Varicella zoster virus-specific immune responses to a herpes zoster vaccine in elderly recipients with major depression and the impact of antidepressant medications.

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.

• Authors: Michael R Irwin, Myron J Levin, Mark L Laudenslager, Richard Olmstead, Anne Lucko, Nancy Lang, Carmen Carrillo, Harold A Stanley, Michael J Caulfield, Adriana Weinberg, Ivan S F Chan, Jim Clair, Jeff G Smith, R D Marchese, Heather M Williams, Danielle J Beck, Patricia T McCook, Jane H Zhang, Gary Johnson, Michael N Oxman
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 56 Issue 8 Pg. 1085-93 (Apr 2013) ISSN: 1537-6591 [Electronic] United States
• PMID: 23413415 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Antidepressive Agents
• Herpes Zoster Vaccine

Topics

• Aged
• Antidepressive Agents (therapeutic use)
• Case-Control Studies
• Depressive Disorder, Major (drug therapy, immunology, virology)
• Female
• Herpes Zoster (immunology, prevention & control)
• Herpes Zoster Vaccine (immunology)
• Herpesvirus 3, Human (immunology)
• Humans
• Immunity, Cellular (drug effects)
• Longitudinal Studies
• Male
• Middle Aged
• Vaccination