Majör depresyon saptanan meme kanseri hastalarında plazma interlökin-6 düzeyleri deksametazyon supresyon testi sonuçları ve essitalopiram tedavisine yanıt
Özet
Plasma Levels of lnterleukin-6, Dexamethasone Suppression Test Results and Escitalopram Treatment Response in Breast Cancer Patients With Major Depressive Disorder Cancer is associated with a rate of major depression that is higher than general population, because cancer patients show obvious psychological and physical distress. There are many evidences for the role of proinflammatuar cytokines in the etiology of of depression. A number of studies were reported about the neurochemical, neuroendocrine, neuroimmun and neuroanatomical alterations in major depression. However, only very few of these alterations have been systematically investigated in cancer patients with major depression. This study investigated whether breast cancer patients with and without major depressive disorder, exhibit plasma interleukin-6 abnormalities, dexamethasone suppression test results and treatment response with escitalopram similar to those reported in medical healthy, patients with major depressive disorder. Four groups, 30 women in each, were compared to each other in this study: 1- Healthy women 2- Patients with major depressive disorders (without cancer or another organic disease) 3- Breast cancer patients without major depressive disorder 4- Breast cancer patients with major depressive disorder Psychiatric evaluation were made by structured clinical interview for DSM-IV (SCID). Severity of depression was measured with Hamilton Depression Rating Scale. Plasma levels of interleukin-6 were measured. Dexamethasone suppression test was made and then plasma levels of postDST Cortisol were measured. Measures were repeated before and after escitalopram treatment. Breast cancer patients with major depressive disorder had markedly higher plasma levels of interleukin-6 than breast cancer patients without major depressive disorder, patients only with major depressive disorder and healthy subjects. All of patients with breast cancer and major depressive disorder together had abnormal dexamethasone suppression test results. There was not any significant correlation between severity of depression and plasma levels of interleukin-6 and plasma levels of postDST Cortisol. Symptoms of depression, elevated plasma levels of IL-6 and abnormal dexamethasone suppression test results were significantly decreased after treatment with escitalopram. A significant hyperactivation of hypothalamo-pituiter-adrenal axis was found in breast cancer patients with major depressive disorder and it was thought that interleukin-6 could be responsible for this activation. This immun and endocrine activation could be reverted by antidepressant treatment. But it is concluded that the matter if this activation is adaptive or maladaptive for the breast cancer should be searched very carefully and the use of antidepressant treatment should be evaluated considering this point of view. Key Words; Dexamethasone supression test, Interleukin-6, Cortisol, Major Depressive Disorder, Breast Cancer 64