Sara är en utåtriktad, positiv och energisk person som alltid strävar efter att nå sina mål. Hon är snabblärd och mycket samarbetsvillig, vilket gör att hon trivs bra i team och är skicklig på att lösa utmaningar tillsammans med andra. Hennes sociala personlighet gör att hon älskar att hjälpa människor omkring sig, och hon har lätt för att skapa goda relationer. Sara arbetar effektivt även under press och hanterar stressiga situationer på ett lugnt och konstruktivt sätt.
At this pharmacy, I worked as the responsible pharmacist, which involved informing other pharmacists about updates on medications, medical advice
Abstract:Alterations in immune function as a potential causative factor in major depressive disorder (MDD) were first proposed over 30 years ago (Smith R. 1990 Med Hypotheses, 35: 298-306), and have recently gained momentum in the wake of the COVID-19 pandemic. It is posited that the immune alterations in MDD would be associated with increased levels of circulating pro-inflammatory cytokines, such as IL-6, IL-1β,and TNF- α. A therapeutic consequence would be that immunomodulatory drugs may possess antidepressant properties. The purpose of this study was to evaluate the clinical evidence of the role the immune system plays in MDD and to investigate whether immunomodulatory drugs do display antidepressant potential. Two separate systematic reviews were conducted, with the first review examining circulating pro-inflammatory cytokine concentrations in MDD, investigating IL-6, IL-1β,TNF- α and also C-reactive protein (CRP), a commonly used inflammatory biomarker. The other review examined the antidepressant potential of immunomodulatory drugs in MDD. Each review involved literature searches of three databases (Web of Science, PubMed and Embase). The data (mean, standard deviation, and group size) of the studies that fulfilled the outlined criteria were extracted and analyzed using Forest Plots generated standardized mean differences with their corresponding 95% confidence intervals, and Z scores to denote statistical significance (p<0.05 was deemed as statistically significant). IL-6 measurements were identified in 18 studies; it showed a significant elevation in IL-6 levels (p<0.00001; CI [0.35, 0.56]). In 12 individual studies, it was shown a significant elevation in TNF- α levels (p<0.00001; CI [0.43, 0.65]). Lastly, 7 individual studies have shown a significant elevation in both IL-1β and CRP levels (p<0.01; CI [0.06, 0.51] and p<0.00001; CI [0.16, 0.36], respectively). In addition to that, the adjunctive treatment of celecoxib was used in 3 different studies where, overall, it did not show significant improvement in the Montgomery-Åsberg Depression Rating Scale compared to standard treatment. Even though the use of celecoxib along with vortioxetine have shown significance, the size difference between the studies is so wide that the antidepressant effects of celecoxib can be doubted. In conclusion, although we were able to demonstrate elevations in circulating cytokines in MDD and the antidepressant potential of certain immunomodulatory drugs, there have been disappointing results regarding the effects of celecoxib in MDD. Future studies will attempt to stratify patients based on inflammatory biomarkers to improve the likelihood of detecting effects with immunomodulatory drugs.