Evidence for an enhanced procoagulant state in remitted major depression

Abstract

Objectives

Hypercoagulability is one mechanism to explain the increased risk of incident atherothrombotic disease in patients with major depressive disorder (MDD). We examined whether patients with remitted MDD show an enhanced procoagulant state.

Methods

63 individuals (median age 35 years, 59% women), 40 with a DSM-IV diagnosis of remitted MDD, made by a clinical interview, and 23 healthy controls provided blood samples for the measurement of fibrinogen, D-dimer, von Willebrand factor, and plasminogen activator inhibitor-1. Standardised z-scores of plasma levels of these haemostatic factors were added to form a procoagulant index (PCI) as the primary outcome variable. Self-ratings of residual depressive symptoms and trait anxiety were also obtained.

Results

Compared with controls, remitted MDD patients had higher PCI (p = 0.013, Cohen’s d = 0.69) and fibrinogen (p = 0.001, d = 0.91), controlling for age, sex, body mass index, smoking and C-reactive protein. There were no significant associations of the PCI and individual haemostatic molecules with age of MDD onset, time since the last MDD episode, the number of previous MDD episodes and residual depressive symptoms. Additional adjustment for anxiety symptoms did not change these results.

Conclusions

Remitted MDD is associated with an enhanced procoagulant state. Hypercoagulability seems more a trait than a state characteristic of depression.

Keywords:

• Biomarker
• blood coagulation
• cardiovascular disease
• fibrinolysis
• major depression

Acknowledgements

We wish to thank Melanie Huber for excellent technical assistance, and Susanne Kirchner, Charlotte Wink, Lioba LaRosee, Esther Täumer, Sandra Zänkert and Stephany Fulda for their support in conducting the diagnostic interviews.

Statement of interest

None to declare.

Additional information

Funding

The study was supported by a grant from the Max Planck Society within the EuroStress project ‘Vulnerable phenotypes for stress-related mental disorders: focus on glucocorticoids (BALANCE)’ and by NeuroNova gGmbH, Munich.