Journal
BIOLOGICAL PSYCHIATRY
Volume 88, Issue 5, Pages 369-380Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.biopsych.2020.01.014
Keywords
Depression; Heterogeneity; Homeostasis; Inflammation; Metabolism; Treatment
Categories
Funding
- National Health and Medical Research Council Senior Principal Research Fellowship [APP1059660, APP1156072]
- European Union Seventh Framework Programme FP7-Marie Curie Career Integration Grant [PCIG12-GA-2012-334065]
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Epidemiological evidence indicates the presence of dysregulated homeostatic biological pathways in depressed patients, such as increased inflammation and disrupted energy-regulating neuroendocrine signaling (e.g., leptin, insulin). Alterations in these biological pathways may explain the considerable comorbidity between depression and cardiometabolic conditions (e.g., obesity, metabolic syndrome, diabetes) and represent a promising target for intervention. This review describes how immunometabolic dysregulations vary as a function of depression hetero-geneity by illustrating that such biological dysregulations map more consistently to atypical behavioral symptoms reflecting altered energy intake/expenditure balance (hyperphagia, weight gain, hypersomnia, fatigue, and leaden paralysis) and may moderate the antidepressant effects of standard or novel (e.g., anti-inflammatory) therapeutic approaches. These lines of evidence are integrated in a conceptual model of immunometabolic depression emerging from the clustering of immunometabolic biological dysregulations and specific behavioral symptoms. The review finally elicits questions to be answered by future research and describes how the immunometabolic depression dimension could be used to dissect the heterogeneity of depression and potentially to match subgroups of patients to specific treatments with higher likelihood of clinical success.
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