(#51) To Infliximab and Beyond: Using immunotherapy as alternative treatment option for treatment resistant depression

Abstract: Treating depression resistant to conventional medical management has always been a dilemma. This has led to further exploration of the role of immunotherapy which is commonly used in autoimmune disease in the management of treatment resistant depression. The pathophysiology of depression involves several pathways overlapping changes in both genetic and environmental components. Due to the "heterogeneity in biological mechanisms of depression;" at least 30% of patients have not responded to common antidepressants. One theory that explains this is the "cytokine theory of depression." In times of infection, inflammation, and stress, there is an increase in cytokines such as C-reactive protein (CRP), IL-1, IL-6, and TNF-alpha in both peripheral and central circulations. Upon thorough literature review, infliximab, a monoclonal antibody, has been shown to have favorable effects on depression. In all, three studies (114 patients) were included; two studies were randomized clinical trials using infliximab infusions in TRD patients and the other study utilized 2 case reports both treated with etanercept. The results from the studies indicated that patients undergoing infliximab infusions had reduction in depressive symptoms, specifically those who had high levels of inflammation markers. The studies also suggested that patients with low levels of inflammation seemed to do worse on infliximab therapy than those receiving the placebo treatment. Patients that received etanercept mimicked similar results as those in the infliximab study. This identifies a subgroup of treatment resistant depression: patients who have high levels of inflammatory markers respond clinically better to TNF-alpha inhibitors.

Short Description: To evaluate the role of biologics, such as TNF-alpha inhibitors in the management of treatment resistant depression (TRD). Our literature review reveals that a class of immunotherapy, TNF-alpha inhibitors like infliximab offer alternative options for the management of refractory depression. Results in the study showed that the participants treated with TNF-alpha inhibitors did experience a reduction in their depressive symptoms and overall improvement in their mental health.

Name of Sponsoring Organization(s): n/a