Cited by 3,848Tryptophan and brain disordersTreatment of Major DepressionStress Responses and Cortisol

Inflammation and Its Discontents: The Role of Cytokines in the Pathophysiology of Major Depression

Open access
Miller, Andrew H., Maletic, Vladimir, Raison, Charles L.·2009·Biological Psychiatry

Abstract

Recognition that inflammation may represent a common mechanism of disease has been extended to include neuropsychiatric disorders including major depression. Patients with major depression have been found to exhibit increased peripheral blood inflammatory biomarkers, including inflammatory cytokines, which have been shown to access the brain and interact with virtually every pathophysiologic domain known to be involved in depression, including neurotransmitter metabolism, neuroendocrine function, and neural plasticity. Indeed, activation of inflammatory pathways within the brain is believed to contribute to a confluence of decreased neurotrophic support and altered glutamate release/reuptake, as well as oxidative stress, leading to excitotoxicity and loss of glial elements, consistent with neuropathologic findings that characterize depressive disorders. Further instantiating the link between inflammation and depression are data demonstrating that psychosocial stress, a well-known precipitant of mood disorders, is capable of stimulating inflammatory signaling molecules, including nuclear factor kappa B, in part, through activation of sympathetic nervous system outflow pathways. Interestingly, depressed patients with increased inflammatory biomarkers have been found to be more likely to exhibit treatment resistance, and in several studies, antidepressant therapy has been associated with decreased inflammatory responses. Finally, preliminary data from patients with inflammatory disorders, as well as medically healthy depressed patients, suggest that inhibiting proinflammatory cytokines or their signaling pathways may improve depressed mood and increase treatment response to conventional antidepressant medication. Translational implications of these findings include the unique opportunity to identify relevant patient populations, apply immune-targeted therapies, and monitor therapeutic efficacy at the level of the immune system in addition to behavior.

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Crossref · 10.1016/j.biopsych.2008.11.029

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  • Patients with major depressive disorder exhibit all of the cardinal features of an inflammatory response, including increased expression of pro-inflammatory cytokines and their receptors and increased levels of acute-phase reactants, chemokines and soluble adhesion molecules in peripheral blood and cerebrospinal fluid.

    “Patients with major depressive disorder exhibit all of the cardinal features of an inflammatory response, including increased expression of pro-inflammatory cytokines and their receptors and increased levels of acute-phase reactants, chemokines and soluble adhesion molecules in peripheral blood and cerebrospinal fluid (CSF)16,17.”

    From The role of inflammation in depression: from evolutionary imperative to modern treatment target (2016) · cites this paper as [16]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • SSRI might have a beneficial effect on inflammation.

    “we found, like others,14 that SSRI might have a beneficial effect on inflammation”

    From Association of depressive disorders, depression characteristics and antidepressant medication with inflammation (2012) · cites this paper as [14]

    The Translational Implications section reports that antidepressant treatment was associated with decreased inflammatory markers in 11 of 20 studies. It does not establish that finding specifically for SSRIs, so the drug-class specificity of the claim is unsupported. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • Earlier studies found decreases in inflammatory marker levels after antidepressant treatment, mainly SSRI.

    “Earlier studies found decreases in inflammatory marker levels after antidepressant treatment, mainly SSRI (see ref. 14 for an overview)”

    From Association of depressive disorders, depression characteristics and antidepressant medication with inflammation (2012) · cites this paper as [14]

    The Translational Implications section reports decreases in inflammatory markers after antidepressant treatment in 11 of 20 studies, supporting the overview of earlier findings. The passage does not say that those studies mainly used SSRIs, so that qualification is unsupported by our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Meta-analyses conclude that peripheral blood IL-1β, IL-6, TNF and CRP are the most reliable biomarkers of inflammation in patients with depression.

    “Meta-analyses of the literature conclude that peripheral blood IL-1β, IL-6, TNF and C-reactive protein (CRP) are the most reliable biomarkers of inflammation in patients with depression16.”

    From The role of inflammation in depression: from evolutionary imperative to modern treatment target (2016) · cites this paper as [16]

    The section “Evidence for a Cytokine Basis for Major Depression” (page unavailable) describes elevated peripheral inflammatory markers in patients with major depression and calls IL-6 one of the most reliable peripheral biomarkers. It mentions IL-1 and TNF-alpha, but does not identify them or CRP as equally reliable biomarkers or state that meta-analyses reached the claimed four-marker conclusion. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Increased expression of innate immune genes and proteins, including IL-1β, IL-6, TNF, TLR3 and TLR4, has been found in post-mortem brain samples from suicide victims that had depression.

    “increased expression of a variety of innate immune genes and proteins, including IL-1β, IL-6, TNF, Toll-like receptor 3 (TLR3) and TLR4, has been found in post-mortem brain samples from suicide victims that had depression16,18,19,21.”

    From The role of inflammation in depression: from evolutionary imperative to modern treatment target (2016) · cites this paper as [16]

    The ‘Cytokine Effects on Neural Plasticity’ section (page not provided) reports postmortem evidence associating suicide with increased microglia in the prefrontal cortex. It does not report increased expression of IL-1β, IL-6, TNF, TLR3 or TLR4 in those brain samples; the ‘Evidence for a Cytokine Basis for Major Depression’ section discusses cytokine elevations in blood and cerebrospinal fluid instead. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Authors
Miller, A. H., Maletic, V., & Raison, C. L.
Affiliations
Emory University (US)
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2009-05
Volume
65
Issue
9
Pages
732-741
ISSN
0006-3223 (ISSN-L)
OpenAlex
W1996454121
Cited by
3,848
References
121
Citations by year
2026: 163 · 2025: 243 · 2024: 237 · 2023: 226 · 2022: 263 · 2021: 318 · 2020: 277 · 2019: 229 · 2018: 263 · 2017: 216 · 2016: 244 · 2015: 255 · 2014: 220 · 2013: 206 · 2012: 180
FWCI
6.51
Type
journal article
Language
en
Open access
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000454)
  • National Heart, Lung, and Blood Institute (R01HL073921)
  • National Institute of Mental Health (R01MH083746, K23MH064619, T32MH020018, R01MH070553, K05MH069124)
  • National Center for Research Resources (M01-RR00039, M01RR000039)
  • National Center for Advancing Translational Sciences
Topics
  • Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords
major depressive disorder, inflammation, cytokines, inflammatory markers, neuroinflammation, neurotrophic support, glutamate release, oxidative stress, excitotoxicity, neuroendocrine function, neuroplasticity, psychosocial stress, NF-κB, sympathetic nervous system, antidepressant resistance, immune-targeted therapy, treatment response
MeSH terms
Animals, Anti-Inflammatory Agents, Basal Ganglia, Brain, Major Depressive Disorder, Depressive Disorder, Major, Humans, Inflammation, Neuronal Plasticity, Neurosecretory Systems, Stress, Psychological, Biomarkers, Cytokines, Neurotransmitter Agents

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