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Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression

Abstract

The hypothalamic–pituitary–adrenal (HPA) axis and the inflammatory response system have been suggested as pathophysiological mechanisms implicated in the etiology of major depressive disorder (MDD). Although meta-analyses do confirm associations between depression and these biological systems, effect sizes vary greatly among individual studies. A potentially important factor explaining variability is heterogeneity of MDD. Aim of this study was to evaluate the association between depressive subtypes (based on latent class analysis) and biological measures. Data from 776 persons from the Netherlands Study of Depression and Anxiety, including 111 chronic depressed persons with melancholic depression, 122 with atypical depression and 543 controls were analyzed. Inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-α), metabolic syndrome components, body mass index (BMI), saliva cortisol awakening curves (area under the curve with respect to the ground (AUCg) and with respect to the increase (AUCi)), and diurnal cortisol slope were compared among groups. Persons with melancholic depression had a higher AUCg and higher diurnal slope compared with persons with atypical depression and with controls. Persons with atypical depression had significantly higher levels of inflammatory markers, BMI, waist circumference and triglycerides, and lower high-density lipid cholesterol than persons with melancholic depression and controls. This study confirms that chronic forms of the two major subtypes of depression are associated with different biological correlates with inflammatory and metabolic dysregulation in atypical depression and HPA-axis hyperactivity in melancholic depression. The data provide further evidence that chronic forms of depressive subtypes differ not only in their symptom presentation, but also in their biological correlates. These findings have important implications for future research on pathophysiological pathways of depression and treatment.

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Acknowledgements

The infrastructure for the NESDA study (www.nesda.nl) is funded through the Geestkracht program of the Netherlands Organisation for Health Research and Development (Zon-Mw, grant number 10-000-1002) and is supported by participating universities and mental health care organizations (VU University Medical Center, GGZ inGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Scientific Institute for Quality of Healthcare (IQ healthcare), Netherlands Institute for Health Services Research (NIVEL) and Netherlands Institute of Mental Health and Addiction (Trimbos). Biomarker funding was provided by the Neuroscience Campus Amsterdam and the Netherlands Organisation for Scientific research (VIDI project). BWJHP is supported by a VICI grant from the Netherlands Organisation for Scientific research. FL is supported by a Rubicon fellowship from the Netherlands Organisation for Scientific research and by a Supplemental Intramural Research Training Award from the National Institute of Mental Health, Genetic Epidemiology Research Branch. The views and opinions expressed in this article are ours and should not be construed to represent the views of any of the sponsoring organizations, agencies or US Government.

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Lamers, F., Vogelzangs, N., Merikangas, K. et al. Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Mol Psychiatry 18, 692–699 (2013). https://doi.org/10.1038/mp.2012.144

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  • DOI: https://doi.org/10.1038/mp.2012.144

Keywords

  • depression
  • inflammation
  • metabolic syndrome
  • salivary cortisol
  • subtypes

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