Serum Cortisol, Nesfatin-1, and IL-1β: Potential Diagnostic Biomarkers in Elderly Patients with Treatment-Resistant Depression

Xiaoping Wu,1,2,* Biao Dai,2,3,* Fanfan Yan,1,2 Yang Chen,2,4 Yayun Xu,5 Qingrong Xia,2,6 Xulai Zhang1,2 1Department of Geriatric Psychology, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China; 2Department of Medical Education and Research, Anhui Mental Health Center, Hefei, People’s Republic of China; 3Department of Pharmacy, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China; 4Modified Electroconvulsive Therapy Room, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230032, People’s Republic of China; 5Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People’s Republic of China; 6Department of Science and Education, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xulai Zhang, Department of Geriatric Psychology, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, No. 316 Huangshan Road, Hefei, 230032, People’s Republic of China, Tel +86 551 63616022, Fax +86 551 63616022, Email Xulaizhang@ahmhcentre.comAim: Treatment-resistant depression (TRD) affects approximately 30% of patients with major depressive disorder (MDD), especially elderly patients. As individuals with TRD are at an increased risk of committing suicide and pose a higher risk of relapse, early diagnostic biomarkers of TRD and a better understanding of the resistance mechanism are highly needed. This study aimed to determine whether serum cortisol, nesfatin-1, and pro-inflammatory cytokines can be used as biomarkers for the diagnosis of elderly patients with TRD.Methods: Thirty elderly patients with TRD were selected as the TRD group. Thirty elderly patients with MDD who were effectively treated with conventional antidepressants were selected as the non-TRD group. The baseline levels of serum cortisol, nesfatin-1, and pro-inflammatory cytokines were measured and compared, and their diagnostic values were evaluated using the receiver operating characteristic (ROC) curve method for discriminating patients with TRD from those without TRD.Results: Serum cortisol, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were significantly higher in the non-TRD and TRD groups than in the control group. Moreover, serum cortisol, CRP, TNF-α, and IL-6 levels in the TRD group were significantly lower than those in the non-TRD group. Furthermore, serum nesfatin-1 levels in the non-TRD group were significantly lower than those in the control and TRD groups, while the serum IL-1β levels in the non-TRD group were significantly higher than those in the control and TRD groups. Additionally, an ROC analysis revealed an area under the curve (AUC) of 0.929 for the combination of nesfatin-1 and IL-1β and an AUC of 0.956 for the combination of cortisol, nesfatin-1, and IL-1β in discriminating elderly patients with TRD from those without non-TRD.Conclusion: Serum cortisol, nesfatin-1, and IL-1β may be potential diagnostic biomarkers for discriminating elderly patients with TRD from those without TRD.Keywords: treatment-resistant depression, nesfatin-1, cortisol, pro-inflammatory cytokine, diagnosis, elderly