title: Prothrombotic platelet phenotype in major depression: downregulation by antidepressant treatment.
abstract: BACKGROUND
  Serotonergic mechanisms have been suggested as a link between major depression and cardiovascular risk. We investigated the existence of a prothrombotic condition in depressed patients and its possible modulation during treatment with a selective serotonin-reuptake inhibitor (SSRI).
  
  
  METHODS
  Modifications in a series of biomarkers of platelet and coagulation activation were evaluated in blood from 19 patients with a major depression disorder (MDD) at the time of diagnosis, and at 8 and 24 weeks of treatment with escitalopram. Response of blood aliquots recirculated through a thrombogenic surface was assessed in a thrombosis model. Results were compared with those of 20 healthy-matched controls.
  
  
  RESULTS
  In comparison with controls, platelets from MDD patients showed elevated volumes (p<0.01), significantly enhanced aggregating response to arachidonic acid and augmented expression of GPIb, fibrinogen, factor V, and anionic phospholipids by flow cytometry (p<0.05). Clot firmness and procoagulant activity of platelet-associated tissue factor were also significantly elevated (p<0.05). Studies with circulating blood revealed increased fibrin formation in early diagnosed patients (71.1±9.5% vs. 45.8±5.3%; p<0.05 vs. controls). After 24 weeks of treatment with escitalopram, the majority of the alterations observed were normalized, except for a residual increased expression of GPIIbIIIa (p<0.05) and persistent alterations in thromboelatometic parameters.
  
  
  CONCLUSIONS
  Despite the reduced number of followed-up patients our findings were consistent reaching statistical significance.
  
  
  CONCLUSIONS
  Our results reveal a prothrombotic phenotype in MDD patients. While continuous treatment with an SSRI downregulated the majority of the biomarkers analyzed, alterations in viscoelastic parameters of clot formation remained unaffected by the antidepressant treatment.
authors.affiliation: Department of Hemotherapy and Hemostasis, Hospital Clinic, Biomedical Diagnosis Centre, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain. Electronic address: ilopez1@clinic.ub.es.
authors.forename: Irene
authors.initials: I
authors.lastname: Lopez-Vilchez
authors.affiliation: Department of Psychiatry, Hospital Clinic, Institute Clinic of Neurosciences, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Serra-Millas
authors.affiliation: Department of Psychiatry, Hospital Clinic, Institute Clinic of Neurosciences, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Navarro
authors.affiliation: Department of Hemotherapy and Hemostasis, Hospital Clinic, Biomedical Diagnosis Centre, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rosa Hernandez
authors.affiliation: Department of Internal Medicine, Hospital Clinic, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Villalta
authors.affiliation: Department of Hemotherapy and Hemostasis, Hospital Clinic, Biomedical Diagnosis Centre, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Maribel
authors.initials: M
authors.lastname: Diaz-Ricart
authors.affiliation: Department of Psychiatry, Hospital Clinic, Institute Clinic of Neurosciences, Barcelona, Spain.
authors.forename: Cristobal
authors.initials: C
authors.lastname: Gasto
authors.affiliation: Department of Hemotherapy and Hemostasis, Hospital Clinic, Biomedical Diagnosis Centre, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Gines
authors.initials: G
authors.lastname: Escolar
authors.affiliation: Department of Hemotherapy and Hemostasis, Hospital Clinic, Biomedical Diagnosis Centre, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Galan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000187:drug effects* / Q000502:physiology*; D015283:Citalopram / Q000494:pharmacology* / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000097:blood* / Q000188:drug therapy*; D015536:Down-Regulation / Q000187:drug effects*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015539:Platelet Activation / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D013927:Thrombosis / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Cardiovascular risk; Major depression; Platelets; Procoagulant profile; Prothrombotic phenotype; Selective serotonin reuptake inhibitor (SSRI).