title: Varicella zoster virus-specific immune responses to a herpes zoster vaccine in elderly recipients with major depression and the impact of antidepressant medications.
abstract: BACKGROUND
  The Depression Substudy of the Shingles Prevention Study (SPS) was designed to evaluate the association between major depression and immune responses to a high-titer live attenuated varicella zoster virus (VZV) vaccine (zoster vaccine), which boosts cell-mediated immunity (CMI) to VZV and decreases the incidence and severity of herpes zoster (HZ). The Depression Substudy was a 2-year longitudinal cohort study in 92 community-dwelling adults≥60 years of age who were enrolled in the SPS, a large, double-blind, placebo-controlled Veterans Affairs Cooperative zoster vaccine efficacy study.
  
  
  METHODS
  Forty subjects with major depressive disorder, stratified by use of antidepressant medications, and 52 age- and sex-matched controls with no history of depression or other mental illness had their VZV-CMI measured prior to vaccination with zoster vaccine or placebo and at 6 weeks, 1 year, and 2 years postvaccination.
  
  
  RESULTS
  Depressed subjects who were not treated with antidepressant medications had lower levels of VZV-CMI following administration of zoster vaccine than nondepressed controls or depressed subjects receiving antidepressants even when antidepressant medications failed to alter depressive symptom severity (P<.005). Similar results were obtained taking into account the time-varying status of depression and use of antidepressant medications, as well as changes in depressive symptoms, during the postvaccination period.
  
  
  CONCLUSIONS
  Depressed patients have diminished VZV-CMI responses to zoster vaccine, and treatment with antidepressant medication is associated with normalization of these responses. Because higher levels of VZV-CMI correlate with lower risk and severity of HZ, untreated depression may increase the risk and severity of HZ and reduce the efficacy of zoster vaccine.
authors: Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, University of California, Los Angeles, Los Angeles, CA 90095-7057, USA. mirwin1@ucla.edu
authors: Michael R
authors: MR
authors: Irwin
authors: Myron J
authors: MJ
authors: Levin
authors: Mark L
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authors: Marchese
authors: Heather M
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authors: DJ
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authors: McCook
authors: Jane H
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authors: Oxman
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D005260:Female; D006562:Herpes Zoster / Q000276:immunology / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000276:immunology*; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D014611:Vaccination
chemical_list: D000928:Antidepressive Agents; D053061:Herpes Zoster Vaccine