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

F. Lamers*, N. Vogelzangs, K. R. Merikangas, P. de Jonge, A. T. F. Beekman, B. W. J. H. Penninx

*Corresponding author for this work

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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-alpha), 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.

Original languageEnglish
Pages (from-to)692-699
Number of pages8
JournalMolecular Psychiatry
Volume18
Issue number6
DOIs
Publication statusPublished - Jun-2013

Keywords

  • depression
  • inflammation
  • metabolic syndrome
  • salivary cortisol
  • subtypes
  • MAJOR DEPRESSION
  • SALIVARY CORTISOL
  • ANTIDEPRESSANT USE
  • ANXIETY NESDA
  • GENETIC-LINKAGE
  • CYTOKINES
  • ASSOCIATIONS
  • DISORDER
  • FEATURES
  • METAANALYSIS

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