Plasma C-reactive protein levels in bipolar depression during cyclooxygenase-2 inhibitor combination treatment Journal Article


Authors: Edberg, D.; Hoppensteadt, D; Walborn, A.; Fareed, J; Sinacore, J; Halaris, A.
Article Title: Plasma C-reactive protein levels in bipolar depression during cyclooxygenase-2 inhibitor combination treatment
Abstract: Immune system activation and neuroinflammation appear to play a key role in the pathophysiology and treatment of bipolar depression (BDD). This study is the first to analyze blood levels of the pro-inflammatory biomarker C-reactive protein (CRP) in bipolar disorder patients treated with the cyclooxygenase-2 inhibitor, celecoxib (CBX). In this double-blind study, 47 consenting patients with BDD were randomized to receive either escitalopram (10 mg twice/day) + CBX (200 mg twice/day), or escitalopram (10 mg twice/day) + placebo (twice/day). Plasma CRP levels were measured in both patient groups at baseline, week 4, and week 8, and in a healthy control (HC) group of subjects (N = 35) once. Symptoms were rated using the 17-item Hamilton Depression Scale (HAMD-17). The CBX group had significantly lower HAMD-17 scores vs. placebo at week 4 (P = 0.026) and week 8 (P = 0.002). Therefore, SSRI + CBX is more effective than SSRI + placebo in reversing treatment resistance and augmenting antidepressant response in BDD. Baseline CRP levels were significantly increased amongst BDD patients versus HC subjects, indicating that CRP may be a useful biomarker for BDD (P = 0.044). No significant differences in CRP levels were measured between CBX and placebo groups at baseline (P = 0.156), but by week 8 CRP was significantly decreased in the CBX group vs. placebo (P = 0.003). This indicates reduced inflammation in CBX-treated patients, and that CRP may be a useful biomarker for monitoring treatment response in BDD patients during SSRI + CBX combination treatment. CRP and IL-6 levels were positively correlated in the CBX group, and CRP levels were positively correlated with BMI.
Keywords: Inflammation; CRP; bipolar disorder; Celecoxib; Treatment-resistant bipolar depression
Journal Title: Journal of psychiatric research
Volume: 102
ISSN: 1879-1379; 0022-3956
Publisher: Elsevier Inc  
Journal Place: England
Date Published: 2018
Start Page: 1
End Page: 7
Language: eng
DOI/URL:
Notes: LR: 20180319; CI: Copyright (c) 2018; JID: 0376331; OTO: NOTNLM; 2017/08/15 00:00 [received]; 2018/01/19 00:00 [revised]; 2018/02/08 00:00 [accepted]; 2018/03/20 06:00 [entrez]; 2018/03/20 06:00 [pubmed]; 2018/03/20 06:00 [medline]; aheadofprint