Euteneuer F, Dannehl K, Del Rey A, Engler H, Schedlowski M, Rief W
Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany.
Research Group Immunophysiology, Institute of Physiology and Pathophysiology, Philipps University of Marburg, Marburg, Germany.
Transl Psychiatry. 2017 May 16;7(5):e1132. doi: 10.1038/tp.2017.76.
Major depression (MD) is associated with peripheral inflammation and increased cardiovascular risk. Regular physical exercise can have anti-inflammatory effects. The present study examined whether behavioral activation with exercise affects inflammatory processes in MD. Ninety-eight patients with MD were randomly assigned to cognitive-behavioral therapy (CBT) emphasizing exercise during behavioral activation (CBT-E), CBT with pleasurable low-energy activities as an active control condition (CBT-C) or a passive waiting list control group (WL). Plasma levels of C-reactive protein (CRP), interleukin (IL)-6, IL-10, lipopolysaccharide (LPS)-stimulated IL-6 production, and blood immune cell counts were analyzed at baseline and weeks 8 (post-behavioral activation) and 16 (post-treatment). Thirty non-depressed age- and sex-matched controls were included to examine potential immunological alterations in MD at baseline. Patients with MD exhibited higher levels of CRP, higher neutrophil and monocyte counts, lower IL-10 levels and reduced LPS-stimulated IL-6 production compared to controls (P<0.001-0.045). Multilevel modeling indicated that CBT-E was associated with increased anti-inflammatory IL-10 at weeks 8 and 16 compared to CBT-C and WL (P=0.004-0.018). CBT-E did not significantly affect other immunological makers in the total sample. A subgroup analysis including patients with potentially higher cardiovascular risk (CRP ⩾1 μg ml) indicated that CRP was reduced in CBT-E compared to CBT-C (P<0.007) and marginally reduced compared to WL (P<0.085) after week 16. The present findings provide new insights into immunological effects of behavioral treatments against depression. Behavioral activation in conjunction with exercise may have the potential to reverse, in part, immunological alterations in MD.
重度抑郁症（MD）与外周炎症及心血管风险增加有关。规律的体育锻炼具有抗炎作用。本研究探讨了通过运动进行行为激活是否会影响MD患者的炎症过程。98例MD患者被随机分配至在行为激活期间强调运动的认知行为疗法（CBT-E）组、以愉悦的低能量活动作为积极对照条件的CBT组（CBT-C）或被动等待名单对照组（WL）。在基线、第8周（行为激活后）和第16周（治疗后）分析血浆C反应蛋白（CRP）、白细胞介素（IL）-6、IL-10、脂多糖（LPS）刺激的IL-6产生水平以及血液免疫细胞计数。纳入30名年龄和性别匹配的非抑郁对照者，以检查MD患者在基线时的潜在免疫改变。与对照组相比，MD患者表现出更高的CRP水平、更高的中性粒细胞和单核细胞计数、更低的IL-10水平以及LPS刺激的IL-6产生减少（P<0.001 - 0.045）。多水平模型表明，与CBT-C和WL相比，CBT-E在第8周和第16周与抗炎性IL-10增加有关（P = 0.004 - 0.018）。CBT-E对总样本中的其他免疫标志物没有显著影响。一项包括心血管风险可能较高（CRP⩾1μg/ml）患者的亚组分析表明，第16周后，与CBT-C相比，CBT-E组的CRP降低（P<0.007），与WL相比略有降低（P<0.085）。本研究结果为行为治疗对抑郁症的免疫效应提供了新的见解。结合运动的行为激活可能有潜力部分逆转MD患者中的免疫改变。
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