition of patient subpopulations with differing cytokine responses that are related to succesful treatment of depression.

Harvard Citation style: Peters, E., Neusetzer, M., Akinci, S., Murat, A., Treuherz, S., Rose, M., et al. (2020) Multimodal Psychotherapeutic Inpatient Therapy of Depression Is Successful in Patients With High Cytokine Production, Frontiers in Psychiatry, 11, Article 571636. https://doi.org/10.3389/fpsyt.2020.571636

APA Citation style: Peters, E., Neusetzer, M., Akinci, S., Murat, A., Treuherz, S., Rose, M., Leweke, F., Leichsenring, F., Conrad, M., & Kruse, J. (2020). Multimodal Psychotherapeutic Inpatient Therapy of Depression Is Successful in Patients With High Cytokine Production. Frontiers in Psychiatry. 11, Article 571636. https://doi.org/10.3389/fpsyt.2020.571636