If you’ve been following me for a while now, you might know that anxiety disorder is an issue very close to my heart as I suffer from it. I’ve decided to use my platform to raise awareness on the matter, but also to help people who might not be very familiar with it understand the issue
Multiple prior studies have found higher levels of inflammation in older individuals with depression. Now, a new Penn Medicine study has found that clinically depressed older individuals, on average, don’t have elevated levels of inflammation if they don’t already have other inflammatory conditions such as arthritis.
The new study, published recently in Nature Translational Psychiatry, suggests that depression occurs independently of inflammation for many older adults. Furthermore, depression-inflammation links are due to the greater incidence of inflammatory conditions, which in general are common in older people.
“It is still true that inflammatory illnesses can contribute to depression, but our findings suggest that there is a subset of individuals with late-life depression who do not have elevated levels of inflammation,” said study senior author Yvette Sheline, MD, McLure Professor of Psychiatry and Behavioral Research in the Perelman School of Medicine at the University of Pennsylvania.
National surveys in the United States suggest that, although depression is diagnosed more often among younger adults, about five percent of people who are at least 50 years old have had a major depressive episode in the past year. Researchers suspect that many of these cases of late-life depression are caused by inflammation—in part because studies have found higher levels of inflammatory immune proteins in the blood of older people with depression, compared to non-depressed people of the same age.
Prior research also has shown that levels of inflammation markers generally tend to rise with increased age, as chronic illnesses set in and the body’s immune-regulating systems weaken. Based on such findings, doctors have tested anti-inflammatory drugs in patients with depression, and have found that they can improve outcomes when added to standard anti-depressant therapy.
The new study reveals, however, that the link between depression and inflammation is not as clear-cut as the prior literature suggests. Sheline and colleagues used online and in-person screening of over 1,100 depressed individuals to recruit a group of 63 individuals, age 50 to 80, who met criteria for major depressive disorder but did not have other inflammatory conditions. Comparing this group to 29 healthy individuals of the same age, even with highly sensitive measurements, the researchers found no significant differences in bloodstream levels of 29 different inflammation-linked immune proteins.
The researchers then randomized 60 of the depressed patients to receive either a standard antidepressant drug, or the antidepressant plus an anti-inflammatory drug, or placebo, for eight weeks. They found that while the two antidepressant-treated groups showed significant improvement in their depression ratings relative to placebo, there was no significant difference in outcome between the antidepressant and the antidepressant-plus-anti-inflammatory group. Moreover, in all three groups, the subjects’ blood levels of inflammatory markers were low before treatment and did not drop significantly as a result of treatment. The researchers even tested the cerebrospinal fluid of the subjects for levels of the inflammatory protein IL-1β, and again found low levels both before and after treatment.
The study therefore suggests that, in many older adults, depression occurs independently of inflammation, and probably won’t be alleviated by anti-inflammatory treatments unless inflammation is present in addition to depression.
The researchers note, however, that because their study excluded late-life depression patients who have inflammatory disorders, it leaves open the possibility that inflammation from such disorders can contribute to depression.
“Our study supports the view that depression consists of different sub-categories, some with inflammation and some without,” said Sheline, who is also director of Penn’s Center for Neuromodulation in Depression and Stress. “People who have depression should consult with their doctor to see if they have other illnesses that could cause inflammation, since there is evidence that increased inflammation can cause depressive symptoms.”
The results of a study presented today at the Annual European Congress of Rheumatology (EULAR) has shown that Acceptance and Commitment Therapy, a form of cognitive behavioural therapy (CBT) that focuses on psychological flexibility and behaviour change, provided a significant reduction in self-reported depression and anxiety among patients participating in a pain rehabilitation programme.
This treatment also resulted in significant increases in self-efficacy, activity engagement and pain acceptance.
To assess the potential benefits of an 8-week programme of group Acceptance and Commitment Therapy (ACT) in people with persistent pain, measures of pain acceptance and activity engagement were taken using the Chronic Pain Acceptance Questionnaire. Measures of psychological distress using the Hospital Anxiety and Depression Scale and self-efficacy were also taken at assessment, on the final day of the programme, and at the follow up six-month review.
For those chronic pain patients with scores at all three time points, there were statistically significant improvements in all parameters between baseline and at six-months follow-up, including the change in mean score of depression, anxiety, self-efficacy, activity engagement and pain willingness (p<0.001).
“To further validate the role of ACT in the treatment of chronic pain, specifically in a rheumatology context, a randomised controlled clinical trial that includes measures of physical and social functioning within a Rheumatology service would be desirable,” said lead author Dr. Noirin Nealon Lennox from Ulster University in Northern Ireland.
ACT is a form of CBT that includes a specific therapeutic process referred to as “psychological flexibility”. ACT focuses on behaviour change consistent with patients’ core values rather than targeting symptom reduction alone. Evidence for this approach to the treatment of chronic pain has been mounting since the mid 2000’s. A previous systematic review had concluded that ACT is efficacious for enhancing physical function and decreasing distress among adults with chronic pain attending a pain rehabilitation programme.
In this study, patients were referred into the ACT programme by three consultant rheumatologists over a five-year period. Over one hundred patients’ outcome measures were available for a retrospective analysis.
Those suffering from depressive symptoms have an increased risk for physical diseases, especially for arthrosis and arthritis. These findings were reported by researchers from the University of Basel and the Ruhr-University Bochum. Their results, based on data from 14,300 people living in Switzerland, have been published in the scientific journal Frontiers in Public Health.
Depression is one of the leading health risks and affects 350 million people worldwide. In Switzerland, around 400,000 people individuals suffer from it each year. Several studies in countries around the globe have shown that depression is associated with an elevated risk for a variety of physical diseases. However, for Switzerland, a country ranked as one of the wealthiest and with one of the best and most expensive health care systems worldwide, the association between depressive symptoms and physical diseases had yet been unclear.
A research group led by Prof. Gunther Meinlschmidt from the Faculty of Psychology at the University of Basel and the Faculty of Medicine at the Ruhr-University Bochum has now attempted to close this gap. They conducted analyses, using data from the Swiss Health Survey, comprising of 14,348 subjects aged 15 years and older.
Risk for arthrosis and arthritis
The psychologists report that participants with depressive symptoms have a higher risk of suffering from a physical disease. Roughly one third of the participants suffering from depression also suffer from at least one physical disease. This association was evident especially with arthrosis and arthritis that are degenerative and inflammatory diseases of the joints.
More studies are now needed to further scrutinize the association between depression and joint diseases. According to the study, it can be speculated that depressive symptoms result in a lack of interest in physical activity, which may then lead to joint diseases. However, it could also be the other way around: People with joint diseases may be impaired in their daily activities negatively affecting their mental health and ultimately resulting in depressive symptoms. Or: Joint diseases are often caused by inflammatory processes, which have also been speculated for certain types of depressive disorders. Therefore, inflammatory processes may represent the link between depressive symptoms and physical diseases.
Improving health care
“A better understanding of the association between depressive symptoms and physical diseases in Switzerland is the basis for a better health care provision for people suffering from mental disorders as well as physical diseases”, says Gunther Meinlschmidt, author of the study. In addition, these findings are also important for health care policy, for example by improving the precision of future estimates of societal burden and costs related to depression.
Depression is common in people with multiple sclerosis (MS), and a new study shows that people with both conditions may be more likely to die over the next decade than people with just one or neither condition. The study is published in the September 1, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study also found that people with MS and depression have an increased risk of developing vascular disease such as heart attack and stroke.
“These findings underscore the importance of identifying depression in people with MS as well as monitoring for other risk factors for heart disease and stroke,” said study author Raffaele Palladino, MD, PhD, of Imperial College of London in the United Kingdom. “Future studies need to be conducted to look at whether treating depression in people with MS could reduce the risk of vascular disease as well as death over time.”
The study involved 12,251 people with MS and 72,572 people who did not have MS. Researchers looked at medical records to see who developed vascular disease or died over a period of 10 years. At the start of the study, 21% of the people with MS had depression and 9% of the people without MS had depression.
The researchers found that people with both MS and depression had a mortality rate from any cause of 10.3 cases per 100,000 person-years. Person-years take into account the number of people in a study as well as the amount of time spent in the study. The mortality rate for people with MS without depression was 10.6, for people who had depression without MS it was 3.6 and for people with neither condition it was 2.5.
Once researchers adjusted for other factors that could affect the risk of death such as smoking and diabetes, they found that people with both conditions were more than five times more likely to die during the next decade than people with neither condition. People with MS without depression were nearly four times more likely to die than people with neither condition and people with depression without MS were nearly twice as likely to die.
For the risk of vascular disease, the rate for people with both MS and depression was 2.4 cases per 100,000 person-years; 1.2 for people with MS without depression; 1.3 for people with depression without MS; and 0.7 for people with neither condition.
After adjusting for other factors, researchers found that people with both conditions were more than three times as likely to develop vascular disease as people with neither condition.
“When we looked at the risk of death, we found that the joint effect of MS plus depression equaled more than the effect for each individual factor alone—in other words, the two conditions had a synergistic effect,” Palladino said. “A total of 14% of the effect on mortality rate could be attributed to the interaction between these two conditions.”
A limitation of the study was that researchers did not have information on risk factors such as body mass index (BMI), which could affect the risk of vascular disease and death.
Learn more about multiple sclerosis at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.
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The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.