Clinical correlates of elevated C-reactive protein (CRP) in Major Depressive disorder (MDD)

Abstract

ajor Depressive disorder is a common illness worldwide, with more than 264 million people affected. At its worst, depression can lead to suicide. Close to 800 000 people die due to suicide every year which is the second leading cause of death in 15-29-year-olds. Disturbances in four spheres (mood, psychomotor activity, cognitive, and vegetative) should be ordinarily present for a definitive diagnosis of MDD. Mood disturbances includes painfully aroused mood typically experienced as worse than the severest physical pain, thus depressed mood has a somatic quality. In psychomotor disturbances, there may be either psychomotor agitation (pressured speech, restlessness, hand wringing, and hair pulling) or psychomotor retardation, which underlie diminished efficiency or those patients’ inability to work. The cognitive view of depression considers negative evaluations of the self, the world, and the future (the negative triad). Faulty thinking patterns are clinically expressed as ideas of deprivation and loss, low self-esteem, helplessness, hopelessness, and pessimism; and recurrent thoughts of death and suicide. Some of the thoughts may verge on the delusional. For vegetative disturbances, the mood change in depressive disorder is accompanied by measurable alterations of biorhythms that implicate midbrain dysfunction. The biological concomitants of melancholia include profound reductions in appetite, sleep, and sexual functioning, as well as alterations in other circadian rhythms, especially matinal worsening of mood and psychomotor performance. An equally prominent subgroup of depressed persons exhibits a reversal of the vegetative and circadian functions, with increases in appetite and sleep—and sometimes in sexual functioning—and an evening worsening of mood.