Abstract
Diabetes, obesity, atherosclerosis, and myocardial infarction are frequently co-morbid with major depressive disorder. In the current review, it is argued that vascular inflammation is a factor that is common to all disorders and that an endothelial dysfunction of the blood-brain barrier could be involved in the induction of depression symptoms. Biomarkers for vascular inflammation include a high plasma level of C-reactive protein, soluble cell-adhesion molecules, von Willebrand factor, aldosterone, and proinflammatory cytokines like interleukin-6 or tumor necrosis factor α. A further possible biomarker is flow-mediated dilation of the brachial artery. Treatment of vascular inflammation is expected to prevent or to reduce symptoms of depression. Several tentative treatments for this form of depression can be envisioned: eicosapentaenoic acid (EPA), valproate, Vagus-nerve stimulation, nicotinic α7 agonists, and agonists of the cannabinoid CB2-receptor.
Highlights
Depression is considered a disorder of the central nervous system, numerous peripheral inflammatory diseases are associated with depressive symptoms [1,2,3,4,5,6]
The presence of elevated levels of proinflammatory cytokines in blood of patients with major depressive disorder has been confirmed in multiple meta-analyses [7,8,9]
Free fatty acids act as toll-like receptor-4 (TLR4)-agonists and trigger nuclear factor-κB (NFκB)-mediated production of the proinflammatory cytokines, tumor necrosis factor-α (TNFα) and IL6 [33]
Summary
Depression is considered a disorder of the central nervous system, numerous peripheral inflammatory diseases are associated with depressive symptoms [1,2,3,4,5,6]. Cardiovascular disorders like atherosclerosis [14], diabetes [15,16], coronary heart disease [17,18], myocardial infarction [19], or congestive heart failure [20,21] and their risk factors like tobacco smoking [22], obesity [23,24,25], homocysteinemia [26], or old age [27,28] involve vascular inflammation and display comorbidity with depression. It is deemed useful to explore the causal link between vascular inflammation and depression, since it may offer information about specific biomarkers and possibilities for targeted treatment
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