الفهرس 
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Abstract
Growing body of evidences have suggested a strong
correlation between major depressive disorder (MDD) and both
inflammatory and phosphodiestrase pathways.
This study aimed at evaluating the adjuvant role of
pentoxifylline (PTX) in the treatment of adult patients with MDD
since it has anti-inflammatory and phosphodiestrase inhibition
activities. Furthermore, it aimed at assessing the relationship between
Hamilton depression rating scale (HAM-D) scores and other studied
biomarkers, and also, evaluating their role in treatment and diagnosis
of MDD.
The study design was a prospective, 12-week, double-blind,
placebo-controlled trial of parallel groups. Eighty adult outpatients
who met the diagnostic and statistical manual of mental disorders-IV
(DSM-IV) criteria for MDD were enrolled in the trial. Patients
enrolled in the study had baseline HAM-D of at least 18. Remission
is defined as HAM-D total scores ≤ 7 (primary outcome). Treatment
response is defined as ≥ 50 % DROP in the HAM-D total scores.
Patients were allocated in random fashion: 40 patients
received escitalopram 20 mg/day plus placebo and the other 40
patients received escitalopram 20 mg/day plus PTX (400 mg bid),
with food. Patients were assessed by a psychiatrist at baseline, 4, 8,
and 12 weeks after starting their medication. Serum levels of tumor
necrosis factor–α (TNF–α) and interleukin-6 (IL-6), interleukin-10
(IL-10), 8-hydroxy-2’-deoxyguanosine (8-OHdG), brain-derived
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neurotrophic factor (BDNF), and serotonin were measured at baseline
and post-therapy.
There were no significant differences between patients
assigned to control or PTX groups with regard to basic demographic
data.
Eighty-five percent (85 %, 32/38) of the patients in the PTX
group and 41% (16/38) in the control group were remitted after 12
weeks; where HAM-D total scores ≤ 7. There was a significant
difference between the two groups in terms of percentage of
responders showing a reduction in the HAM-D total scores of at least
50 %. Responders of PTX group were 92 % (35/38). On the other
hand, those of control group were 58 % (22/38). PTX treated group
showed statistically significant improvement in the HAM-D scores as
compared to control group eight and twelve weeks following
treatment (p < 0.05).
Moreover, after treatment PTX treated group showed
statistically-significant decrease in the serum levels of TNF–α, IL-6,
IL-10, and 8-OHdG (p < 0.05) alongside with statistically-significant
increase in the levels of BDNF and serotonin (p < 0.05) in
comparison with the control group. Furthermore, we reported that the
serum levels of TNF–α, IL-6, IL-10, and 8-OHdG showed
statistically-significant positive correlation with HAM-D scores
before and after treatment. Alternatively, the serum levels of BDNF
and serotonin showed statistically-significant negative correlation
with HAM-D scores before and after treatment. In addition, there was
non-significant difference in adverse effects between the two studied
groups.
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Our results suggest that, PTX augmentation therapy might
present antidepressant effects in MDD patients; therefore, it might be
a potential adjunctive agent to improve the treatment response in
MDD. These findings raise the possibility that, the serum levels of
TNF–α, IL-6, IL-10, 8-OHdG, BDNF, and serotonin could be
clinically valuable biomarkers for diagnosis or as therapeutic targets
for MDD patients. However, further investigations are still
recommended to confirm these promising findings.