Meghan Bialt-DeCelie – ’19

When diagnosed with depression, patients are often left to trial and error with anti-depressant drugs. Incompatible prescriptions along the search can lead to potential issues with side effects, which can be ineffective as well as costly. A study led by Madhukar Trivedi, M.D. assessed a patient’s level of C-reactive protein (CRP) and related it to selection of antidepressant drugs escitalopram, a serotonin reuptake inhibitor (SSRI). CRP is sensitive to inflammatory markers like cytokines and can serve as a biomarker for systemic inflammation.

They used data from the CO-MED (Combining Medications to Depression outcomes) trial. Patients with concentrations above a 1mg/L concentration threshold were more compatible with SSRI. Participants were given either escitalopram or a combination of escitalopram and bupropion. CRP levels were measured. The researchers used Quick Inventory of Depressive Symptomatology Self-Report and Frequency, Intensity, and Burden of Side-Effects Rating Scale over the course of twelve weeks to analyze the status of the patients’ depression.

Patients with CRP levels below the threshold responded more to the escitalopram treatment than those with CRP levels above this threshold. (P=0.05). All participants had similar severity of depression at the start of the study, and after 2 weeks, <1mg/L CRP levels patients’ depression severity was more dramatically reduced with SSRI monotherapy treatment. 57.14% <1mg/L CRP patients achieved remission in comparison to only 29.73% of patients whose CRP levels were above the threshold.

This study allows the CRP biomarker to potentially be a useful biomarker for determining treatment for depression. Patients with relatively lower levels of CRP are likely to respond better to SSRI monotreatment.

References:

1. Skeldon, Anne C., Andrew JK Phillips, and Derk-Jan Dijk, The effects of self-selected light-dark cycles and social constraints on human sleep and circadian timing: a modeling approach. Scientific Reports7, (2017). DOI: 10.1038/srep45158
2. Image retrieved from: https://commons.wikimedia.org/wiki/File:Escitalopram_Structural_Formulae.png