%0 Journal Article
%T Effect of Selective Serotonin Reuptake Inhibitors and Immunomodulator on Cytokines Levels: An Alternative Therapy for Patients with Major Depressive Disorder
%A Mar¨ªa Eugenia Hernandez
%A Danelia Mendieta
%A Mayra P¨¦rez-Tapia
%A Rafael Bojalil
%A Iris Estrada-Garcia
%A Sergio Estrada-Parra
%A Lenin Pav¨®n
%J Journal of Immunology Research
%D 2013
%R 10.1155/2013/267871
%X Major depressive disorder (MDD) is a psychiatric illness that presents as a deficit of serotonergic neurotransmission in the central nervous system. MDD patients also experience alterations in cortisol and cytokines levels. Treatment with selective serotonin reuptake inhibitors (SSRIs) is the first-line antidepressant regimen for MDD. The aim of this study was to determine the effect of a combination of SSRIs and an immunomodulator¡ªhuman dialyzable leukocyte extract (hDLE)¡ªon cortisol and cytokines levels. Patients received SSRIs or SSRIs plus hDLE. The proinflammatory cytokines IL-1¦Â, IL-2, and IFN-¦Ã; anti-inflammatory cytokines IL-13 and IL-10; and 24-h urine cortisol were measured at weeks (W) 0, 5, 20, 36, and 52 of treatment. The reduction in cortisol levels in the SSRI-treated group was 30% until W52, in contrast, the combined treatment induced a 54% decrease at W36. The decline in cortisol in patients who were treated with SSRI plus hDLE correlated with reduction of anti-inflammatory cytokines and increases levels of proinflammatory cytokines at the study conclusion. These results suggest that the immune-stimulating activity of hDLE, in combination with SSRIs, restored the pro- and anti-inflammatory cytokine balance and cortisol levels in depressed patients versus those who were given SSRIs alone. 1. Introduction Clinical and epidemiological studies have established that major depressive disorder (MDD) is a cause of chronic stress [1, 2]. The World Health Organization asserts that MDD will be the second leading cause of incapacity worldwide by 2030 [3], representing a tremendous public health problem with high economic costs [4]. Increased stress levels affect the duration and extent of symptoms of depression [5]. One of the most common clinical features of MDD is the development of hypothalamic-pituitary-adrenal (HPA) axis abnormalities [6, 7]. Chronic hyperactivity of the HPA axis induces hypercortisolism, which affects the nervous, endocrine, and immune systems [8]. The HPA axis function is upregulated by proinflammatory cytokines through the brain receptors for this soluble molecules, expressed mostly at hypothalamus [9]. This stimulation induces a rise on circulatory levels of glucocorticoids that decreases the inflammatory systemic effects induced by cytokines and diminishes the release of CRH at hypothalamus, generating a negative feedback loop. Various studies have linked variations in cytokine and cortisol levels in MDD [10]; one of the first studies of the neuromodulatory effects of cytokines reported the induction of depressive
%U http://www.hindawi.com/journals/jir/2013/267871/