Skip to main content Accessibility help
×
Home

Correlation between white blood cell count and mood-stabilising treatment response in two bipolar disorder trials

  • Ole Köhler-Forsberg (a1) (a2), Louisa G. Sylvia (a3) (a4), Charles L. Bowden (a5), Joseph R. Calabrese (a6), Michael E. Thase (a7), Richard C. Shelton (a8), Melvin McInnis (a9), Mauricio Tohen (a10), James H. Kocsis (a11), Terence A. Ketter (a12), Edward S. Friedman (a13), Thilo Deckersbach (a3) (a4), Michael J. Ostacher (a3), Dan V. Iosifescu (a3), Susan McElroy (a14) and Andrew A. Nierenberg (a3) (a4)...

Abstract

Background:

Immune system markers may predict affective disorder treatment response, but whether an overall immune system marker predicts bipolar disorder treatment effect is unclear.

Methods:

Bipolar CHOICE (N = 482) and LiTMUS (N = 283) were similar comparative effectiveness trials treating patients with bipolar disorder for 24 weeks with four different treatment arms (standard-dose lithium, quetiapine, moderate-dose lithium plus optimised personalised treatment (OPT) and OPT without lithium). We performed secondary mixed effects linear regression analyses adjusted for age, gender, smoking and body mass index to investigate relationships between pre-treatment white blood cell (WBC) levels and clinical global impression scale (CGI) response.

Results:

Compared to participants with WBC counts of 4.5–10 × 109/l, participants with WBC < 4.5 or WBC ≥ 10 showed similar improvement within each specific treatment arm and in gender-stratified analyses.

Conclusions:

An overall immune system marker did not predict differential treatment response to four different treatment approaches for bipolar disorder all lasting 24 weeks.

Copyright

Corresponding author

Author for correspondence: Ole Köhler-Forsberg, Email: karkoe@rm.dk

References

Hide All
1.Amitai, M, Zivony, A, Kronenberg, S, Nagar, L, Saar, S, Sever, J, Apter, A, Shoval, G, Golubchik, P, Hermesh, H, Weizman, A, Zalsman, G. (2014) Short-term effects of lithium on white blood cell counts and on levels of serum thyroid-stimulating hormone and creatinine in adolescent inpatients: a retrospective naturalistic study. Journal of Child and Adolescent Psychopharmacology 24(9), 494500.
2.Bai, YM, Su, TP, Tsai, SJ, Wen-Fei, C, Li, CT, Pei-Chi, T, Mu-Hong, C. (2014) Comparison of inflammatory cytokine levels among type I/type II and manic/hypomanic/euthymic/depressive states of bipolar disorder. Journal of Affective Disorders 166, 187192.
3.Bowden, CL, Vieta, E, Ice, KS, Schwartz, JH, Wang, PP and Versavel, M (2010) Ziprasidone plus a mood stabilizer in subjects with bipolar I disorder: a 6-month, randomized, placebo-controlled, double-blind trial. The Journal of Clinical Psychiatry 71(2), 130137.
4.Brod, S, Rattazzi, L, Piras, G, D’Acquisto, F (2014) ‘As above, so below’ examining the interplay between emotion and the immune system. Immunology 143(3), 311318.
5.Cassidy, F, Wilson, WH and Carroll, BJ (2002) Leukocytosis and hypoalbuminemia in mixed bipolar states: evidence for immune activation. Acta Psychiatrica Scandinavica 105(1), 6064.
6.Dargel, AA, Godin, O, Kapczinski, F, Kupfer, DJ and Leboyer, M (2015) C-reactive protein alterations in bipolar disorder: a meta-analysis. The Journal of Clinical Psychiatry 76(2), 142150.
7.Dickerson, F, Katsafanas, E, Schweinfurth, LA, Savage, CL, Stallings, C, Origoni, A, Khushalani, S, Lillehoj, E, Yolken, R. (2015) Immune alterations in acute bipolar depression. Acta Psychiatrica Scandinavica 132(3), 204210.
8.Drexhage, RC, Knijff, EM, Padmos, RC, Heul-Nieuwenhuijzen, L, Beumer, W, Versnel, MA, Drexhage, HA. (2010) The mononuclear phagocyte system and its cytokine inflammatory networks in schizophrenia and bipolar disorder. Expert Review of Neurotherapeutics 10(1), 5976.
9.Hope, S, Dieset, I, Agartz, I, Steen, NE, Ueland, T, Melle, I, Aukrust, P, Andreassen, OA. (2011) Affective symptoms are associated with markers of inflammation and immune activation in bipolar disorders but not in schizophrenia. Journal of Psychiatric Research 45(12), 16081616.
10.Hope, S, Hoseth, E, Dieset, I, Mørch, RH, Aas, M, Aukrust, P, Djurovic, S, Melle, I, Ueland, T, Agartz, I, Ueland, T, Westlye, LT, Andreassen, OA. (2015) Inflammatory markers are associated with general cognitive abilities in schizophrenia and bipolar disorder patients and healthy controls. Schizophrenia Research 165(2–3), 188194.
11.Hope, S, Ueland, T, Steen, NE, Dieset, I, Lorentzen, S, Berg, AO, Agartz, I, Aukrust, P, Andreassen, OA. (2013) Interleukin 1 receptor antagonist and soluble tumor necrosis factor receptor 1 are associated with general severity and psychotic symptoms in schizophrenia and bipolar disorder. Schizophrenia Research 145(1–3), 3642.
12.Köhler, O, Sylvia, LG, Bowden, CL, Calabrese, JR, Thase, M, Shelton, RC, McInnis, M, Tohen, M, Kocsis, JH, Ketter, TA, Friedman, ES, Deckersbach, T, Ostacher, MJ, Iosifescu, DV, McElroy, S, Nierenberg, AA. (2017) White blood cell count correlates with mood symptom severity and specific mood symptoms in bipolar disorder. Australian and New Zealand Journal of Psychiatry 51(4), 355365.
13.Köhler-Forsberg, O, Sylvia, L, Deckersbach, T, Ostacher, MJ, McInnis, M, Iosifescu, D, Bowden, C, McElroy, S, Calabrese, J, Thase, M, Shelton, RC, Tohen, M, Kocsis, J, Friedman, E, Ketter, T, Nierenberg, AA. (2018) Clinically relevant and simple immune system measure is related to symptom burden in bipolar disorder. Acta Neuropsychiatrica 30(5), 297305.
14.Li, H, Hong, W, Zhang, C, Wu, Z, Wang, Z, Yuan, C, Li, Z, Huang, J, Lin, Z, Fang, Y. (2015) IL-23 and TGF-beta1 levels as potential predictive biomarkers in treatment of bipolar I disorder with acute manic episode. Journal of Affective Disorders 174, 361366.
15.Liu, B and Taioli, E (2015) Seasonal variations of complete blood count and inflammatory biomarkers in the US population – analysis of NHANES data. PLoS One 10(11), e0142382.
16.Lotrich, FE, Butters, MA, Aizenstein, H, Marron, MM, Reynolds, CF 3rd and Gildengers, AG. The relationship between interleukin-1 receptor antagonist and cognitive function in older adults with bipolar disorder. International Journal of Geriatric Psychiatry 2014; 29(6): 635644.
17.Nierenberg, AA, Sylvia, LG, Leon, AC, Reilly-Harrington, NA, Ketter, TA, Calabrese, JR, Thase, ME, Bowden, CL, Friedman, ES, Ostacher, MJ, Novak, L, Iosifescu, DV, Litmus Study Group. (2009) Lithium treatment – moderate dose use study (LiTMUS) for bipolar disorder: rationale and design. Clinical Trials 6(6), 637648.
18.Nierenberg, AA, Sylvia, LG, Leon, AC, Reilly-Harrington, NA, Shesler, LW, McElroy, SL, Friedman, ES, Thase, ME, Shelton, RC, Bowden, CL, Tohen, M, Singh, V, Deckersbach, T, Ketter, TA, Kocsis, JH, McInnis, MG, Schoenfeld, D, Bobo, WV, Calabrese, JR, Bipolar CHOICE Study Group. (2014) Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE): a pragmatic trial of complex treatment for a complex disorder. Clinical Trials 11(1), 114127.
19.Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC. (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry 59(Suppl 20), 2233; quiz 34–57.
20.Spearing, MK, Post, RM, Leverich, GS, Brandt, D andNolen, W (1997) Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Research 73(3), 159171.
21.Uher, R, Tansey, KE, Dew, T, Maier, W, Mors, O, Hauser, J, Dernovsek, MZ, Henigsberg, N, Souery, D, Farmer, A, McGuffin, P. (2014) An inflammatory biomarker as a differential predictor of outcome of depression treatment with escitalopram and nortriptyline. The American Journal of Psychiatry 171(12), 12781286.
22.Vieta, E, T’joen, C, McQuade, RD, Carson, WH Jr, Marcus, RN, Sanchez, R, Owen, R, Nameche, L. (2008) Efficacy of adjunctive aripiprazole to either valproate or lithium in bipolar mania patients partially nonresponsive to valproate/lithium monotherapy: a placebo-controlled study. The American Journal of Psychiatry 165(10), 13161325.

Keywords

Type Description Title
WORD
Supplementary materials

Köhler-Forsberg et al. supplementary material
Table S1

 Word (22 KB)
22 KB
WORD
Supplementary materials

Köhler-Forsberg et al. supplementary material
Table S2

 Word (23 KB)
23 KB

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed