The effects of depression on the body beyond suicide: Keypoints from Podcast “Psyched!”

So I was just listening to a podcast “Psyched!” with an episode titled “Depression: A killing disease” hosted by Dr. David Carreon and Dr. Jessica Gold.

The guest of the episode was Dr. Charles Nemeroff, a renowned psychiatrist who is currently working as the Director of University of Miami Center on Aging and Chairman of the Department of Psychaitry and Behavioral Sciences at University of Miami.

The topics of discussion were depression, including its epidemiology, symptoms and link to other physical illnesses like diabetes and stroke. He discussed the role of inflammation on depression. He also discussed future studied and treatments that might target inflammatory factors, including stem cells.

Some of the highlights of the talk were:

Depression is a syndrome, a collection of symptoms like any disease. It happens to be a very common disorder, so that about 11% of men and about 21% of women in their lifetime will suffer with what we call major depression.

The symptom we worry about the most in depression is suicide. Suicide is the 10th leading cause of death in the United States. It’s the only one of the top 10 causes of death that are increasing in number. All the others, including stroke, cancer, heart disease, are decreasing in number.

One of the really important facts to know is that depression is a systemic illness. It affects the whole body. Part of having depression is being very vulnerable for other medical disorders, including diabetes, heart disease, certain forms of cancer, stroke. Not only does it kill you by suicide, it kills you because your life expectancy is shorter because of the biology of the illness.

There have been many meta-analyses done that have looked at this already, but the fact of the matter is depressed patients have markedly abnormal inflammatory markers, C-reactive protein, Interleukin-6, tumor necrosis factor. Not all, but clearly a sizable percent.

American Heart Association has a cut-off of three for C-reactive protein as a risk for myocardial infarction. A substantial percent of depressed patients have levels of three and above.
patients with inflammatory diseases have high rates of depression, and people with depression have high rates of inflammation.

If you give somebody a treatment to increase their inflammatory response, for example, treating someone with malignant melanoma with interferon in order to create an inflammatory response to fight the cancer, one of the major side effects is robust and severe depression in a sizable subset of patients. There is this link.

An article was published characterizing depression associated with inflammation that was produced by interferon, and then learned that we could pre-treat patients with SSRIs, beginning two weeks before the interferon and ameliorate the depression.

There was a study done by Dr. Ranga Krishnan at Duke many years ago. Etanercept is a drug that’s used to treat psoriasis. It’s a tumor necrosis factor monoclonal antibody. He infused it to patients with psoriasis and depression, who had failed antibiotic therapy. In a placebo-controlled study, he found that it had anti-depressant properties.

There was a second study done by Andy Miller, Chuck Raison, and their colleagues at Emory, in which they looked at different TNF Alpha antagonist called infliximab. Interestingly, in the patients with elevated CRP levels, indicative of inflammation, the drug did have anti-depressant properties.

The Stanley Foundation has just agreed to fund a pilot study for us, looking at treatment-resistant depression, looking at these patients who are treatment-resistant to, say, SSRIs and have elevated inflammatory markers. We’re going to do that, and I have an NIH application in to look at a very unique population of patients who ought to have robust inflammation, which are patients with comorbid alcohol abuse and depression because both alcohol abuse and depression are associated with robust increases in inflammation. I’m pretty excited about this.

To listen to the full podcast, visit the link here.

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