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Accepted manuscript

C-reactive protein is not a biomarker of depression severity in drug-naïve obese patients with metabolic syndrome

Published online by Cambridge University Press:  26 August 2025

Abbas F. Almulla Open the ORCID record for Abbas F. Almulla [Opens in a new window] ,
Spas Kitov ,
Tanya Deneva ,
Maria-Florance Kitova ,
Lyudmila Kitova ,
Kristina Stoyanova ,
Drozdstoy Stoyanov Open the ORCID record for Drozdstoy Stoyanov [Opens in a new window]  and
Michael Maes Open the ORCID record for Michael Maes [Opens in a new window]
Abbas F. Almulla
Affiliation:
Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China. Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China. Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, 31001, Iraq.
Spas Kitov
Affiliation:
Section of Cardiology, First Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria. Clinic of Cardiology, “St. George University Hospital”, Plovdiv, Bulgaria.
Tanya Deneva
Affiliation:
Department of Clinical Laboratory, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
Maria-Florance Kitova
Affiliation:
5th years at Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
Lyudmila Kitova
Affiliation:
Section of Cardiology, First Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria. Clinic of Cardiology, “St. George University Hospital”, Plovdiv, Bulgaria. Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria.
Kristina Stoyanova
Affiliation:
Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria. Research and Innovation Program for the Development of MU - PLOVDIV (SRIPD-MUP), Creation of a network of research higher schools, National Plan for Recovery and Sustainability, European Union – NextGenerationEU, Medical University of Plovdiv, Plovdiv, Bulgaria.
Drozdstoy Stoyanov
Affiliation:
Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria. Research and Innovation Program for the Development of MU - PLOVDIV (SRIPD-MUP), Creation of a network of research higher schools, National Plan for Recovery and Sustainability, European Union – NextGenerationEU, Medical University of Plovdiv, Plovdiv, Bulgaria.
Michael Maes*
Affiliation:
Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China. Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China. Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria. Research and Innovation Program for the Development of MU - PLOVDIV (SRIPD-MUP), Creation of a network of research higher schools, National Plan for Recovery and Sustainability, European Union – NextGenerationEU, Medical University of Plovdiv, Plovdiv, Bulgaria. Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea.
*
*Corresponding author: Prof. Dr. Michael Maes, M.D., Ph.D., Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China, Email: michaelmaes@uestc.edu.cn
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Abstract

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Background:

Metabolic syndrome (MetS) is highly prevalent among adults and is frequently accompanied by depressive symptoms. While high-sensitivity C-reactive protein (hsCRP) has been proposed as a potential indicator of depression, existing evidence remains inconclusive.

Objective:

This study aimed to determine whether increased serum hsCRP or other immune-metabolic biomarkers are associated with depressive symptoms in drug-naïve individuals with obesity and MetS.

Methods:

A total of 88 drug-naïve patients with obesity and MetS but without coronary-artery disease were enrolled and serum levels of neuro-immune and metabolic biomarkers were assessed.

Results:

In MetS, the severity of depression, as assessed using the von Zerssen Depression Rating (VZDR) scale was significantly associated with interleukin (IL)-6, leukocyte numbers, triglyceride x glucose (Tyg) index, low-density lipoprotein cholesterol, Apolipoprotein B (all positively) and mean platelet volume (MPV), visfatin and adiponectin (all negatively). There were no significant associations between hsCRP and severity of depression. In MetS patients, hsCRP is strongly associated with increased leukocyte numbers, alkaline phosphatase, γ-glutamyl transferase, uric acid, platelet numbers and MPV, thereby shaping a distinct subtype of MetS, which is not related to depression.

Conclusions:

Our findings indicate that depressive symptoms in MetS patients are associated with immune–metabolic biomarkers indicating immune activation, atherogenicity and insulin resistance, but not with hsCRP. The reason is that hsCRP in MetS is a biomarker of a specific MetS subtype that is characterized by megakaryopoiesis, hepatocyte activation, and uric acid production, which were not associated with depression.

Keywords

Metabolic syndromedepressioninflammationhsCRPobesity

Information

Type
Original Article
Information
Acta Neuropsychiatrica , Accepted manuscript , pp. 1 - 43
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology