Department of Psychiatry and Behavioral Neuroscience, Loyola University Stritch School of Medicine, Chicago, IL, USA.
Department of Pathology, Loyola University Stritch School of Medicine, Chicago, IL, USA.
J Psychiatr Res. 2018 Jul;102:1-7. doi: 10.1016/j.jpsychires.2018.02.004. Epub 2018 Feb 13.
Immune system activation and neuroinflammation appear to play a key role in the pathophysiology and treatment of bipolar depression (BDD). This study is the first to analyze blood levels of the pro-inflammatory biomarker C-reactive protein (CRP) in bipolar disorder patients treated with the cyclooxygenase-2 inhibitor, celecoxib (CBX). In this double-blind study, 47 consenting patients with BDD were randomized to receive either escitalopram (10 mg twice/day) + CBX (200 mg twice/day), or escitalopram (10 mg twice/day) + placebo (twice/day). Plasma CRP levels were measured in both patient groups at baseline, week 4, and week 8, and in a healthy control (HC) group of subjects (N = 35) once. Symptoms were rated using the 17-item Hamilton Depression Scale (HAMD-17). The CBX group had significantly lower HAMD-17 scores vs. placebo at week 4 (P = 0.026) and week 8 (P = 0.002). Therefore, SSRI + CBX is more effective than SSRI + placebo in reversing treatment resistance and augmenting antidepressant response in BDD. Baseline CRP levels were significantly increased amongst BDD patients versus HC subjects, indicating that CRP may be a useful biomarker for BDD (P = 0.044). No significant differences in CRP levels were measured between CBX and placebo groups at baseline (P = 0.156), but by week 8 CRP was significantly decreased in the CBX group vs. placebo (P = 0.003). This indicates reduced inflammation in CBX-treated patients, and that CRP may be a useful biomarker for monitoring treatment response in BDD patients during SSRI + CBX combination treatment. CRP and IL-6 levels were positively correlated in the CBX group, and CRP levels were positively correlated with BMI.
免疫系统激活和神经炎症似乎在双相抑郁症（BDD）的病理生理学和治疗中发挥关键作用。这项研究首次分析了接受环氧化酶-2 抑制剂塞来昔布（CBX）治疗的双相障碍患者的促炎生物标志物 C 反应蛋白（CRP）的血液水平。在这项双盲研究中，47 名同意参加的 BDD 患者被随机分配接受依他普仑（10mg，每日两次）+CBX（200mg，每日两次）或依他普仑（10mg，每日两次）+安慰剂（每日两次）。在基线、第 4 周和第 8 周，测量两组患者的血浆 CRP 水平，并在健康对照组（N=35）中测量一次。使用 17 项汉密尔顿抑郁量表（HAMD-17）评定症状。与安慰剂组相比，CBX 组在第 4 周（P=0.026）和第 8 周（P=0.002）时 HAMD-17 评分显著降低。因此，SSRI+CBX 比 SSRI+安慰剂更有效地逆转 BDD 的治疗抵抗并增强抗抑郁反应。BDD 患者的基线 CRP 水平明显高于健康对照组，表明 CRP 可能是 BDD 的有用生物标志物（P=0.044）。CBX 组和安慰剂组在基线时的 CRP 水平无显著差异（P=0.156），但在第 8 周时 CBX 组的 CRP 显著低于安慰剂组（P=0.003）。这表明 CBX 治疗的患者炎症减轻，并且 CRP 可能是监测接受 SSRI+CBX 联合治疗的 BDD 患者治疗反应的有用生物标志物。CBX 组的 CRP 和 IL-6 水平呈正相关，CRP 水平与 BMI 呈正相关。
