Neuroinflammatory Hypothesis in Major Depressive Disorder

Abstract

Faced with stress and acute instances, brain cells trigger neuroinflammation and increase inflam-mation response and can cause cell damage, cell death and thereby functional insufficiencies, behavioral disorders and autonomic imbalances. Cytokines that play an important role in inflamma-tory processes affect neurotransmitter metabolism, neuroendocrine functions and synaptic plasticity. It has been proven that inflammatory activity increases in depression. Proinflammatory cytokines such as interleukin (IL)-1, IL-6 and tumor necrosis factor (TNF)-α along with acute phase reactants increase in depression. If the inflammatory response becomes chronic and cannot be balanced, inflammation and cytokines may cause behavioral symptoms and neuropsychiatric disorders such as major depression and anxiety disorders. In this article, the changes that occur in inflammatory processes in depressive disorder will be summarized; the effects of pharmacologic and psychotherapeutic approaches on these changes will be reviewed.

Keywords

• Major depressive disorder, neuroinflammatory hypothesis, treatment

Major Depresif Bozuklukta Nöroinflamatuvar Hipotez

Öz

Beyin hücreleri stres ve akut olaylar karşısında nöroinflamasyonu tetikleyerek ve inflamasyon yanıtını arttırarak hücre hasarına, ölümüne ve dolayısıyla fonksiyonel yetersizliklere, davranışsal bozukluklara ve otonomik dengesizliklere yol açabilmektedir. İnflamatuvar süreçlerde önemli rol oynayan sitokinler nörotransmitter metabolizması, nöroendokrin işlevler ve sinaptik plastisiteyi etkilemektedir. Depresyonda inflamatuvar aktivitenin artmış olduğu kanıtlanmıştır. Depresyonda interlökin (IL)-1, IL-6 ve tümör nekroz faktör (TNF)-α gibi proinflamatuvar sitokinler ve akut faz reaktanları artmaktadır. Psikososyal stresörlere yanıt olarak ortaya çıkan bu immun değişiklikler geçicidir ve anti-inflamatuvar mekanizmalarla dengelenmektedir. Bununla birlikte, inflamatuvar yanıt kronikleşirse ya da dengelenemezse inflamasyon ve sitokinler davranışsal belirtilere ve major depresyon, anksiyete bozuklukları gibi nöropsikiyatrik hastalıklara yol açabilmektedir. Bu yazıda, major depresif bozuklukta inflamatuvar süreçlerde meydana gelen değişiklikler özetlenecek, farmakolojik ve psikoterapötik yaklaşımların bu değişiklikler üzerine etkileri gözden geçirilmiştir.

Anahtar Kelimeler

• Major depresif bozukluk, nöroinflamatuvar hipotez, tedavi

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