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Hypothalamic–pituitary–adrenal (HPA) system activity in depression and infection with Borna disease virus and Chlamydia pneumoniae

Molecular Psychiatry volume 8, pages 469–470 (2003)Cite this article

SIR – The pathophysiology of severe depression may be associated with mutual immune and hypothalamic–pituitary–adrenal (HPA) system activation,1,2 by which infection-induced immune response is triggering the HPA system, thereby changing behavior,3 and stress hormones, in turn, the immune system.4 In this context, we investigated infections with two independent agents (Borna disease virus (BDV) and Chlamydia pneumoniae (CP)), one of which already under debate to specifically contribute to depression.5,6,7,8 Our study provides the first clinical evidence that in depressed patients, infection with Bornavirus is associated with activation of the HPA system.

The study enrolled 48 patients with a major depressive episode (DSM-IV), giving informed consent and presenting with at least 18 points in the Hamilton Depression Scale (HAMD) after a 6-day wash-out, who were kept off psychotropic medication for 1 week (except lorazepam and zolpidem) and subsequently treated with 150 mg amitriptyline or 40 mg paroxetine for weeks 1–4. Excluded were patients with schizophrenia, bipolar or current substance-related disorders. Saliva cortisol was measured daily at 8.00, 16.00 and 22.00 h during weeks −1 to 4, and mean daily concentrations were calculated each week. Citrated blood was drawn weekly for 6 weeks. IgG, IgM and IgA antibodies to CP were analyzed twice (weeks −1 and 4) using a commercially available assay. BDV structural proteins p40 and p24 and specific circulating immune complexes (CICs), together indicating antigenemia as a result of viral replication, were determined by enzyme immune assays (EIAs) using specific monoclonal antibodies.5,8 BDV antigen-positive scoring requested moderate or high reactivity in the BDV-CIC and/or plasma antigen EIA. Nonreactivity in either assay was considered BDV negative. Laboratories (endocrinology, microbiology) were mutually kept blind as to their results. Analysis of variance with repeated measures (ANOVA-rm) and t-tests were used to compare HPA system activity between subgroup of patients.

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Authors and Affiliations

  1. Central Institute of Mental Health, Mannheim, Germany

    M Deuschle, U Meyding-Lamadé, A Plesch, B Hamann & I Heuser

  2. Robert-Koch-Institute, Berlin, Germany

    L Bode

  3. Hygiene Institute, University Heidelberg, Germany

    P Schnitzler

  4. Department of Neurology, University Heidelberg, Germany

    U Meyding-Lamadé

  5. Institute of Virology, Free University of Berlin, Germany

    H Ludwig

  6. Department of Psychiatry, Free University of Berlin, Germany

    I Heuser

Authors
  1. M Deuschle
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  2. L Bode
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  3. P Schnitzler
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  5. A Plesch
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  6. H Ludwig
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  7. B Hamann
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  8. I Heuser
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Correspondence to M Deuschle.

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Deuschle, M., Bode, L., Schnitzler, P. et al. Hypothalamic–pituitary–adrenal (HPA) system activity in depression and infection with Borna disease virus and Chlamydia pneumoniae. Mol Psychiatry 8, 469–470 (2003). https://doi.org/10.1038/sj.mp.4001312

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