Highlights from 2024 NEI Congress: Inflammatory Remarks: Our Evolving Understanding of the Role of Inflammation in Mental Health
Saturday, November 9, 2024

Inflammation triggers chemical reactions in the body that can directly impact brain function and mood regulation. Indeed, inflammatory markers like C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-a) are elevated in depression (Figure 1). Moreover, patients with higher levels of inflammation tend to show poorer response to standard antidepressant medications. There are several pharmacological and non-pharmacological strategies that may be used to reduce inflammation in patients with mood disorders; however, more research is needed before making definitive recommendations for routine clinical use.

Drs. Vladimir Maletic and Roger McIntyre delved into this fascinating topic by first interrogating the clinical manifestations and brain changes associated with inflammation in mood disorders. They considered the sources of pro-inflammatory balance in mood disorders (e.g., trauma, poverty) and how they map on to clinical features like fatigue, cognition, and suicidality, as well as brain function in reward and emotion regulation circuitry. These association were further scrutinized by considering the neurotransmitter and cellular changes underlying inflammation in mood disorders, such as the role of microglia. These mechanisms provide treatment targets related to inflammatory signaling. Indeed, treatments enhancing dopamine and norepinephrine or blocking glutamate may be considered in patients with moderate to high inflammation and/or multiple risk factors for inflammation. Following a review of the evidence base, Drs. Maletic and McIntyre recommended not using a selective serotonin reuptake inhibitor as first-line therapy in these patients. Furthermore, clinicians may consider using or augmenting with medications like bupropion, stimulants (methylphenidate, dextroamphetamine), pramipexole, and es(ketamine). Importantly, several lifestyle interventions have been shown to reduce inflammation and improve mood (exercise, sleep hygiene, meditation, and yoga) and should be recommended to patients.

The recording of this presentation, as well as all of the presentations from 2024 NEI Fall Congress, will be made available on the NEI website as Encore Presentations for NEI Members.

Source:
Vladimir Maletic, MD, MS, Roger S. McIntyre, MD, FRCPC. Inflammatory Remarks: Our Evolving Understanding of the Role of Inflammation in Mental Health. Presented November 9 at 2024 NEI Congress, Colorado Springs, CO.