Do psychotropic medications reduce inflammation in women with antenatal depression/anxiety?

To evaluate the association between psychotropic medication and maternal serum inflammatory cytokines in women with antenatal depression and/or anxiety. In this prospective multicenter observational study, women between 12-21 weeks gestation underwent an assessment of their medication use and depressive symptomatology using the Center for Epidemiologic Studies Depression Scale (CESD). Serum was collected and inflammatory cytokines (IFNγ, IL13, IL6, IL8, TNFα, CRP) were measured. Women were determined to have depression and/or anxiety if 1) they had a CESD score of at least 23 and/or 2) they reported current use of mediation for depression or anxiety. These women were stratified into 3 categories: untreated depression (CESD≥23 with no reported medication), depression not responsive to medication (CESD≥23 despite medication), and depression responsive to medication (CESD<16 with medication). Levels of inflammatory cytokines were compared between groups. Post-hoc analyses were performed using the Bonferroni correction. Of the 85 women with depression/anxiety, 57 (67%) had untreated depression, 12 (14%) had depression not responsive to medication, and 16 (19%) had depression responsive to medication. TNFα concentrations significantly differed among the groups (Table), with post-hoc analyses demonstrating that women with depression and/or anxiety who had responded to medication had lower concentrations of serum TNFα compared to non-responders (p=0.018) or women with untreated depression (p=0.013). There were no differences in TNFα concentrations between untreated women and non-responders (p=0.762). Pregnant women who respond to medication for depression/anxiety have lower concentrations of TNFα compared to women not responsive to medications or women with untreated depression. These data suggest that either pharmacotherapy for perinatal depression/anxiety may exhibit therapeutic effects via immunomodulation or that pre-existing higher levels TNFα may predict a poorer response to traditional pharmacotherapy.