Varicella Zoster Virus–Specific Immune Responses to a Herpes Zoster Vaccine in Elderly Recipients With Major Depression and the Impact of Antidepressant Medications
- Michael R. Irwin1,
- Myron J. Levin2,
- Mark L. Laudenslager2,
- Richard Olmstead1,
- Anne Lucko3,
- Nancy Lang2,
- Carmen Carrillo1,
- Harold A. Stanley3,
- Michael J. Caulfield4,
- Adriana Weinberg2,
- Ivan S. F. Chan4,
- Jim Clair4,
- Jeff G. Smith4,
- R. D. Marchese4,
- Heather M. Williams3,
- Danielle J. Beck3,
- Patricia T. McCook3,
- Jane H. Zhang5,
- Gary Johnson5, and
- Michael N. Oxman3,6
+Author Affiliations
- Correspondence: Michael R. Irwin, MD, Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, 300 UCLA Medical Plaza, Suite 3109, Los Angeles, CA 90095-7057 (mirwin1@ucla.edu).
Abstract
Background. The Depression Substudy of the Shingles Prevention Study (SPS) was designed to evaluate the association between major depression and immune responses to a high-titer live attenuated varicella zoster virus (VZV) vaccine (zoster vaccine), which boosts cell-mediated immunity (CMI) to VZV and decreases the incidence and severity of herpes zoster (HZ). The Depression Substudy was a 2-year longitudinal cohort study in 92 community-dwelling adults ≥60 years of age who were enrolled in the SPS, a large, double-blind, placebo-controlled Veterans Affairs Cooperative zoster vaccine efficacy study.
Methods. Forty subjects with major depressive disorder, stratified by use of antidepressant medications, and 52 age- and sex-matched controls with no history of depression or other mental illness had their VZV-CMI measured prior to vaccination with zoster vaccine or placebo and at 6 weeks, 1 year, and 2 years postvaccination.
Results. Depressed subjects who were not treated with antidepressant medications had lower levels of VZV-CMI following administration of zoster vaccine than nondepressed controls or depressed subjects receiving antidepressants even when antidepressant medications failed to alter depressive symptom severity (P < .005). Similar results were obtained taking into account the time-varying status of depression and use of antidepressant medications, as well as changes in depressive symptoms, during the postvaccination period.
Conclusions. Depressed patients have diminished VZV-CMI responses to zoster vaccine, and treatment with antidepressant medication is associated with normalization of these responses. Because higher levels of VZV-CMI correlate with lower risk and severity of HZ, untreated depression may increase the risk and severity of HZ and reduce the efficacy of zoster vaccine.
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