An Increase in C-Reactive Protein Levels during Antidepressant Treatment as a Candidate Marker for Treatment Nonresponse in Major Depressive Disorder.

INTRODUCTION

One-third of patients with major depressive disorder (MDD) exhibit low-grade inflammation as reflected by C-reactive protein (CRP) concentrations >3 mg/L. We explored whether CRP changes from baseline to week one of antidepressant treatment (ΔCRP) can serve as a marker of treatment response.

METHODS

CRP serum levels were measured at baseline and after the first week of treatment in 33 MDD patients and correlated with patients' Hamilton Depression Rating Scale (HAM-D), while adjusting for age, gender, and body mass index. We assessed antidepressant responses at weeks one and four of treatment as a >25% and >50% HAM-D score reduction (ΔHAM-D) compared to baseline, respectively. We compared baseline and week-one CRP levels with the paired t test within responders and nonresponders separately and ΔCRP between the groups with the ANCOVA.

RESULTS

Higher ΔCRP correlated with lower week-four ΔHAM-D scores (r = -0.5, p = 0.006). Nonresponders showed higher ΔCRP - but not baseline and week-one CRP - than responders (p = 0.018, Cohen's d = 1.1). A ΔCRP increase was observed in 13/16 (81%) nonresponders and 7/17 (41%) responders (Fisher's exact test's p = 0.03). A ΔCRP increase combined with a week-one nonresponse was observed in 13/16 (81%) nonresponders and 1/17 (6%) responders (p < 0.0001).

CONCLUSIONS

Rather ΔCRP at week one than baseline CRP might be indicative of treatment response at week four, especially if combined with week-one ΔHAM-D. In the future, ΔCRP could be introduced into psychiatric practice to guide treatment plans.