Info

Major

Depression

Matched

Normal Subjects

Figure 5. Varicella-zoster virus responder cell frequency (VZV-RCF) in depressed subjects and age- and gender-matched normal controls; mean + SD. Depressed subjects: n = 11; mean age 51.3 + 15.7 years; range 32-77; Normal controls: n = 11; mean age 51.4 ± 17.2 years; range 28-79.

those in the normal older subjects. The results are shown in Figure 6. As reported previously (Hayward & Herberger, 1987), VZV-RCF values decline with increasing age. Normal subjects younger than 60 years of age (n = 7, mean age = 40.1 ± 9.3 years, range 28 to 57) had higher levels of VZV-RCF than normal subjects 60 years of age and older (mean age = 71.2 ± 6.7 years. Depressed subjects (mean age = 51.4 ± 8.2 years, range 28 to 79) had a level of VZV-RCF comparable to that of normal subjects more than 20 years their senior.

These findings suggest that major depression is associated with a marked decline in VZV-specific cellular immunity, as measured by the frequency of peripheral blood mononuclear cells capable of proliferating in response to VZV antigens. Furthermore, consistent with prior observations, the present study documents an age-related decline in VZV-specific cellular immunity in normal adults. While the results reported here do not directly link depression with an increase in VZV reactivation and in the incidence of HZ, comparable declines in VZV-specific cellular immunity observed in older adults have been correlated with a significant increase in the incidence of HZ and its complications (Oxman & Alani, 1993). The levels of VZV-RCF observed in our depressed

Figure 6. Varicella-zoster virus responder cell frequency (VZV-RCF) in depressed subjects and in normal subjects <60 and > 60 years of age; mean ± SD. Depressed subjects: n = 11; mean age 51.3 ± 15.7 years; range 32-77; Normal subjects <60 years: n = 7; mean age 40.1 ± 9.3 years; range 28-57; Normal subjects > 60 years: n = 35; mean age 71.2 ± 6.7 years; range 60-80.

Major Normal Subjects

Depression <60 years >60 years

Figure 6. Varicella-zoster virus responder cell frequency (VZV-RCF) in depressed subjects and in normal subjects <60 and > 60 years of age; mean ± SD. Depressed subjects: n = 11; mean age 51.3 ± 15.7 years; range 32-77; Normal subjects <60 years: n = 7; mean age 40.1 ± 9.3 years; range 28-57; Normal subjects > 60 years: n = 35; mean age 71.2 ± 6.7 years; range 60-80.

subjects are similar to those observed in normal adults over the age of 60, in whom the incidence of HZ is more than double that in younger normal adults.

Animal models have yielded compelling evidence that behavioral stressors may impact viral diseases, such as herpes simplex, influenza, and coxsackievirus infections, via alterations in immune function (Sheridan, Dobbs, Brown, & Zwilling, 1994). In contrast, there is a paucity of clinical data addressing the confluence of behavioral, immunologic, and outcome variables in the same individual at the same time (Kiecolt-Glaser & Glaser, 1995). Psychosocial stress appears to be associated with reduced immunologic control of latent herpesviruses (Epstein-Barr virus, herpes simplex virus, and cytomegalovirus) as evidenced by elevated antibody titers (Kiecolt-Glaser & Glaser, 1995). Cohen and colleagues have found that psychological stress is associated with increased rates of respiratory infection after experimental inoculation of common cold viruses (Cohen, Tyrrell, & Smith, 1991; Cohen, Doyle, Skoner, Rabin, & Gwaltney, 1997), and Glaser and colleagues have reported that psychological stress is associated with decreased immune responses to hepatitis B and influenza vaccinations (Glaser, Kiecolt-Glaser, Bonneau, Malarkey, Kennedy, Hughes, 1992; Kiecolt-Glaser, Glaser, Gravenstein, & Malarkey, 1996). Whether these observations generated in psychologically stressed persons will generalize to depressed subjects is not yet known.

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