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Major Depressive Disorder in Older Patients as an Inflammatory Disorder: Implications for the Pharmacological Management of Geriatric Depression

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Abstract

Depression is a common and highly disabling condition in older adults. It is a heterogenous disorder and there is emerging evidence of a link between inflammation and depression in older patients, with a possible inflammatory subtype of depression. Persistent low-level inflammation, from several sources including psychological distress and chronic disease, can disrupt monoaminergic and glutaminergic systems to create dysfunctional brain networks. Despite the evidence for the role of inflammation in depression, there is insufficient evidence to recommend use of any putative anti-inflammatory agent in the treatment of depression in older adults at this stage. Further characterisation of markers of inflammation and stratification of participants with elevated rates of inflammatory markers in treatment trials is needed.

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Authors and Affiliations

  1. Mental Health, Drugs and Alcohol Services, Barwon Health, Geelong, VIC, 3216, Australia

    Malcolm P. Forbes

  2. The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, 3216, Australia

    Malcolm P. Forbes, Adrienne O’Neil, Melissa Lane, Bruno Agustini & Michael Berk

  3. Department of Psychiatry, University of Melbourne, Parkville, VIC, 3050, Australia

    Malcolm P. Forbes & Michael Berk

  4. Faculty of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia

    Nick Myles

  5. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia

    Adrienne O’Neil & Michael Berk

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MF, AO, ML, BA, NM and MB declare no conflict of interest. MB is supported by an NHMRC Senior Principal Research Fellowship (1156072). MB has received Grant/Research Support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, Medical Benefits Fund, National Health and Medical Research Council, Medical Research Futures Fund, Beyond Blue, Rotary Health, A2 milk company, Meat and Livestock Board, Woolworths, Avant and the Harry Windsor Foundation; has been a speaker for Abbot, Astra Zeneca, Janssen and Janssen, Lundbeck and Merck; and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Janssen and Janssen, Lundbeck Merck, Pfizer and Servier—all unrelated to this work. AO is supported by a Future Leader Fellowship (#101160) from the Heart Foundation Australia and Wilson Foundation. She has received research funding from National Health & Medical Research Council, Australian Research Council, University of Melbourne, Deakin University, Sanofi, Meat and Livestock Australia and Woolworths Limited and Honoraria from Novartis. The Food & Mood Centre has received funding from the Fernwood Foundation, the A2 Milk Company and Be Fit Foods unrelated to this paper.

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MF, AO and MB conceptualised the paper. MF wrote the first draft, with AO, ML and MB. BA and NM reviewed and edited the manuscript.

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Forbes, M.P., O’Neil, A., Lane, M. et al. Major Depressive Disorder in Older Patients as an Inflammatory Disorder: Implications for the Pharmacological Management of Geriatric Depression. Drugs Aging 38, 451–467 (2021). https://doi.org/10.1007/s40266-021-00858-2

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