Immuno-metabolic depression: from concept to implementation

作者：Brenda W.J.H. Penninx, Femke Lamers, Rick Jansen, Michael Berk, Golam M. Khandaker, Livia De Picker, Yuri Milaneschi · 发表于：The Lancet Regional Health - Europe · 年份：2024 · DOI：10.1016/j.lanepe.2024.101166 · 被引用次数：112 · 研究领域：Tryptophan and brain disorders、Stress Responses and Cortisol、Health, psychology, and well-being

Major depressive disorder is a common, disabling mental disorder characterized by extensive etiological and phenotypic heterogeneity. This heterogeneity makes treatment approaches imprecise and often ineffective. Insight into the underlying biological mechanisms underpinning depression and its subtypes may enable more personalized treatments. In this review, we provide an overview of immuno-metabolic depression and illustrate that significant immuno-metabolic dysregulations are present in about 20-30% of people with depression. Such immuno-metabolic depression is characterized by the clustering of 1) atypical, energy-related depressive symptoms such as hypersomnia, fatigue, hyperphagia, and possibly anhedonia, 2) systemic low-grade inflammation with elevated levels of e.g., C-reactive protein, cytokines and glycoprotein acetyls, and 3) metabolic abnormalities involving e.g., obesity, dyslipidaemia, insulin and leptin resistance. Persons with immuno-metabolic depression are at a higher risk for cardiometabolic diseases and seem to respond less well to standard antidepressant treatment. Interventions targeting inflammation, metabolism or lifestyle may be more effective treatment options for individuals with immuno-metabolic depression, in line with principles of precision psychiatry.