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Publications

Journal Article Epublish 1 citation

PubMed: 40548319 DOI: 10.1176/appi.prcp.20240112

Major Depressive Disorder in Long COVID and Exposure to Pro-Inflammatory Cytokines During Infection by SARS-CoV-2.

Psychiatr Res Clin Pract 7(2):139-149

Authors: Hernan F Guillen-Burgos, Juan F Gálvez-Flórez, Sergio Moreno-López, Sabrina Wong, Angela T H Kwan, Mariana Ramirez-Posada, Juan-Manuel Anaya, Roger S McIntyre

Affiliations

  • Centro de Investigaciones en Ciencias de la Vida Universidad Simón Bolívar Center for Clinical and Translational Research Barranquilla Colombia.
  • Faculty of Medicine Universidad El Bosque Center for Clinical and Translational Research Bogotá Colombia.
  • Department of Psychiatry and Mental Health Pontificia Universidad Javeriana PhD Program in Neuroscience Hospital Universitario San Ignacio Bogota Colombia.
  • Universidad El Bosque Bogotá Colombia.
  • Zerenia Clinic. Consultation - Liaison Psychiatric Unit Bogotá Colombia.
  • Faculty of Medicine Universidad de Los Andes Bogotá Colombia.
  • Mood Disorders Psychopharmacology Unit University Health Network Toronto ON Canada.
  • Department of Pharmacology and Toxicology University of Toronto Toronto ON Canada.
  • Brain and Cognition Discovery Foundation Toronto ON Canada.
  • Faculty of Medicine University of Ottawa Ottawa ON Canada.
  • Coosalud IPS Research and Innovation Center, and Universidad de la Costa Barranquilla Colombia.
  • Department of Psychiatry and Pharmacology University of Toronto Toronto ON Canada.

Abstract

Objective

Major Depressive Disorder (MDD) is common in long COVID syndrome; however, the neurobiological mechanisms are unclear. An immune activation response has been associated with COVID-19 severity as well as in MDD. We hypothesize that high levels of pro-inflammatory cytokines during SARS-CoV-2 infection may be associated with new-onset MDD and severe outcomes such as treatment-resistant depression (TRD) and risk of suicide ideation and behavior (SI/SB).

Methods

A case-control nested to a cohort study was carried out on a total of 678 COVID-19 survivors (MDD = 184 vs. non-MDD = 494). A pro-inflammatory panel of serum levels of cytokines (IL-1β, IL-4, IL-6, IL-8, IL-13, IL-17α, TNF-α) was evaluated during COVID-19 hospitalization and severe outcomes such as TRD and SI/SB were assessed in individuals with new onset of MDD after hospital discharge compared to non-MDD COVID-19 survivors.

Results

High levels of pro-inflammatory cytokines during SARS-CoV-2 infection were identified in MDD participants compared to non-MDD subgroups during long COVID. These differences were sustained also for TRD and SI/SB severity outcomes. There is a mild association of high levels of pro-inflammatory cytokines and MDD, TRD, and SI/SB.

Conclusion

High levels of pro-inflammatory cytokines during severe or critical COVID-19 exposure may explain long COVID associated MDD and thus severe outcomes such as TRD and SI/SB.

Relevance to clinical practice

Identifying elevated pro-inflammatory cytokines during COVID-19 as a risk factor for MDD and severe outcomes underscores the need for early screening and targeted treatments in long COVID. Monitoring cytokine levels may help clinicians predict and manage TRD and SI/SB in this population, improving long-term psychiatric outcomes.

MeSH

Cytokines, Sars-Cov-2, Depressive Disorder, Covid-19, Therapeutics, Severe Acute Respiratory Syndrome-Related Coronavirus, Infections, Depressive Disorder, Major, Post-Acute Covid-19 Syndrome