Antidepressants boosted response to VZV vaccine in depressed seniors
Older patients with depression have diminished immune responses to the varicella-zoster virus vaccine, but antidepressant medication may help normalize the responses, recent data suggest.
“We had hypothesized that untreated depression would be associated with a poor response to the shingles vaccine,” Michael R. Irwin, MD, Cousins Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at the University of California, Los Angeles, told Infectious Disease News. “However, we were surprised to see how much treatment of the depression improved the immune response to the vaccine, even though these elderly remained depressed.”
Michael R. Irwin
According to background information in the Clinical Infectious Diseases paper, previous studies have shown that older adults with major depression had lower baseline levels of VZV cell-mediated immunity compared with nondepressed controls. In addition, the levels of immunity were higher among older adults with depression who were receiving antidepressant medication.
In the Depression Substudy of the Shingles Prevention Study, Irwin and colleagues included 40 participants (aged at least 60 years) with major depressive disorder and 52 age- and sex-matched controls who had no history of depression or mental illness. All of the participants had their varicella zoster virus cell-mediated immunity measured before receiving the zoster vaccine or placebo. The immunity was also measured at 6 weeks, 1 year and 2 years after vaccination.
The participants with depression who were not assigned antidepressants had lower levels of immunity after receiving the zoster vaccine vs. the controls at baseline and at all points after vaccination. Those with depression who were assigned antidepressants had higher levels of immunity compared with those not assigned antidepressants.
Those assigned antidepressants also had increases in immunity levels from baseline to 6 weeks after vaccination. The levels among those with depression not assigned antidepressants did not change, despite having the lowest levels at baseline. The two groups with depression had similar severity in depressive symptoms and sleep disturbances, and neither group was associated with differences in immunity levels.
“Diagnosis and treatment of depression in older adults may increase the effectiveness of the shingles vaccine and help diminish the risk of shingles,” Irwin said. “Efforts are needed to identify and diagnose elderly patients who might benefit from either a more potent vaccine or a multi-dose vaccination schedule.”
Disclosure: Irwin reports no relevant financial disclosures.