Pro- and anti-inflammatory cytokine associations with major depression in cancer patients

Abstract

Objective

Cytokines may be linked to depression, although it has been challenging to demonstrate this association in cancer because of the overlap between depressive symptoms and other sickness behaviours. This study investigates the relationship between cytokines and depression in cancer patients, accounting for confounding clinical and methodological factors.

Methods

The GRID Hamilton Rating Scale for Depression (Ham-D) and Neurotoxicity Rating Scale (NRS) for cytokine-induced sickness behaviours were administered to 61 cancer patients, and 38 healthy controls. The cancer group were of mixed type and largely late stage, with a recruitment rate of 35% and completion rate of 47%. Major depression was diagnosed in 19/61 (31%) of cancer patients. Multiplexed cytokine assays for inflammatory and anti-inflammatory cytokines were conducted in plasma samples using electrochemiluminescence.

Results

All cancer patients had high NRS scores and elevated levels of most cytokines. Cancer patients with major depression had higher NRS scores than those without major depression. IL-1r was positively associated with Ham-D scores of depressive symptoms (regression coefficient: 3.52 ± 1.18, p = 0.004), but not major depression. Major depression was negatively associated with the anti-inflammatory cytokine IL-4 (regression coefficient: - 0.65 ± 0.26, p = 0.013), but not IL-1r.

Conclusions

Depressive symptoms in cancer patients may represent sickness behaviours, which may have distinct cytokine associations from major depression. Sickness behaviours may be associated with an increase in inflammatory cytokines, whereas major depression may be induced by a failure to adequately resolve inflammation. Our findings suggest that cytokine-mediated interventions may be of value to treat depression in this population.

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