Research Article
BibTex RIS Cite

Comparison of the intensity of peripheral inflammation between major depressive disorder and bipolar depression by means of neutrophil-lymphocyte and plateletlymphocyte ratios: The possible role of clinical severity and psychotic features

Year 2022, Volume: 35 Issue: 1, 100 - 106, 31.01.2022
https://doi.org/10.5472/marumj.1065834

Abstract

Objective: The present study aimed to compare the intensity of inflammation between major depressive disorder (MDD) and bipolar
disorder-depressive episode (BD-D) by using neutrophil to lymphocyte (NLR) and platelet to lymphocyte ratios (PLR) as nonspecific
markers for peripheral immune response, and to investigate whether and how these parameters correlate with the clinical
characteristics of the depressive episodes within and between the diagnoses.
Patients and Methods: The medical records of 209 psychiatric inpatients (126 diagnosed with MDD, 83 with BD-D) and 150 healthy
controls (HC) were retrospectively screened to obtain NLR and PLR values.
Results: Both MDD and BD-D presented with significantly elevated NLR and PLR compared to HC, with the increase being associated
with the severity of depression but not with the presence of psychotic features. The severity of inflammation was found to be of a
comparable magnitude between the two conditions, or at least indistinguishable by means of the NLR and PLR.
Conclusion: Our results suggest that both MDD and BD-D involve a presumably complex inflammatory process resulting in an
observable, albeit nonspecific alteration in the distribution of peripheric blood cells. Moreover, the magnitude of the observed immune
response appears to relate to the severity of the depressive episode for both conditions.

References

  • Leonpacher A, Liebers D, Pirooznia M, et al. Distinguishing bipolar from unipolar depression: the importance of clinical symptoms and illness features. Psychol Med 2015;45:2437-46. doi: 10.1017/S003.329.1715000446.
  • Bromet E, Andrade LH, Hwang I, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med 2011;9:90. doi: 10.1186/1741-7015-9-90.
  • Merikangas KR, Jin R, He J-P, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011;68:241-51. doi: 10.1001/archgenpsychiatry.2011.12.
  • Gibney SM, Drexhage HA. Evidence for a dysregulated immune system in the etiology of psychiatric disorders. J Neuroimmune Pharmacol 2013;8:900-20. doi: 10.1007/ s11481.013.9462-8.
  • Vogelzangs N, Duivis HE, Beekman AT, et al. Association of depressive disorders, depression characteristics and antidepressant medication with inflammation. Transl Psychiatry 2012;2:e79-e79. doi: 10.1038/tp.2012.8.
  • Bai YM, Su TP, Li CT, et al. Comparison of pro‐inflammatory cytokines among patients with bipolar disorder and unipolar depression and normal controls. Bipolar Disorders 2015;17:269-77.
  • Köhler C, Freitas T, Maes Md, et al. Peripheral cytokine and chemokine alterations in depression: a meta‐analysis of 82 studies. Acta Psychiatr Scand 2017;135:373-87. doi: 10.1111/ acps.12698.
  • Maes M, Carvalho AF. The compensatory immune-regulatory reflex system (CIRS) in depression and bipolar disorder. Mol Neurobiol 2018;55:8885-8903 doi: 10.1007/s12035.018.1016-x.
  • Brunoni AR, Supasitthumrong T, Teixeira AL, et al. Differences in the immune-inflammatory profiles of unipolar and bipolar depression. J Affect Disord 2020;262:8-15. doi: 10.1016/j. jad.2019.10.037.
  • Wang Q, Yu C, Shi S, et al. An analysis of plasma reveals proteins in the acute phase response pathway to be candidate diagnostic biomarkers for depression. Psychiatry Res 2019;272:404-10. doi: 10.1016/j.psychres.2018.11.069.
  • Maes M, Bonifacio KL, Morelli NR, et al. Major differences in neurooxidative and neuronitrosative stress pathways between major depressive disorder and types I and II bipolar disorder. Mol Neurobiol 2019;56:141-56. doi: 10.1007/s12035.018.1051-7.
  • Al-Hakeim HK, Al-Rammahi DA, Al-Dujaili AH. IL- 6, IL-18, sIL-2R, and TNFα proinflammatory markers in depression and schizophrenia patients who are free of overt inflammation. J Affect Disord 2015;182:106-14. doi: 10.1016/j. jad.2015.04.044.
  • Kuyumcu ME, Yesil Y, Oztürk ZA, et al. The evaluation of neutrophil-lymphocyte ratio in Alzheimer’s disease. Dement Geriatr Cogn Disord 2012;34:69-74. doi: 10.1159/000341583.
  • Semiz M, Yildirim O, Canan F, et al. Elevated neutrophil/ lymphocyte ratio in patients with schizophrenia. Psychiatr Danub 2014;26:220-5.
  • Kulaksizoglu B, Kulaksizoglu S. Relationship between neutrophil/lymphocyte ratio with oxidative stress and psychopathology in patients with schizophrenia. Neuropsychiatr Dis Treat 2016;12:1999. doi: 10.2147/NDT. S110484.
  • Demir S, Atli A, Bulut M, et al. Neutrophil–lymphocyte ratio in patients with major depressive disorder undergoing no pharmacological therapy. Neuropsychiatr Dis Treat 2015;11:2253. doi: 10.2147/NDT.S89470.
  • Giynas Ayhan M, Cicek IE, Inanli I, et al. Neutrophil/ lymphocyte and platelet/lymphocyte ratios in all mood states of bipolar disorder. Psychiatr Clin Psychopharmacol 2017;27:278-82. doi: 10.1080/24750.573.2017.1338822.
  • Kayhan F, Gündüz Ş, Ersoy SA, et al. Relationships of neutrophil–lymphocyte and platelet–lymphocyte ratios with the severity of major depression. Psychiatry Res 2017;247:332- 5. doi: doi.org/10.1016/j.psychres.2016.11.016.
  • Sunbul EA, Sunbul M, Yanartas O, et al. Increased neutrophil/ lymphocyte ratio in patients with depression is correlated with the severity of depression and cardiovascular risk factors. Psychiatry Investig 2016;13:121. doi: 10.4306/pi.2016.13.1.121.
  • Chang HH, Chen PS. C-reactive protein as a differential biomarker of bipolar versus unipolar depression: Response. World J Biol Psychiatry 2017;18:73-4. doi: 10.1080/15622.975.2016.1208845.
  • Mota R, Gazal M, Acosta BA, et al. Interleukin-1β is associated with depressive episode in major depression but not in bipolar disorder. J Psychiatr Res 2013;47:2011-4. doi: 10.1016/j. jpsychires.2013.08.020.
  • Hung YJ, Hsieh CH, Chen YJ, et al. Insulin sensitivity, proinflammatory markers and adiponectin in young males with different subtypes of depressive disorder. Clin Endocrinol 2007;67:784-9. doi: 10.1111/j.1365-2265.2007.02963.x.
  • Su SC, Sun MT, Wen MJ, et al. Brain-derived neurotrophic factor, adiponectin, and proinflammatory markers in various subtypes of depression in young men. Int J Psychiatry Med 2011;42:211-26. doi: 10.2190/PM.42.3.a.
  • Wysokiński A, Margulska A, Strzelecki D, et al. Levels of C-reactive protein (CRP) in patients with schizophrenia, unipolar depression and bipolar disorder. Nord J Psychiatry 2015;69:346-53. doi: 10.3109/08039.488.2014.984755.
  • Mao R, Zhang C, Chen J, et al. Different levels of pro-and antiinflammatory cytokines in patients with unipolar and bipolar depression. J Affect Disord 2018;237:65-72. doi: 10.1016/j. jad.2018.04.115.
  • Ekinci O, Ekinci A. The connections among suicidal behavior, lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio. Nord J Psychiatry 2017;71:574-80. doi: 10.1080/08039.488.2017.1363285.
Year 2022, Volume: 35 Issue: 1, 100 - 106, 31.01.2022
https://doi.org/10.5472/marumj.1065834

Abstract

References

  • Leonpacher A, Liebers D, Pirooznia M, et al. Distinguishing bipolar from unipolar depression: the importance of clinical symptoms and illness features. Psychol Med 2015;45:2437-46. doi: 10.1017/S003.329.1715000446.
  • Bromet E, Andrade LH, Hwang I, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med 2011;9:90. doi: 10.1186/1741-7015-9-90.
  • Merikangas KR, Jin R, He J-P, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011;68:241-51. doi: 10.1001/archgenpsychiatry.2011.12.
  • Gibney SM, Drexhage HA. Evidence for a dysregulated immune system in the etiology of psychiatric disorders. J Neuroimmune Pharmacol 2013;8:900-20. doi: 10.1007/ s11481.013.9462-8.
  • Vogelzangs N, Duivis HE, Beekman AT, et al. Association of depressive disorders, depression characteristics and antidepressant medication with inflammation. Transl Psychiatry 2012;2:e79-e79. doi: 10.1038/tp.2012.8.
  • Bai YM, Su TP, Li CT, et al. Comparison of pro‐inflammatory cytokines among patients with bipolar disorder and unipolar depression and normal controls. Bipolar Disorders 2015;17:269-77.
  • Köhler C, Freitas T, Maes Md, et al. Peripheral cytokine and chemokine alterations in depression: a meta‐analysis of 82 studies. Acta Psychiatr Scand 2017;135:373-87. doi: 10.1111/ acps.12698.
  • Maes M, Carvalho AF. The compensatory immune-regulatory reflex system (CIRS) in depression and bipolar disorder. Mol Neurobiol 2018;55:8885-8903 doi: 10.1007/s12035.018.1016-x.
  • Brunoni AR, Supasitthumrong T, Teixeira AL, et al. Differences in the immune-inflammatory profiles of unipolar and bipolar depression. J Affect Disord 2020;262:8-15. doi: 10.1016/j. jad.2019.10.037.
  • Wang Q, Yu C, Shi S, et al. An analysis of plasma reveals proteins in the acute phase response pathway to be candidate diagnostic biomarkers for depression. Psychiatry Res 2019;272:404-10. doi: 10.1016/j.psychres.2018.11.069.
  • Maes M, Bonifacio KL, Morelli NR, et al. Major differences in neurooxidative and neuronitrosative stress pathways between major depressive disorder and types I and II bipolar disorder. Mol Neurobiol 2019;56:141-56. doi: 10.1007/s12035.018.1051-7.
  • Al-Hakeim HK, Al-Rammahi DA, Al-Dujaili AH. IL- 6, IL-18, sIL-2R, and TNFα proinflammatory markers in depression and schizophrenia patients who are free of overt inflammation. J Affect Disord 2015;182:106-14. doi: 10.1016/j. jad.2015.04.044.
  • Kuyumcu ME, Yesil Y, Oztürk ZA, et al. The evaluation of neutrophil-lymphocyte ratio in Alzheimer’s disease. Dement Geriatr Cogn Disord 2012;34:69-74. doi: 10.1159/000341583.
  • Semiz M, Yildirim O, Canan F, et al. Elevated neutrophil/ lymphocyte ratio in patients with schizophrenia. Psychiatr Danub 2014;26:220-5.
  • Kulaksizoglu B, Kulaksizoglu S. Relationship between neutrophil/lymphocyte ratio with oxidative stress and psychopathology in patients with schizophrenia. Neuropsychiatr Dis Treat 2016;12:1999. doi: 10.2147/NDT. S110484.
  • Demir S, Atli A, Bulut M, et al. Neutrophil–lymphocyte ratio in patients with major depressive disorder undergoing no pharmacological therapy. Neuropsychiatr Dis Treat 2015;11:2253. doi: 10.2147/NDT.S89470.
  • Giynas Ayhan M, Cicek IE, Inanli I, et al. Neutrophil/ lymphocyte and platelet/lymphocyte ratios in all mood states of bipolar disorder. Psychiatr Clin Psychopharmacol 2017;27:278-82. doi: 10.1080/24750.573.2017.1338822.
  • Kayhan F, Gündüz Ş, Ersoy SA, et al. Relationships of neutrophil–lymphocyte and platelet–lymphocyte ratios with the severity of major depression. Psychiatry Res 2017;247:332- 5. doi: doi.org/10.1016/j.psychres.2016.11.016.
  • Sunbul EA, Sunbul M, Yanartas O, et al. Increased neutrophil/ lymphocyte ratio in patients with depression is correlated with the severity of depression and cardiovascular risk factors. Psychiatry Investig 2016;13:121. doi: 10.4306/pi.2016.13.1.121.
  • Chang HH, Chen PS. C-reactive protein as a differential biomarker of bipolar versus unipolar depression: Response. World J Biol Psychiatry 2017;18:73-4. doi: 10.1080/15622.975.2016.1208845.
  • Mota R, Gazal M, Acosta BA, et al. Interleukin-1β is associated with depressive episode in major depression but not in bipolar disorder. J Psychiatr Res 2013;47:2011-4. doi: 10.1016/j. jpsychires.2013.08.020.
  • Hung YJ, Hsieh CH, Chen YJ, et al. Insulin sensitivity, proinflammatory markers and adiponectin in young males with different subtypes of depressive disorder. Clin Endocrinol 2007;67:784-9. doi: 10.1111/j.1365-2265.2007.02963.x.
  • Su SC, Sun MT, Wen MJ, et al. Brain-derived neurotrophic factor, adiponectin, and proinflammatory markers in various subtypes of depression in young men. Int J Psychiatry Med 2011;42:211-26. doi: 10.2190/PM.42.3.a.
  • Wysokiński A, Margulska A, Strzelecki D, et al. Levels of C-reactive protein (CRP) in patients with schizophrenia, unipolar depression and bipolar disorder. Nord J Psychiatry 2015;69:346-53. doi: 10.3109/08039.488.2014.984755.
  • Mao R, Zhang C, Chen J, et al. Different levels of pro-and antiinflammatory cytokines in patients with unipolar and bipolar depression. J Affect Disord 2018;237:65-72. doi: 10.1016/j. jad.2018.04.115.
  • Ekinci O, Ekinci A. The connections among suicidal behavior, lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio. Nord J Psychiatry 2017;71:574-80. doi: 10.1080/08039.488.2017.1363285.
There are 26 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Research
Authors

Necati Serkut Bulut This is me 0000-0003-3044-3999

Nese Yorguner This is me 0000-0001-8411-0466

Publication Date January 31, 2022
Published in Issue Year 2022 Volume: 35 Issue: 1

Cite

APA Serkut Bulut, N., & Yorguner, N. (2022). Comparison of the intensity of peripheral inflammation between major depressive disorder and bipolar depression by means of neutrophil-lymphocyte and plateletlymphocyte ratios: The possible role of clinical severity and psychotic features. Marmara Medical Journal, 35(1), 100-106. https://doi.org/10.5472/marumj.1065834
AMA Serkut Bulut N, Yorguner N. Comparison of the intensity of peripheral inflammation between major depressive disorder and bipolar depression by means of neutrophil-lymphocyte and plateletlymphocyte ratios: The possible role of clinical severity and psychotic features. Marmara Med J. January 2022;35(1):100-106. doi:10.5472/marumj.1065834
Chicago Serkut Bulut, Necati, and Nese Yorguner. “Comparison of the Intensity of Peripheral Inflammation Between Major Depressive Disorder and Bipolar Depression by Means of Neutrophil-Lymphocyte and Plateletlymphocyte Ratios: The Possible Role of Clinical Severity and Psychotic Features”. Marmara Medical Journal 35, no. 1 (January 2022): 100-106. https://doi.org/10.5472/marumj.1065834.
EndNote Serkut Bulut N, Yorguner N (January 1, 2022) Comparison of the intensity of peripheral inflammation between major depressive disorder and bipolar depression by means of neutrophil-lymphocyte and plateletlymphocyte ratios: The possible role of clinical severity and psychotic features. Marmara Medical Journal 35 1 100–106.
IEEE N. Serkut Bulut and N. Yorguner, “Comparison of the intensity of peripheral inflammation between major depressive disorder and bipolar depression by means of neutrophil-lymphocyte and plateletlymphocyte ratios: The possible role of clinical severity and psychotic features”, Marmara Med J, vol. 35, no. 1, pp. 100–106, 2022, doi: 10.5472/marumj.1065834.
ISNAD Serkut Bulut, Necati - Yorguner, Nese. “Comparison of the Intensity of Peripheral Inflammation Between Major Depressive Disorder and Bipolar Depression by Means of Neutrophil-Lymphocyte and Plateletlymphocyte Ratios: The Possible Role of Clinical Severity and Psychotic Features”. Marmara Medical Journal 35/1 (January 2022), 100-106. https://doi.org/10.5472/marumj.1065834.
JAMA Serkut Bulut N, Yorguner N. Comparison of the intensity of peripheral inflammation between major depressive disorder and bipolar depression by means of neutrophil-lymphocyte and plateletlymphocyte ratios: The possible role of clinical severity and psychotic features. Marmara Med J. 2022;35:100–106.
MLA Serkut Bulut, Necati and Nese Yorguner. “Comparison of the Intensity of Peripheral Inflammation Between Major Depressive Disorder and Bipolar Depression by Means of Neutrophil-Lymphocyte and Plateletlymphocyte Ratios: The Possible Role of Clinical Severity and Psychotic Features”. Marmara Medical Journal, vol. 35, no. 1, 2022, pp. 100-6, doi:10.5472/marumj.1065834.
Vancouver Serkut Bulut N, Yorguner N. Comparison of the intensity of peripheral inflammation between major depressive disorder and bipolar depression by means of neutrophil-lymphocyte and plateletlymphocyte ratios: The possible role of clinical severity and psychotic features. Marmara Med J. 2022;35(1):100-6.