Abstract
Objective: Immunological theories, particularly the sickness syndrome theory, may explain psychopathology in mood disorders. However, no clinical trials have investigated the association between overall immune system markers with a wide range of specific symptoms including potential gender differences. Methods: We included two similar clinical trials, the lithium treatment moderate-dose use study and clinical and health outcomes initiatives in comparative effectiveness for bipolar disorder study, enrolling 765 participants with bipolar disorder. At study entry, white blood cell (WBC) count was measured and psychopathology assessed with the Montgomery and Aasberg depression rating scale (MADRS). We performed analysis of variance and linear regression analyses to investigate the relationship between the deviation from the median WBC, and multinomial regression analysis between different WBC levels. All analyses were performed gender-specific and adjusted for age, body mass index, smoking, race, and somatic diseases. Results: The overall MADRS score increased significantly for each 1.0×109/l deviation from the median WBC among 322 men (coefficient=1.10; 95% CI=0.32–1.89; p=0.006), but not among 443 women (coefficient=0.56; 95% CI=−0.19–1.31; p=0.14). Among men, WBC deviations were associated with increased severity of sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, inability to feel, and suicidal thoughts. Among women, WBC deviations were associated with increased severity of reduced appetite, concentration difficulties, lassitude, inability to feel, and pessimistic thoughts. Both higher and lower WBC levels were associated with increased severity of several specific symptoms. Conclusion: Immune system alterations were associated with increased severity of specific mood symptoms, particularly among men. Our results support the sickness syndrome theory, but furthermore emphasise the relevance to study immune suppression in bipolar disorder. Due to the explorative nature and cross-sectional design, future studies need to confirm these findings.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1-9 |
| Number of pages | 9 |
| Journal | Acta Neuropsychiatrica |
| DOIs | |
| State | Accepted/In press - Dec 7 2017 |
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Keywords
- affective disorder
- bipolar disorder
- clinical trials
- lithium
- mood stabilisers
- psychoneuroimmunology
ASJC Scopus subject areas
- Psychiatry and Mental health
- Biological Psychiatry
Cite this
Clinically relevant and simple immune system measure is related to symptom burden in bipolar disorder. / Köhler-Forsberg, Ole; Sylvia, Louisa; Deckersbach, Thilo; Ostacher, Michael Joshua; McInnis, Melvin; Iosifescu, Dan; Bowden, Charles; McElroy, Susan; Calabrese, Joseph; Thase, Michael; Shelton, Richard Charles; Tohen, Mauricio; Kocsis, James; Friedman, Edward; Ketter, Terence; Nierenberg, Andrew Alan.
In: Acta Neuropsychiatrica, 07.12.2017, p. 1-9.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clinically relevant and simple immune system measure is related to symptom burden in bipolar disorder
AU - Köhler-Forsberg, Ole
AU - Sylvia, Louisa
AU - Deckersbach, Thilo
AU - Ostacher, Michael Joshua
AU - McInnis, Melvin
AU - Iosifescu, Dan
AU - Bowden, Charles
AU - McElroy, Susan
AU - Calabrese, Joseph
AU - Thase, Michael
AU - Shelton, Richard Charles
AU - Tohen, Mauricio
AU - Kocsis, James
AU - Friedman, Edward
AU - Ketter, Terence
AU - Nierenberg, Andrew Alan
PY - 2017/12/7
Y1 - 2017/12/7
N2 - Objective: Immunological theories, particularly the sickness syndrome theory, may explain psychopathology in mood disorders. However, no clinical trials have investigated the association between overall immune system markers with a wide range of specific symptoms including potential gender differences. Methods: We included two similar clinical trials, the lithium treatment moderate-dose use study and clinical and health outcomes initiatives in comparative effectiveness for bipolar disorder study, enrolling 765 participants with bipolar disorder. At study entry, white blood cell (WBC) count was measured and psychopathology assessed with the Montgomery and Aasberg depression rating scale (MADRS). We performed analysis of variance and linear regression analyses to investigate the relationship between the deviation from the median WBC, and multinomial regression analysis between different WBC levels. All analyses were performed gender-specific and adjusted for age, body mass index, smoking, race, and somatic diseases. Results: The overall MADRS score increased significantly for each 1.0×109/l deviation from the median WBC among 322 men (coefficient=1.10; 95% CI=0.32–1.89; p=0.006), but not among 443 women (coefficient=0.56; 95% CI=−0.19–1.31; p=0.14). Among men, WBC deviations were associated with increased severity of sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, inability to feel, and suicidal thoughts. Among women, WBC deviations were associated with increased severity of reduced appetite, concentration difficulties, lassitude, inability to feel, and pessimistic thoughts. Both higher and lower WBC levels were associated with increased severity of several specific symptoms. Conclusion: Immune system alterations were associated with increased severity of specific mood symptoms, particularly among men. Our results support the sickness syndrome theory, but furthermore emphasise the relevance to study immune suppression in bipolar disorder. Due to the explorative nature and cross-sectional design, future studies need to confirm these findings.
AB - Objective: Immunological theories, particularly the sickness syndrome theory, may explain psychopathology in mood disorders. However, no clinical trials have investigated the association between overall immune system markers with a wide range of specific symptoms including potential gender differences. Methods: We included two similar clinical trials, the lithium treatment moderate-dose use study and clinical and health outcomes initiatives in comparative effectiveness for bipolar disorder study, enrolling 765 participants with bipolar disorder. At study entry, white blood cell (WBC) count was measured and psychopathology assessed with the Montgomery and Aasberg depression rating scale (MADRS). We performed analysis of variance and linear regression analyses to investigate the relationship between the deviation from the median WBC, and multinomial regression analysis between different WBC levels. All analyses were performed gender-specific and adjusted for age, body mass index, smoking, race, and somatic diseases. Results: The overall MADRS score increased significantly for each 1.0×109/l deviation from the median WBC among 322 men (coefficient=1.10; 95% CI=0.32–1.89; p=0.006), but not among 443 women (coefficient=0.56; 95% CI=−0.19–1.31; p=0.14). Among men, WBC deviations were associated with increased severity of sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, inability to feel, and suicidal thoughts. Among women, WBC deviations were associated with increased severity of reduced appetite, concentration difficulties, lassitude, inability to feel, and pessimistic thoughts. Both higher and lower WBC levels were associated with increased severity of several specific symptoms. Conclusion: Immune system alterations were associated with increased severity of specific mood symptoms, particularly among men. Our results support the sickness syndrome theory, but furthermore emphasise the relevance to study immune suppression in bipolar disorder. Due to the explorative nature and cross-sectional design, future studies need to confirm these findings.
KW - affective disorder
KW - bipolar disorder
KW - clinical trials
KW - lithium
KW - mood stabilisers
KW - psychoneuroimmunology
UR - http://www.scopus.com/inward/record.url?scp=85038024403&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85038024403&partnerID=8YFLogxK
U2 - 10.1017/neu.2017.34
DO - 10.1017/neu.2017.34
M3 - Article
SP - 1
EP - 9
JO - Acta Neuropsychiatrica
JF - Acta Neuropsychiatrica
SN - 0924-2708
ER -