Depressive symptoms and the regulation of proinflammatory cytokine expression in patients with coronary heart disease.
OBJECTIVE
Depressive symptoms increase the risk of morbidity and mortality in patients with coronary heart disease (CHD). Mounting evidence indicates that inflammatory processes may underlie this association. This study examined whether depressive symptoms are associated with the dysregulation of inflammatory cytokine production in response to an in vitro infectious challenge.


METHODS
Forty-one patients with CHD were enrolled 3 months or more after an acute myocardial infarction or revascularization procedure. Depressive symptoms were assessed through self-report and interviewer ratings. Cytokine production was measured after white blood cells were cultured in vitro with endotoxin in the presence of varying concentrations of dexamethasone.


RESULTS
Depressive symptoms were not associated with the quantity of in vitro inflammatory cytokine production. However, to the extent that they reported symptoms of depression, patients showed greater sensitivity to the anti-inflammatory properties of glucocorticoids. This was manifested by increased suppression of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) production by dexamethasone.


CONCLUSIONS
Increased sensitivity to glucocorticoid inhibition could render depressed patients vulnerable to latent infections and inflammatory processes that accelerate the progression of cardiac disease.
Miller
Gregory E
GE
Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver BC, Canada V6T 1Z4. gemiller@psych.ubc.ca
Freedland
Kenneth E
KE
Carney
Robert M
RM
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000494:pharmacology*; D003863:Depression / Q000175:diagnosis / Q000378:metabolism*; D003907:Dexamethasone / Q000494:pharmacology*; D005260:Female; D006304:Health Status; D006801:Humans; D066298:In Vitro Techniques; D015850:Interleukin-6 / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D015854:Up-Regulation
D000893:Anti-Inflammatory Agents; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D003907:Dexamethasone