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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by SLS on September 16, 2014, at 8:07:04
C-Reactive Protein (CRP) is a measure of inflammation occurring somewhere in the body. Many researchers believe that inflammation in the brain participates in the evolution of depression. Some even suggest that minocycline, a potent anti-inflammatory that penetrates the brain, has antidepressant properties.
Here, we have a study that reports an association between CRP blood levels and the responsitivity to two different antidepressants: escitalopram (Lexapro) and nortriptyline (Pamelor).
Low CRP = escitalopram
High CRP = nortriptyline
- Scott--------------------------------------
An Inflammatory Biomarker as a Differential Predictor of Outcome of Depression Treatment With Escitalopram and Nortriptyline
The American Journal of Psychiatry
http://ajp.psychiatryonline.org/Article.aspx?ArticleID=1888992
--------------------------------------
Paraphrase:
Study Finds That Common Lab Test Can Help Predict Antidepressant Treatment Response
Monday, July 21, 2014
APA Psychiatric News Alert
Researchers have been studying the interaction between inflammation and depression for decades. Now a team of Canadian and European scientists report in AJP in Advance on a way to help predict treatment outcomes based on levels of C-reactive protein (CRP), a biomarker of systemic inflammation. The study was part of the Genome-Based Therapeutic Drugs for Depression (GENDEP) study and compared outcomes in patients randomized to the SSRI escitalopram (n=115) or the tricyclic antidepressant nortriptyline (n=126). GENDEP is a multinational study sponsored by the European Commission designed to identify genetic markers that can help physicians decide which antidepressant is likely to be effective in a particular patient.
Patients with low baseline levels of CRP improved more with escitalopram, while those with higher CRP levels did better with nortriptyline, as measured on the Montgomery-Åsberg Depression Rating Scale, reported Rudolph Uher, M.D., Ph.D., an associate professor of psychiatry at Dalhousie University in Halifax, Nova Scotia, and colleagues. The effect size of the differential prediction met criteria for clinical significance, suggesting that the prediction can be meaningful in individual cases.
The study must be replicated and tested with other antidepressants, said Uher. However, this exploration of the different effects of norepinephrine and serotonin on the immune system may open doors to predict how patients respond to treatments and perhaps narrow the trial-and-error process of finding the right antidepressant for each individual.
Posted by Phillipa on September 16, 2014, at 9:56:36
In reply to CRP levels predict which AD someone responds to., posted by SLS on September 16, 2014, at 8:07:04
I asked for this test two years ago and the doc said at my age you would expect it to be elevated. True or not? Thanks Phillipa
Posted by SLS on September 16, 2014, at 15:26:38
In reply to Re: CRP levels predict which AD someone responds to. » SLS, posted by Phillipa on September 16, 2014, at 9:56:36
> I asked for this test two years ago and the doc said at my age you would expect it to be elevated. True or not? Thanks Phillipa
CRP is higher in females.
There is a tendency for CRP to be higher in older folks. However, it is thought that this statistic is really an index of the greater number of pathologies associated with this age group. A healthy individual may not have an elevation of CRP.
- Scott
Posted by Phillipa on September 16, 2014, at 18:19:31
In reply to Re: CRP levels predict which AD someone responds to. » Phillipa, posted by SLS on September 16, 2014, at 15:26:38
Scott thanks. That's why I wanted on to see. Phillipa
Posted by gadchik on September 16, 2014, at 19:01:51
In reply to Re: CRP levels predict which AD someone responds to. » SLS, posted by Phillipa on September 16, 2014, at 18:19:31
i had one of those tests and mine was pretty low, so that says I'd do well on Lexapro? I did well on Zoloft, which is an ssri. I had that test when I was depressed, just b/c I was having every test in the book, but that was back in 2007. Interesting stuff.
Posted by Phillipa on September 16, 2014, at 19:32:15
In reply to Re: CRP levels predict which AD someone responds to., posted by gadchik on September 16, 2014, at 19:01:51
G sounds like you are physically healthy and lexapro? P
Posted by gadchik on September 16, 2014, at 19:38:19
In reply to Re: CRP levels predict which AD someone responds to. » gadchik, posted by Phillipa on September 16, 2014, at 19:32:15
I'm very healthy now. I had to work hard tho. I'm not on any ssri now, only the Valium, which I'm slowly tapering. I did well on Zoloft when I did take an ssri back
In 2007, and my test showed very low level of inflammation
Posted by Phillipa on September 16, 2014, at 22:04:28
In reply to Re: CRP levels predict which AD someone responds to. » Phillipa, posted by gadchik on September 16, 2014, at 19:38:19
It's been a while then since SSRI. And congrats again on the taper so for you the CRP didn't hold true? P
Posted by gadchik on September 17, 2014, at 6:08:30
In reply to CRP levels predict which AD someone responds to., posted by SLS on September 16, 2014, at 8:07:04
Patients with low baseline levels of CRP improved more with escitalopram
That's generic Lexapro, which is an ssri. I did well on an ssri, with very low CRP results, mine where in the - range. So the study holds true for me. Glad I was put on an ssri then!
Posted by gadchik on September 17, 2014, at 6:24:55
In reply to Re: CRP levels predict which AD someone responds to. » SLS, posted by gadchik on September 17, 2014, at 6:08:30
Posted by jane d on September 17, 2014, at 20:00:13
In reply to CRP levels predict which AD someone responds to., posted by SLS on September 16, 2014, at 8:07:04
Thanks for posting this. I wonder just how much difference they saw. I don't know that I'll be rushing out to get this test (though I see it's less than fifty dollars at a discount lab) but it's definitely very interesting.
Posted by oceansun on October 22, 2014, at 20:02:27
In reply to CRP levels predict which AD someone responds to., posted by SLS on September 16, 2014, at 8:07:04
Thank you for this post! My CRP is 0.2, very low. I wonder if that's from the SSRI I was taking at the time? SSRIs had a numbing effect on me, kinda worked a bit though. It helped with the deepest lows, but not the daily depression. I only tried Prozac and Zoloft. That was forever ago. Maybe Lexapro for the next (I hope not) major depressive episode...
I guess this relates to the new study about Celebrex and SSRIs being helpful, given the inflammatory factor?
C-Reactive Protein (CRP) is a measure of inflammation occurring somewhere in the body. Many researchers believe that inflammation in the brain participates in the evolution of depression. Some even suggest that minocycline, a potent anti-inflammatory that penetrates the brain, has antidepressant properties.
>
> Here, we have a study that reports an association between CRP blood levels and the responsitivity to two different antidepressants: escitalopram (Lexapro) and nortriptyline (Pamelor).
>
> Low CRP = escitalopram
> High CRP = nortriptyline
>
>
> - Scott
>
> --------------------------------------
>
> An Inflammatory Biomarker as a Differential Predictor of Outcome of Depression Treatment With Escitalopram and Nortriptyline
>
> The American Journal of Psychiatry
>
> http://ajp.psychiatryonline.org/Article.aspx?ArticleID=1888992
>
> --------------------------------------
>
> Paraphrase:
>
> Study Finds That Common Lab Test Can Help Predict Antidepressant Treatment Response
>
> Monday, July 21, 2014
>
> APA Psychiatric News Alert
>
> Researchers have been studying the interaction between inflammation and depression for decades. Now a team of Canadian and European scientists report in AJP in Advance on a way to help predict treatment outcomes based on levels of C-reactive protein (CRP), a biomarker of systemic inflammation. The study was part of the Genome-Based Therapeutic Drugs for Depression (GENDEP) study and compared outcomes in patients randomized to the SSRI escitalopram (n=115) or the tricyclic antidepressant nortriptyline (n=126). GENDEP is a multinational study sponsored by the European Commission designed to identify genetic markers that can help physicians decide which antidepressant is likely to be effective in a particular patient.
>
> Patients with low baseline levels of CRP improved more with escitalopram, while those with higher CRP levels did better with nortriptyline, as measured on the Montgomery-Åsberg Depression Rating Scale, reported Rudolph Uher, M.D., Ph.D., an associate professor of psychiatry at Dalhousie University in Halifax, Nova Scotia, and colleagues. The effect size of the differential prediction met criteria for clinical significance, suggesting that the prediction can be meaningful in individual cases.
>
> The study must be replicated and tested with other antidepressants, said Uher. However, this exploration of the different effects of norepinephrine and serotonin on the immune system may open doors to predict how patients respond to treatments and perhaps narrow the trial-and-error process of finding the right antidepressant for each individual.
Posted by Phillipa on October 22, 2014, at 20:17:59
In reply to Re: CRP levels predict which AD someone responds to. » SLS, posted by oceansun on October 22, 2014, at 20:02:27
I asked for this blood test two years ago at a routine check up as used to be called. Was told that medicaire would not cover the test. And that as one got older you would expect it to be higher than a younger person. Any truth to this? Thanks P
Posted by oceansun on October 22, 2014, at 20:31:24
In reply to Re: CRP levels predict which AD someone responds to. » oceansun, posted by Phillipa on October 22, 2014, at 20:17:59
Yes, it's supposed to be higher in an older person than in a younger person, but it still tells you something. It's a marker for cardiovascular risk. So if you have any risk factors for cardiovascular disease, this test would be good in any event. It's terrible Medicare doesn't cover it, it's a basic test I believe.
> I asked for this blood test two years ago at a routine check up as used to be called. Was told that medicaire would not cover the test. And that as one got older you would expect it to be higher than a younger person. Any truth to this? Thanks P
Posted by Phillipa on October 22, 2014, at 20:41:22
In reply to Re: CRP levels predict which AD someone responds to. » Phillipa, posted by oceansun on October 22, 2014, at 20:31:24
I wish we had the right to go to a lab and ask for the test and pay them or have them bill you directly. And since heart attacks & strokes in family as causes of death would love to know how to possibly keep it from happening. Phillipa
Posted by 10derheart on October 23, 2014, at 23:39:21
In reply to Re: CRP levels predict which AD someone responds to. » oceansun, posted by Phillipa on October 22, 2014, at 20:41:22
> I wish we had the right to go to a lab and ask for the test and pay them or have them bill you directly.
?? Who has taken away this right? I've done it a couple of times. Has someone told you cannot do this?
I did it when I knew either my doc wouldn't agree to order something and/or insurance would never pay for certain tests I still wanted. Last time was in 2013 when the lab my PCP used returned crazy results on lipids and glucose that were so far off from the ones from just three months prior, I wondered about quality controls and if that was actually *my* blood sample! (a bit paranoid, I know)
I use:
http://www.privatemdlabs.com/index.php
They are nationwide. Everything done online but I think you can call, too. Just look up your area. C-reactive protein was about $50.00, I think. Price list on site. If you can afford it, it's a handy tool sometimes.
Posted by Phillipa on October 24, 2014, at 21:22:40
In reply to ordering your own lab tests » Phillipa, posted by 10derheart on October 23, 2014, at 23:39:21
I didn't know this. But who draws the blood if online? Or there are places to have drawn listed on the site? Thanks $50 is fine. Phillipa
Posted by Phillipa on October 24, 2014, at 21:56:42
In reply to Re: ordering your own lab tests » 10derheart, posted by Phillipa on October 24, 2014, at 21:22:40
One right down the road l0 minutes from here. Does it have to be ordered by phone or email? Thanks
Posted by 10derheart on October 25, 2014, at 14:00:05
In reply to Re: ordering your own lab tests, posted by Phillipa on October 24, 2014, at 21:56:42
I can't remember specific options besides online, but I don't like to call people I don't know so I did it all online. Just follow the instructions. You choose your tests, pay online with a credit/debit card, and at the end you get a lab requisition to print out. (I think it's good for 6 months or something.)
You use a related site to choose your location and make an appointment online to have blood drawn. Then just show up with your requisition. They notify you and you see your results online. I loved it 'cause I like to do things on my own, how I want, when I want, not 100% dependent on what a certain provider thinks. ;-)
Explore the site and you'll find everything. It was really easy to use, IMO. You have to create an account, but that would be necessary to keep it safe and confidential.
Glad you have a lab that participates near your home :-)
Posted by Phillipa on October 25, 2014, at 17:53:48
In reply to Re: ordering your own lab tests » Phillipa, posted by 10derheart on October 25, 2014, at 14:00:05
There is more than one very close by here. All within 15 minutes with traffic factored in. Did you know they also have a facebook page? I like to be in control of me. Hence being on Medicaire I refer myself to all the specialty docs. One good thing. Hoping this option does not disappear anytime soon. And I hate using the phone. Glad to hear not the only one. Thanks again P
Posted by 10derheart on October 26, 2014, at 1:16:26
In reply to Re: ordering your own lab tests » 10derheart, posted by Phillipa on October 25, 2014, at 17:53:48
You're welcome. I just wish the costs of the tests would drop. They really are waaaay to expensive.
I will check out FB maybe.
Posted by Phillipa on October 26, 2014, at 20:54:17
In reply to Re: ordering your own lab tests » Phillipa, posted by 10derheart on October 26, 2014, at 1:16:26
I added the lab to my likes so won't forget to do this. I think there is a facebook page for about everything. P
Posted by phidippus on November 3, 2014, at 16:46:32
In reply to Re: CRP levels predict which AD someone responds to. » SLS, posted by oceansun on October 22, 2014, at 20:02:27
I wonder if there is a correlation between Cymbalta, inflammation and Cymbalta's analgesic qualities.
Eric
Posted by andrewb on November 10, 2014, at 10:38:25
In reply to CRP levels predict which AD someone responds to., posted by SLS on September 16, 2014, at 8:07:04
Hi Scott and others. I've been involved with helping someone with related issues on an ongoing basis, so I have some input.
Broadly speaking insulin resistance causes inflammation (but this is also bi-directional) as measured by CRP and IL-6. IL-6 can be predictive of depression.
Concerning Lexapro being ineffective or pooping out if insulin resistance is suspected: insulin resistance interferes with tryptophan availability for conversion to serotonin. Furthermore, citalopram, of which Lexapro of the left-sided enantiomer decreases the synthesis of 5-hydroxytryptamine (5-HT) in the mouse brain and also seems to require endogenous 5-HT for its full effect (see Pharmacological characterization of the decrease in 5-HT synthesis in the mouse brain evoked by the selective serotonin re-uptake inhibitor citalopram.) Note this effect may not apply to Lexapro (the right-side enantiomer of citalopram), as citalopram has already been found to antagonize escitalopram in other ways.
A recent large study looked at whether 5-HTP and relevant co-factors could reverse citalopram poop-out. They claimed dramatic results. They also state that Seratonin Syndrome is not possible with this add-on at the dose of 300mg/day. Also, insulin resistance interferes with tryptophan availability for conversion to serotonin.
Source: Monoamine depletion by reuptake inhibitors, (FullText, 11), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237392/. Notes: This study is was done by a clinic that is under FDA order to stop selling the amino acid formula it is promoting as being able to treat various conditions. Reason: unproven claims.
Notes: If taking 5-HTP, take these cofactors: vitamin C 1000 mg, calcium citrate 220 mg, vitamin B6 75 mg. Also, start with just 100mg of 5-HTP and stay at that dose for (3) days before stepping up to 200, etc. Be aware of the symptoms of too much 5-HTP (e.g. grogginess). 100mg may be plenty. Also be aware of the symptoms of serotonin syndrome. There is controversy here, but some, especially older sources, state the serotonin syndrome is poss. with the combo. of an SSRI and 5-HTP.NOW!!....what I really want to talk about: insulin resistance, inflammation, and depression, and how to identify and treat.
There is evidence that when IL-6 inflammation caused insulin resistance is present, an insulin sensitizer such as pioglitazone can be effective.
Evidence: 1) PPAR-y agonism as a modulator of mood: proof-of-concept for pioglitazone in bipolar depression. Abstract, 14, http://www.ncbi.nlm.nih.gov/pubmed/24715548. In this study, pioglitazone decreased depression and anxiety in treatment resistant bipolars with metabolic syndrome/insulin resistance, and the degree of response was associated with a) a higher initial IL-6 score and b) the amount the IL-6 was reduced. Reduction in inflammation may represent a novel mechanism by which pioglitazone modulates mood.
Evidence: 2) Does pioglitazone improve depression through insulin-sensitization? Results of a randomized double-blind metformin-controlled trial in patients with polycystic ovarian syndrome and comorbid depression. Ab.s, 12, http://www.ncbi.nlm.nih.gov/pubmed/22999261. In this study they found pioglitazone, but not metformin, to be effective for depression in those with PCOS. Metformin isn't effective for insulin resistance. PCOS is a genetic disorder where insulin resistance is inherent and the depression prevalence is as high as 40%. Furthermore, obese (BMI > or = 27 Kg/m(2)) PCOS women have significantly higher IL-6 and other inflammatory markers than matched controls. BMI and HOMA (a test of insulin resistance) were predictors of IL-6 levels. While BMI alone predicted CRP.
ALL THIS IS TO SAY...if you suspect you have insulin resistance or metabolic syndrome, get tested.
When you or yourdoctor should suspect insulin resistance (even though glucose tolerance test is normal)?. These are some warning signs: high BMI, high waist to hip ratio, high triglycerides, elevated CRP, diagnosed with PCOS, and taking antipsychotics (e.g. Zyprexa!). But the list goes on, it is really quite common nowadays, after a certain age anyway.
TESTING.... Insulin resistance is measured with the HOMA-IR test or the QUICKI test. Should be covered by insurance. If the test comes back showing insulin resist. I suggest spending, if you can spare it, about $150 for an IL-6 test.
From there you can proceed to discussing treatment with your doctor (e.g. pioglitazone). Perhaps specialists in Metabolism and Endocrinology have the most relevant expertise in this area. They would also tell you that how and what you eat is very important when insulin resistance is involved and perhaps give specific advice.
Posted by SLS on November 10, 2014, at 12:51:39
In reply to Re: CRP levels predict which AD someone responds to., posted by andrewb on November 10, 2014, at 10:38:25
Hi Andrew.
I thought that perhaps you had become stuck in an alternate space-timeline.
It's nice to see you again. I consider PB lucky to have you around.
- Scott
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