Examining Subclinical Inflammation in Major Depressive Disorder Subtypes

Year 2025, Volume: 35 Issue: 6, 1081 - 1089, 31.12.2025

Esra Aslan , Bahadır Demir

https://doi.org/10.54005/geneltip.1609236

Abstract

Aims: There is increasing evidence that neuroinflammation and inflammatory processes play roles in psychiatric disorders. In the present study, the purpose was to investigate the role of systemic inflammation in major depressive disorder (MDD) subtypes, to compare the inflammation rates between subtypes and healthy controls, to help elucidate the pathophysiology of the disease, and to contribute to the determination of biochemical parameters.
Material and Methods: A total of 244 participants (180 patients diagnosed with MDD; 30 from the subtypes of catatonia, melancholy, mixed, atypical, anxious distress, psychosis, and 64 healthy controls )were included in the study. Participants who had a history of comorbid medical disease and/or any medication use were excluded from the study. Hemoglobin, hematocrit, platelets, neutrophils, lymphocytes, monocytes, Monocyte/Lymphocyte Ratio (MLR), Neutrophil/Lymphocyte Ratio (NLR), and Platelet/Lymphocyte Ratio (PLR) of the groups were compared.
Results: Sex, age and Body Mass Index (BMI) values did not differ between MDD subtypes and healthy controls (p>0.05). No differences were detected between healthy controls and MDD subtypes in neutrophil and lymphocyte counts (p>0.05). NLR and MLR values differed between healthy controls and MDD subtypes (p=0.023, p=0.002, respectively). NLR and MLR were significantly higher in the MDD subtype with catatonic characteristics than in healthy controls (p=0.002, p<0.001, respectively).
Conclusion: These results may contribute to a better understanding of subclinical inflammation,

Keywords

Biomarkers , catatonia , major depressive disorder , monocyte/lymphocyte ratio , subclinical inflammation , neutrophil/lymphocyte ratio , platelet/lymphocyte ratio

Ethical Statement

The study was approved by the ethical commission of Gaziantep University with the decision number 2022/265.

Supporting Institution

None

Thanks

None

Majör depresif bozukluk alt tiplerinde subklinik inflamasyonun incelenmesi

Abstract

Amaç: Psikiyatrik bozukluklarda nöroinflamasyonun ve inflamatuar süreçlerin rol oynadığına dair kanıtlar giderek artmaktadır. Çalışmamızda Majör depresif bozukluk (MDB) alt tiplerinde sistemik inflamasyonun rolünün araştırılması, alt tipler arasındaki inflamasyon oranlarının sağlıklı kontroller ile karşılaştırılması, hastalığın patofizyolojisinin aydınlatılmasına yardımcı olunması, biyokimyasal parametrelerin tespit edilmesine katkı sağlanması amaçlandı.
Gereç ve Yöntem: Çalışmaya MDB tanısı alan 180 hasta (katatoni ile giden, melankoli, karma, atipik, bunaltılı sıkıntı, psikoz özellikleri gösteren alt tiplerin her birinden 30 hasta) ve 64 sağlıklı kontrol olmak üzere 244 katılımcı dahil edildi. Komorbid tıbbi hastalık öyküsü ve/veya herhangi bir ilaç kullanımı olan katılımcılar çalışmaya dahil edilmedi. Grupların hemoglobin, hematokrit, platelet, nötrofil, lenfosit, monosit, monosit/lenfosit oranı (MLO), nötrofil/lenfosit oranı (NLO), platelet/lenfosit oranı (PLO) karşılaştırıldı.
Bulgular: Cinsiyet, yaş ve vücut kitle indeksi (VKİ) değerleri; MDB alt tipleri ile sağlıklı kontroller
arasında farklılık göstermedi (p>0.05). Nötrofil ve lenfosit sayıları açısından sağlıklı kontroller ve MDB alt tipleri arasında fark saptanmadı (p>0.05). NLO ve MLO değerleri sağlıklı kontroller ile MDB alt tipleri arasında farklılık gösterdi (sırasıyla p=0.023, p=0.002). Katatonik özellikli MDB alt tipinde NLO ve MLO sağlıklı kontrollere göre anlamlı düzeyde yüksek saptandı (sırasıyla p=0.002, p<0.001).
Sonuç: Araştırmamızın bulguları MDB alt tiplerinde subklinik inflamasyonun, patofizyolojinin, bireyselleştirilmiş tedavi yaklaşımlarının ve prognostik değerlendirmenin daha iyi anlaşılmasına katkıda bulunabilir.

Keywords

Biyobelirteçler , katatoni , majör depresif bozukluk , monosit/lenfosit oranı , nötrofil/ lenfosit oranı , platelet/lenfosit oranı , subklinik inflamasyon

References

• 1. Organization WHO. Depression and other common mental disorders: global health estimates. World Health Organization; 2017.
• 2. Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J. Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. J Psychiatr Res 2020;126:134-40.
• 3. Friedrich MJ. Depression is the leading cause of disability around the world. JAMA 2017;317:15-17.
• 4. Van Loo HM, De Jonge P, Romeijn J-W, Kessler RC, Schoevers RA. Data-driven subtypes of major depressive disorder: a systematic review. BMC Med 2012; 10:1-12.
• 5. Prins J, Olivier B, Korte SM. Triple reuptake inhibitors for treating subtypes of major depressive disorder: the monoamine hypothesis revisited. Expert Opin Investig Drugs 2011; 20:1107-30.
• 6. Edition F. Diagnostic and statistical manual of mental disorders. Am J Psychiatry 2013; 21:591-643.
• 7. Najjar S, Pearlman DM, Alper K, Najjar A, Devinsky O. Neuroinflammation and psychiatric illness. J Neuroinflammation 2013;10:1-24.
• 8. Bauer ME, Teixeira AL. Inflammation in psychiatric disorders: what comes first? Ann N Y Acad Sci 2019; 1437:57-67.
• 9. Chang HH, Chen PS. Inflammatory biomarkers for mood disorders-a brief narrative review. Curr Pharm Des 2020; 26:236-43.
• 10. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102:5-14.
• 11. Mazza MG, Tringali AGM, Rossetti A, Botti RE, Clerici M. Cross-sectional study of neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios in mood disorders. Gen Hosp Psychiatry 2019; 58:7-12.
• 12. Bhikram T, Sandor P. Neutrophil-lymphocyte ratios as inflammatory biomarkers in psychiatric patients. Brain Behav Immun 2022;105:237-46.
• 13. Canlı D. Evaluation of systemic immune-inflammation index, systemic inflammatory response index and hematologic inflammatory parameters in generalized anxiety disorder: a controlled study. Anatolian Curr Med J. 2024; 6: 161-167.
• 14. Garip B, Oğur B, Tekin Ş, İnanç Ö. Comparative Study of Inflammatory Markers in Schizophrenia, First Episode Psychosis, and Bipolar Disorder. Genel Tıp Derg. 2024; 34: 624-628.
• 15. Kulu M, Özsoy F, Demir B. Inflammation levels in patients with alcohol and substance use disorders. Cukurova Med J. 2021; 46: 1558-1565.
• 16. Su M, Ouyang X, Song Y. Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio in depression: a meta-analysis. J Affect Disord. 2022; 308:375-83.
• 17. Liqiang C, Luoyi X, Lili W, Wei C. Relationship of mean platelet volume to MDD: a retrospective study. Shanghai Arch Psychiatry 2017;29:21.
• 18. Demir S, Atli A, Bulut M, İbiloğlu AO, Güneş M, Kaya MC, et al. Neutrophil–lymphocyte ratio in patients with major depressive disorder undergoing no pharmacological therapy. Neuropsychiatr Dis Treat. 2015; 11 : 2253-2258.
• 19. Demircan F, Gözel N, Kılınç F, Ulu R, Atmaca M. The impact of red blood cell distribution width and neutrophil/lymphocyte ratio on the diagnosis of major depressive disorder. Neurol Ther. 2016; 5: 27-33.
• 20. Ozdin S, Ozdin SB. Does late and early onset depression differ in terms of inflammation? Dusunen Adam. 2020; 33: 334-339.
• 21. Martínez-Botía P, Velasco A, Rolle V, Jiménez-Trevino L, Fuente-Tomás L, Bernardo Á, et al. Sex-dependent grades of haematopoietic modulation in patients with major depressive episodes are associated with suicide attempts. Eur Neuropsychopharmacol 2020;40:17-30.
• 22. Gündüz N, Timur Ö, Erzincan E, Turgut C, Turan H, Akbey ZY. Evaluation of mean platelet volume, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and red cell distribution width in patients with diagnosis of major depressive disorder. Medeni Med J. 2017; 32.
• 23. Ayhan MG, Dağistan AA, Tanrikulu CŞ, Bozdoğan ŞY, Eren I. Increased neutrophil/lymphocyte ratio in suicide attempters. Anadolu Psikiyatri Derg. 2019; 20: 305-312.
• 24. Uçar HN, Eray Ş, Murat D. Simple peripheral markers for inflammation in adolescents with major depressive disorder. Psychiatry Clin Psychopharmacol. 2018; 28: 254-260.
• 25. Özyurt G, Binici NC. Increased neutrophil-lymphocyte ratios in depressive adolescents is correlated with the severity of depression. Psychiatry Res. 2018; 268: 426-431.
• 26. Meng F, Yan X, Qi J, He F. Association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio with depression: A cross-sectional analysis of the NHANES data. J Affect Disord 2022;315:168-73.
• 27. Cheng Y, Wang Y, Wang X, Jiang Z, Zhu L, Fang S. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio in depression: an updated systematic review and meta-analysis. Front Psychiatry 2022;13:893097.
• 28. Velasco Á, Rodríguez-Revuelta J, Olié E, Abad I, Fernández-Peláez A, Cazals A, et al. Neutrophil-to-lymphocyte ratio: A potential new peripheral biomarker of suicidal behavior. Eur Psychiatry 2020;63(1);e14:1-6.
• 29. Aslan E, Demir B, Ulusal H, Şahin Ş, Taysi S, Elboğa G, et al. Sestrin-2 and hypoxia-ınducible factor-1 alpha levels in major depressive disorder and its subtypes. Psychopharmacology. 2023;240:1691-704.
• 30. Kayhan F, Gündüz Ş, Ersoy SA, Kandeğer A, Annagür BB. Relationships of neutrophil–lymphocyte and platelet–lymphocyte ratios with the severity of major depression. Psychiatry Res 2017;247:332-5.
• 31. Solmi M, Pigato GG, Roiter B, Guaglianone A, Martini L, Fornaro M, et al. Prevalence of catatonia and its moderators in clinical samples: results from a meta-analysis and meta-regression analysis. Schizophr Bull 2018;44:1133-50.
• 32. Sahin SK, Yaşamali C, Özyürek MB, Elboğa G, Altındağ A, Şahin AZ. Neutrophil- lymphocyte ratio in catatonia. Arch. Clin. Psychiatry 2020;47:55-8.
• 33. Lakshmanan A, Saravanan A. Effect of intensity of cigarette smoking on haematological and lipid parameters. J Clin Diagn Res 2014;8: BC11-13.
• 34. Koca TT. Does obesity cause chronic inflammation? The association between complete blood parameters with body mass index and fasting glucose. Pak J Med Sci 2017;33:65.