Peripheral inflammatory effects of different interventions for treatment-resistant depression: A systematic review

Rebecca Strawbridge; Estefany Izurieta; Elana Day; Helena Tee; Kate Young; Co Co Tong; Allan H. Young; Anthony J. Cleare

doi:10.1016/j.nsa.2022.101014

Peripheral inflammatory effects of different interventions for treatment-resistant depression: A systematic review

Rebecca Strawbridge^*, Estefany Izurieta, Elana Day, Helena Tee, Kate Young, Co Co Tong, Allan H. Young, Anthony J. Cleare

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

6 Citations (Scopus)

Abstract

Background: Immune-related mechanisms are increasingly recognised as important in the pathophysiology of depression, particularly treatment-resistant depression (TRD). Preliminary evidence suggests that people with TRD may benefit from anti-inflammatory interventions; however, the relative anti-inflammatory effects of therapies currently recommended for TRD have not been integrated in a specific evidence synthesis. Methods: A systematic search was performed to identify articles published up to February 8, 2021. Results from databases (Pubmed, Embase) and handsearches were reviewed to include any longitudinal study examining circulating marker(s) of inflammation in humans before and after treatment with electroconvulsive therapy (ECT), ketamine, bupropion, lithium, aripiprazole, or quetiapine. We undertook a narrative synthesis of results and risk of bias assessment to incorporate and interpret the evidence. Results: Of 57 included studies, 34 assessed the effects of ketamine and 12 of ECT, with other medications examined in ≤5 studies each. Results were highly heterogeneous. Numerically, more frequent increases than decreases in pro-inflammatory markers were reported after ketamine, quetiapine and lithium (although more frequent significant decreases were observed for lithium). Findings for ECT and bupropion were even more inconsistent. Two studies consistently reported inflammatory reductions (significant/non-significant) after aripiprazole. Conclusions: Treatment effects on inflammatory proteins are confounded by several factors: ketamine, in most studies, was co-administered with other surgical procedures, while ketamine and ECT findings are also obscured by variable post-procedure assessment timing. The evidence base for other treatments is scant. Greater examination is warranted to establish whether inflammatory biomarkers could be used to stratify TRD patients to a ‘most appropriate’ intervention.

Original language	English
Article number	101014
Journal	Neuroscience Applied
Volume	2
DOIs	https://doi.org/10.1016/j.nsa.2022.101014
Publication status	Published - Jan 2023

Keywords

Aripiprazole
Biomarker
Bupropion
cytokine
Electroconvulsive therapy
Inflammation
Ketamine
Lithium
Quetiapine
Systematic review

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10.1016/j.nsa.2022.101014

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@article{4bdc99159ed24f1b8523baf6ac8738b7,

title = "Peripheral inflammatory effects of different interventions for treatment-resistant depression: A systematic review",

abstract = "Background: Immune-related mechanisms are increasingly recognised as important in the pathophysiology of depression, particularly treatment-resistant depression (TRD). Preliminary evidence suggests that people with TRD may benefit from anti-inflammatory interventions; however, the relative anti-inflammatory effects of therapies currently recommended for TRD have not been integrated in a specific evidence synthesis. Methods: A systematic search was performed to identify articles published up to February 8, 2021. Results from databases (Pubmed, Embase) and handsearches were reviewed to include any longitudinal study examining circulating marker(s) of inflammation in humans before and after treatment with electroconvulsive therapy (ECT), ketamine, bupropion, lithium, aripiprazole, or quetiapine. We undertook a narrative synthesis of results and risk of bias assessment to incorporate and interpret the evidence. Results: Of 57 included studies, 34 assessed the effects of ketamine and 12 of ECT, with other medications examined in ≤5 studies each. Results were highly heterogeneous. Numerically, more frequent increases than decreases in pro-inflammatory markers were reported after ketamine, quetiapine and lithium (although more frequent significant decreases were observed for lithium). Findings for ECT and bupropion were even more inconsistent. Two studies consistently reported inflammatory reductions (significant/non-significant) after aripiprazole. Conclusions: Treatment effects on inflammatory proteins are confounded by several factors: ketamine, in most studies, was co-administered with other surgical procedures, while ketamine and ECT findings are also obscured by variable post-procedure assessment timing. The evidence base for other treatments is scant. Greater examination is warranted to establish whether inflammatory biomarkers could be used to stratify TRD patients to a {\textquoteleft}most appropriate{\textquoteright} intervention.",

keywords = "Aripiprazole, Biomarker, Bupropion, cytokine, Electroconvulsive therapy, Inflammation, Ketamine, Lithium, Quetiapine, Systematic review",

author = "Rebecca Strawbridge and Estefany Izurieta and Elana Day and Helena Tee and Kate Young and Tong, {Co Co} and Young, {Allan H.} and Cleare, {Anthony J.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2023",

month = jan,

doi = "10.1016/j.nsa.2022.101014",

language = "English",

volume = "2",

journal = "Neuroscience Applied",

issn = "2772-4085",

}

TY - JOUR

T1 - Peripheral inflammatory effects of different interventions for treatment-resistant depression

T2 - A systematic review

AU - Strawbridge, Rebecca

AU - Izurieta, Estefany

AU - Day, Elana

AU - Tee, Helena

AU - Young, Kate

AU - Tong, Co Co

AU - Young, Allan H.

AU - Cleare, Anthony J.

PY - 2023/1

Y1 - 2023/1

N2 - Background: Immune-related mechanisms are increasingly recognised as important in the pathophysiology of depression, particularly treatment-resistant depression (TRD). Preliminary evidence suggests that people with TRD may benefit from anti-inflammatory interventions; however, the relative anti-inflammatory effects of therapies currently recommended for TRD have not been integrated in a specific evidence synthesis. Methods: A systematic search was performed to identify articles published up to February 8, 2021. Results from databases (Pubmed, Embase) and handsearches were reviewed to include any longitudinal study examining circulating marker(s) of inflammation in humans before and after treatment with electroconvulsive therapy (ECT), ketamine, bupropion, lithium, aripiprazole, or quetiapine. We undertook a narrative synthesis of results and risk of bias assessment to incorporate and interpret the evidence. Results: Of 57 included studies, 34 assessed the effects of ketamine and 12 of ECT, with other medications examined in ≤5 studies each. Results were highly heterogeneous. Numerically, more frequent increases than decreases in pro-inflammatory markers were reported after ketamine, quetiapine and lithium (although more frequent significant decreases were observed for lithium). Findings for ECT and bupropion were even more inconsistent. Two studies consistently reported inflammatory reductions (significant/non-significant) after aripiprazole. Conclusions: Treatment effects on inflammatory proteins are confounded by several factors: ketamine, in most studies, was co-administered with other surgical procedures, while ketamine and ECT findings are also obscured by variable post-procedure assessment timing. The evidence base for other treatments is scant. Greater examination is warranted to establish whether inflammatory biomarkers could be used to stratify TRD patients to a ‘most appropriate’ intervention.

AB - Background: Immune-related mechanisms are increasingly recognised as important in the pathophysiology of depression, particularly treatment-resistant depression (TRD). Preliminary evidence suggests that people with TRD may benefit from anti-inflammatory interventions; however, the relative anti-inflammatory effects of therapies currently recommended for TRD have not been integrated in a specific evidence synthesis. Methods: A systematic search was performed to identify articles published up to February 8, 2021. Results from databases (Pubmed, Embase) and handsearches were reviewed to include any longitudinal study examining circulating marker(s) of inflammation in humans before and after treatment with electroconvulsive therapy (ECT), ketamine, bupropion, lithium, aripiprazole, or quetiapine. We undertook a narrative synthesis of results and risk of bias assessment to incorporate and interpret the evidence. Results: Of 57 included studies, 34 assessed the effects of ketamine and 12 of ECT, with other medications examined in ≤5 studies each. Results were highly heterogeneous. Numerically, more frequent increases than decreases in pro-inflammatory markers were reported after ketamine, quetiapine and lithium (although more frequent significant decreases were observed for lithium). Findings for ECT and bupropion were even more inconsistent. Two studies consistently reported inflammatory reductions (significant/non-significant) after aripiprazole. Conclusions: Treatment effects on inflammatory proteins are confounded by several factors: ketamine, in most studies, was co-administered with other surgical procedures, while ketamine and ECT findings are also obscured by variable post-procedure assessment timing. The evidence base for other treatments is scant. Greater examination is warranted to establish whether inflammatory biomarkers could be used to stratify TRD patients to a ‘most appropriate’ intervention.

KW - Aripiprazole

KW - Biomarker

KW - Bupropion

KW - cytokine

KW - Electroconvulsive therapy

KW - Inflammation

KW - Ketamine

KW - Lithium

KW - Quetiapine

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85168358652&partnerID=8YFLogxK

U2 - 10.1016/j.nsa.2022.101014

DO - 10.1016/j.nsa.2022.101014

M3 - Review article

AN - SCOPUS:85168358652

SN - 2772-4085

VL - 2

JO - Neuroscience Applied

JF - Neuroscience Applied

M1 - 101014

ER -

Peripheral inflammatory effects of different interventions for treatment-resistant depression: A systematic review

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