Anti-inflammatory effects of antidepressant and atypical antipsychotic medication for the treatment of major depression and comorbid arthritis: a case report
Anti-inflammatory effects of antidepressant and atypical antipsychotic medication for the treatment of major depression and comorbid arthritis: a case report
Baune and Eyre Journal of Medical Case Reports 2010, 4:6
Abstract
Introduction:
This case report describes the effects of psychotropic treatment, quetiapine in particular, on systemic inflammation, pain, general functioning and major depression in the treatment of a woman with arthritis.
Case presentation:
A 49-year-old Caucasian Australian woman with arthritis, pain and depression was treated with a course of escitalopram, mirtazapine and quetiapine. Pain levels, general functioning and degree of depressive symptoms were evaluated with a visual analogue scale. Systemic inflammation had been assessed by C-reactiveprotein serum levels since 2003. C-reactive protein levels, physical pain, symptoms of arthritis and depression decreased significantly during the past 12 months of treatment with quetiapine, while treatment with selective serotonin reuptake inhibitors and mirtazapine remained the same.
Conclusions:
We suggest that the treatment particularly with quetiapine may have anti-inflammatory effects in arthritis and comorbid major depression, which eventually led to a remission of pain and depression and to normal general function.
Introduction
Patients with major depression often suffer comorbid physical disorders [1] of which some are related to systemic inflammation, such as cardiovascular disease [2] and rheumatoid arthritis [3]. In turn, systemic inflammation has been related to the onset and course of depression [4]. It has been suggested that stress and inflammatory pathways are involved in the response to antidepressant treatment [5].
In this case report, we describe a patient with chronic psoriatic arthritis that cause impairing pain, increased C-reactive protein levels (CRP) and depressive symptoms. However, a significant improvement of arthritic symptoms including pain and mental symptoms, as well as a decrease in CRP, was observed after the patient was commenced on a combined treatment of psychotropic medication (antidepressant and atypical neuroleptic). The treatment subsequently led to a significant increase in the patient’s levels of general functioning.
Case presentation
A 49-year-old Caucasian Australian woman was referred by her general practitioner to a specialist clinic for mood disorders in October 2007 with the request to assess and manage longstanding symptoms of depression. Her history shows psoriatic arthritis causing significant pain since age 43 and mild to moderate depressive episodes since her early 30 s. In October 2007, the patient presented with severe emotional disturbance characterised by anxiety, frustration and depression. These feelings seemed to be largely brought about by her decreased mobility as a result of severe, debilitating arthritic pain in her joints that worsened over the past 12 months prior to assessment. Due to her depression which had started in 2002, she was seen by her psychiatrist in the community, who diagnosed her with major depressive disorder (MDD).
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