title: Depressive symptoms in Crohn's disease: relationship with immune activation and tryptophan availability.
abstract: Crohn's disease (CD) is associated with immune activation and depressive symptoms. This study determines the impact of anti-tumor necrosis factor (TNF)-α treatment in CD patients on depressive symptoms and the degree to which tryptophan (TRP) availability and immune markers mediate this effect. Fifteen patients with CD, eligible for anti-TNF-α treatment were recruited. Disease activity (Harvey-Bradshaw Index (HBI), Crohn's Disease Activity Index (CDAI)), fatigue (Multidimensional Fatigue Inventory (MFI)), quality of life (Inflammatory Bowel Disease Questionnaire (IBDQ)), symptoms of depression and anxiety (Symptom Checklist (SCL-90), Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS)), immune activation (acute phase proteins (APP)), zinc and TRP availability were assessed before treatment and after 2, 4 and 8 weeks. Anti-TNF-α increased IBDQ scores and reduced all depression scores; however only SCL-90 depression scores remained decreased after correction for HBI. Positive APPs decreased, while negative APPs increased after treatment. After correction for HBI, both level and percentage of γ fraction were associated with SCL-90 depression scores over time. After correction for HBI, patients with current/past depressive disorder displayed higher levels of positive APPs and lower levels of negative APPs and zinc. TRP availability remained invariant over time and there was no association between SCL-90 depression scores and TRP availability. Inflammatory reactions in CD are more evident in patients with comorbid depression, regardless of disease activity. Anti-TNF-α treatment in CD reduces depressive symptoms, in part independently of disease activity; there was no evidence that this effect was mediated by immune-induced changes in TRP availability.
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Centre, EURON, Maastricht, The Netherlands. sguloksuz@yahoo.com
authors.forename: Sinan
authors.initials: S
authors.lastname: Guloksuz
authors.forename: Marieke
authors.initials: M
authors.lastname: Wichers
authors.forename: Gunter
authors.initials: G
authors.lastname: Kenis
authors.forename: Maurice G V M
authors.initials: MG
authors.lastname: Russel
authors.forename: Annick
authors.initials: A
authors.lastname: Wauters
authors.forename: Robert
authors.initials: R
authors.lastname: Verkerk
authors.forename: Baer
authors.initials: B
authors.lastname: Arts
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
mesh_terms: D000328:Adult; D000339:Affect; D003424:Crohn Disease / Q000276:immunology* / Q000523:psychology*; D003863:Depression / Q000276:immunology* / Q000523:psychology*; D005221:Fatigue / Q000276:immunology / Q000523:psychology; D005260:Female; D006801:Humans; D007109:Immunity / Q000276:immunology*; D008297:Male; D011788:Quality of Life; D012016:Reference Values; D011795:Surveys and Questionnaires; D013997:Time Factors; D014364:Tryptophan / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000378:metabolism
chemical_list: D014409:Tumor Necrosis Factor-alpha; D014364:Tryptophan
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