Association of inflammatory markers with depression in perimenopausal women in a tertiary care centre in northern Karnataka-a cross-sectional study

Abstract

BACKGROUND: Menopause is an essential phase in the physiological life cycle of women, associated with changes in the biochemical factors such as decreasing Estrogen level. Estrogen is known to have a mood-elevating effect, and the decrease in levels can explain the onset of mood disorders in women in the peri-menopausal age, particularly depression. 1 However, menopause- associated depression is still a much-debated topic. While there have been significant advances made to prove the prevalence of depression in perimenopausal women, there is still much that needs to be understood.

Identifying the biological markers that reflect the disease pathology is necessary. Major Depressive Disorder has been hypothesized to be an inflammatory process, showing an increase in Inflammatory markers such as CRP, IL-6, D- Dimer, Total WBC count and Neutrophil-Lymphocyte Ratio in depression.43 Correlating the same in perimenopausal women between the ages of 45 to 60 years can help in early identification and possibly predicting post-menopausal women at higher risk of developing Depression at a later stage in life.

The possibility of use of Anti-Inflammatory agents as an adjuvant to treatment in mood disorders and Major Depressive Disorder can also be explored, on understanding the etio-pathology of the same in Peri Menopausal Women.

OBJECTIVES OF THE STUDY: To study the association between Inflammatory markers such as CRP, IL-6, D-Dimer, Total WBC Count and Neutrophil-Lymphocyte Ratio and depression in Peri Menopausal and Menopausal Women between 40 to 55 years. MATERIALS AND METHODS: A cross-sectional study was conducted in BLDE (DU) Department of Obstetrics and Gynaecology and Department of Psychiatry of 110 patients. All patients fitting the inclusion criteria will be included in the study. After obtaining Informed and written consent, the patients were first be screened for depression using the PHQ-9 questionnaire and will be divided into depressed (cases = 55) and non-depressed (controls = 55) patients. Depressed patients will further be categorised based on the severity of depression using PHQ-9 questionnaire. They were asked to rate their menopausal symptoms based on the MRS. Blood Sample were drawn for both the control and test group and sent for CRP, IL-6, D-Dimer, Total Leucocyte Count and Neutrophil-Lymphocyte Ratio. RESULTS: A total of 110 patients were included into the study. Cases were those patients who, according to the PHQ–9 questionnaire, were classified as depressed and controls were those patients who were not depressed. 87.2% of the cases were found to be mildly depressed and 12.8% were moderately depressed. The commonest symptom of menopause reported was vasomotor symptom (98.2%), followed by sleep disturbances (80.1%), physical and mental exhaustion (65.5%), depressive mood (63.6%), irritability (53.7%), and joint and muscular disturbances (32.7%). The least reported symptom was bladder problems. No association was noted between any of the inflammatory markers and depression. CONCLUSION: A lack of association was noted between the acute phase reactants or inflammatory markers and depressive mood amongst the perimenopausal age group of women. This negative result could either suggest that such an association does not exist or that the relationship between inflammation and subthreshold, mild and moderate depression is more complex than previously understood and requires a deeper exploration between the interplay of hormones, inflammation and depression.