Inflammation as a predictor for depression in multiple sclerosis

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Due to its effect on patients’ quality of life and its contribution to the respective economic burden, depression is one of the most relevant comorbidities of multiple sclerosis (MS). Identifying predictors of depression would allow initiating diagnostic and therapeutic steps as early as possible and improve MS care. Major depressive disorder (MDD) studies have highlighted the relevance of inflammatory molecules in the development of depressive symptoms. Thus, investigating inflammatory processes and their relevance for depressive symptoms in MS – which itself is a chronic inflammatory condition – is highly interesting from both scientific and clinical point of view. Our project addresses the unanswered question which inflammatory markers predict the development of depressive symptoms in newly diagnosed MS patients. We focus on studying serum markers which can be determined in both MS and MDD patients. Furthermore, they can be easily obtained with a minimally invasive procedure and are thus potential candidates for a possible implementation in the clinical routine at a later stage. Additionally, we consider also other clinical, demographic, laboratory and imaging parameters (especially MS lesions and the lesion location) as predictors of depression. The project is designed as a prospective cohort study with two cohorts (60 newly diagnosed MS patients and 60 patients with MDD and no history of antidepressant medication in the last 12 months) and measurements at baseline and at a follow-up 12 months later. Serum inflammatory markers (CRP, Albumin, IL-1, sIL2R, IL-3, IL-6, IL-12, IL-17, IL-18, IL-38, TNF-α, Th1-/Th17-/T-regulatory lymphocytes) as well as clinical (including EDSS as an indicator for physical disability) and other variables (for MS patients: cerebrospinal fluid at baseline and MRI parameters at baseline and follow up) will be tested as predictors for depressive symptoms. Furthermore, a comparison between MS and MDD patients will allow the identification of those inflammatory markers, which are relevant for the occurrence of depressive symptoms especially in MS. The effects of disease modifying therapy on depressive symptoms and proinflammatory molecules will be studied as well. The insights from this study would allow to identify MS patients with a higher risk for developing depressive symptoms. Those patients could be more closely monitored and a respective treatment could be provided timely, if necessary. Thus, the disease burden of MS-related depression can be significantly reduced.