Assessing for Inflammation in Depression

CRP or C-reactive protein is a protein made by the liver in response to inflammation in the body; it plays a role in the body’s inflammatory response and acts as a measure of the body’s inflammation. hs-CRP, or high sensitivity CRP is a more sensitive way to evaluate for inflammation. This is important in psychiatry because inflammation can sometimes worsen or even cause depression. An elevated hs-CRP gives us hints about which medications and/or supplements may be helpful in treating depression that may have an inflammatory component.

Is hs-CRP worth checking in all ages of patients with depressive symptoms?

There is evidence that higher levels of hs-CRP correlate with depression across all age groups and is implicated in treatment resistant depression.

What cutoff is used when considering hs-CRP in depression?

Levels over 2mg/dl are often used and would indicate that various interventions may be helpful. Some consider anything over 1mg/dl as worth intervening on but the evidence isn’t as clear at that level.

Which medications are considered if hs-CRP is elevated and thought to play role in the patients depression?

We often look to medications that have some role in dopamine modulation including:

• Wellbutrin (bupropion)
• Nortriptyline (a Tricyclic antidepressant)
• Abilify (aripiprazole)

Which supplements may be beneficial if hs-CRP is elevated and thought to play role in the patients depression?

1. L-methylfolate 15mg/day: For more information on l-methylfolate, click here.
2. NAC, or N-acetylcysteine 1200mg BID: click here for more on dosing and other benefits to NAC.
3. Omega 3 Fatty Acids (fish oil): click here for the best brands and related dosing.

Which lifestyle changes have been shown to improve inflammatory markers including hs-CRP?

• An anti-inflammatory diet can yield major benefits. Look here for our post on an anti-inflammatory diet also called the few foods diet. Also look into the Mediterranean diet.
• 4x per week Aerobic Exercise, of moderate intensity and lasting 45 minutes has been shown to lower inflammation.
• Mindfulness including meditation and yoga have been shown to lower inflammation in general. Here is information on mindfulness including what it helps and how to go about trying it out.