Fondation FondaMental, Créteil, France; Aix-Marseille Univ, Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, Marseille 13005, France.
Fondation FondaMental, Créteil, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
J Affect Disord. 2019 Feb 15;245:468-474. doi: 10.1016/j.jad.2018.11.004. Epub 2018 Nov 6.
Major Depressive Disorder (MDD) is a therapeutic challenge in schizophrenia (SZ). Untangling different forms of MDD appears as the best current strategy to improve remission to treatment in the so-called precision medicine approach.
The objectives of the present study were to determine (i) the prevalence of Inflammatory Depression (ID) in stabilized SZ outpatients (ii) if ID was associated with clinical or cognitive profiles that may help clinicians detecting ID (iii) if antidepressants were effective in ID and (iv) the biological correlates of ID that may orientate personalized treatments.
Participants were consecutively included and received a thorough 2 days- clinical assessment.
785 subjects were recruited in the FACE-SZ cohort. 289 (36.8%) were diagnosed with MDD (remitted or unremitted), of them 57 with ID (19.7%). No clinical or cognitive features were associated with ID (all p > 0.05). ID has been associated with increased abdominal perimeter (aOR = 4.48, p = 0.002) and latent Toxoplasma infection (aOR = 2.19, p = 0.04). While antidepressants were associated with decreased depressive symptoms level in ID, 44% of the subjects remained unremitted under antidepressant, with no association with CRP blood levels.
ID may not differ from other forms of depression by its clinical symptoms but by its aetiologies. ID is associated with increased perivisceral fat and latent Toxoplasma infection that are both potentially related to gut/microbiota disturbances. Specific anti-inflammatory drugs and microbiota-targeted therapeutics appear as promising strategies in the treatment of inflammatory depression in schizophrenia.
重度抑郁症（MDD）是精神分裂症（SZ）的治疗挑战。理清不同形式的 MDD 似乎是目前提高所谓精准医学方法治疗缓解率的最佳策略。
本研究的目的是确定（i）稳定的 SZ 门诊患者中炎症性抑郁症（ID）的患病率；（ii）ID 是否与可能有助于临床医生检测 ID 的临床或认知特征相关；（iii）抗抑郁药在 ID 中的有效性；（iv）ID 的生物学相关性，可能为个性化治疗提供方向。
连续纳入参与者，并接受为期 2 天的全面临床评估。
FACE-SZ 队列共纳入 785 名受试者。289 名（36.8%）被诊断为 MDD（缓解或未缓解），其中 57 名患有 ID（19.7%）。ID 与临床或认知特征无关（均 p>0.05）。ID 与腹部周长增加有关（优势比[OR] = 4.48，p = 0.002）和潜伏性弓形虫感染（OR = 2.19，p = 0.04）。虽然抗抑郁药与 ID 患者的抑郁症状水平降低有关，但 44%的 ID 患者在抗抑郁药治疗下仍未缓解，与 CRP 血水平无关。
ID 与其临床症状不同，而与其病因有关。ID 与内脏周围脂肪增加和潜伏性弓形虫感染有关，这两者都可能与肠道/微生物群紊乱有关。针对炎症的特定抗炎药物和针对微生物群的治疗方法似乎是治疗精神分裂症炎症性抑郁症的有前途的策略。
