Does late and early onset depression differ in terms of inflammation?

Objective: To compare neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) values as inflammation markers in patients with early- and late-onset geriatric depression. Method: Patients aged 60 and over who were hospitalized due to depressive disorder between 01.01.2012 and 01.01.2020 were included in this retrospective record review study. Only patients with unipolar depression were included. Results: No difference was found in terms of NLR, PLR or MLR was found between early- and late-onset depression. However, NLR and PLR values were higher in the early- and late-onset depression groups than in the control group. Lymphocyte and monocyte counts were higher in the control group compared to the early- and late-onset depression groups. Conclusion: NLR and PLR may be regarded as markers reflecting inflammation in geriatric depression patients rather than as markers that can differentiate geriatric depression patients in terms of disease onset time.


1. Turkish Statistical Institute (TUIK), Population and Demography. Accessed February 01,2020.

2. Naveen KHS, Goel AD, Dwivedi S, Hassan MA. Adding life to years: Role of gender and social and family engagement in geriatric depression in rural areas of Northern India. J Family Med Prim Care 2020; 9:721-728.

3. Aziz R, Steffens DC. What are the causes of late-life depression? Psychiatr Clin North Am 2013; 36:497-516.

4. Dols A, Bouckaert F, Sienaert P, Rhebergen D, Vansteelandt K, Ten Kate M, et al. Early- and late-onset depression in late life: a prospective study on clinical and structural brain characteristics and response to electroconvulsive therapy. Am J Geriatr Psychiatry 2017; 25:178-189.

5. Alexopoulos GS, Young RC, Meyers BS, Abrams RC, Shamoian CA. Late-onset depression. Psychiatr Clin North Am 1988; 11:101-115.

6. Paranthaman R, Burns AS, Cruickshank JK, Jackson A, Scott ML, Baldwin RC. Age at onset and vascular pathology in late-life depression. Am J Geriatr Psychiatry 2012; 20:524-532.

7. Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci 2014; 69(Suppl 1):S4-9.

8. Alexopoulos GS, Morimoto SS. The inflammation hypothesis in geriatric depression. Int J Geriatr Psychiatry 2011; 26:1109-1118.

9. Teunissen CE, Durieux-Lu S, Blankenstein MA, Oude Voshaar RC, Comijs HC. The inflammatory marker GDF-15 is not independently associated with late-life depression. J Psychosom Res 2016; 83:46-49.

10. Alexopoulos GS. Mechanisms and treatment of late-life depression. Transl Psychiatry 2019; 9:188.

11. Sonsin-Diaz N, Gottesman RF, Fracica E, Walston J, Windham BG, Knopman DS, et al. Chronic systemic ınflammation ıs associated with symptoms of late-life depression: the arıc study. Am J Geriatr Psychiatry 2020; 28:87-98.

12. Mishra D, Sardesai U, Razdan R. C-reactive protein level in lateonset depression: a case-control study. Indian J Psychiatry 2018; 60:467-471.

13. de la Torre-Luque A, Ayuso-Mateos JL, Sanchez-Carro Y, de la Fuente J, Lopez-Garcia P. Inflammatory and metabolic disturbances are associated with more severe trajectories of latelife depression. Psychoneuroendocrinology 2019; 110:104443.

14. Charlton RA, Lamar M, Zhang A, Ren X, Ajilore O, Pandey GN, et al. Associations between pro-inflammatory cytokines, learning, and memory in late-life depression and healthy aging. Int J Geriatr Psychiatry 2018; 33:104-112.

15. Arts MH, Collard RM, Comijs HC, Naudé PJ, Risselada R, Naarding P, et al. Relationship between physical frailty and lowgrade inflammation in late-life depression. J Am Geriatr Soc 2015; 63:1652-1657.

16. Rozing MP, Veerhuis R, Westendorp RGJ, Eikelenboom P, Stek M, Marijnissen RM, et al. Inflammation in older subjects with earlyand late-onset depression in the NESDO study: a cross-sectional and longitudinal case-only design. Psychoneuroendocrinology 2019; 99:20-27.

17. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102:5-14.

18. Jilma B, Blann A, Pernerstorfer T, Stohlawetz P, Eichler HG, Vondrovec B, et al. Regulation of adhesion molecules during human endotoxemia. No acute effects of aspirin. Am J Respir Crit Care Med 1999; 159:857-863.

19. Lam FW, Vijayan KV, Rumbaut RE. Platelets and their interactions with other immune cells. Compr Physiol 2015; 5:1265-1280.

20. Shi C, Pamer EG. Monocyte recruitment during infection and inflammation. Nat Rev Immunol 2011; 11:762-774.

21. Gokmen F, Akbal A, Resorlu H, Gokmen E, Guven M, Aras AB, Erbag G, Komurcu E, Akbal E, Cosar M. Neutrophil-lymphocyte ratio connected to treatment options and inflammation markers of ankylosing spondylitis. J Clin Lab Anal 2015; 29:294-298.

22. Ozdin S, Boke O. Neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratios in different stages of schizophrenia. Psychiatry Res 2019; 271:131-135.

23. Gundogmus I, Algul A, Karagoz A, Kıyancicek M. PDW and RDW are new parameters for bipolar episodes and unipolar depression. Psychiatry Clin Psychopharmacol 2019; 29:520-526.

24. Arabska J, Łucka A, Magierski R, Sobów T, Wysokiński A. Neutrophil-lymphocyte ratio is increased in elderly patients with first episode depression, but not in recurrent depression. Psychiatry Res. 2018; 263:35-40.

25. Liang M, Du B, Zhang H, Lu X, Chen C, Fan C, et al. NLR Is Associated With Geriatric Depression in Chinese Women: A Community-Based Cross-Sectional Study in Eastern China. Front Psychol 2020; 10:2941.

26. Gaynes BN, Lux L, Gartlehner G, Asher G, Forman-Hoffman V, Green J, et al. Defining treatment-resistant depression. Depress Anxiety 2020; 37:134-145.

27. Baykan H, Baykan O, Esen EC, Tirak A, Akdeniz Gorgulu S, Kargilidere T. Neutrophil-to-lymphocyte ratio as a potential differential diagnostic marker for alzheimer’s disease, major depressive disorder, and parkinson’s disease. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2018; 31:389- 395.

28. Kayhan F, Gunduz S, Ersoy SA, Kandeger A, Annagur BB. Relationships of neutrophil-lymphocyte and platelet-lymphocyte ratios with the severity of major depression. Psychiatry Res 2017; 247:332-335.

29. Ozyurt G, Binici NC. Increased neutrophil-lymphocyte ratios in depressive adolescents is correlated with the severity of depression. Psychiatry Res 2018; 268:426-431.

30. Mazza MG, Lucchi S, Tringali AGM, Rossetti A, Botti ER, Clerici M. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in mood disorders: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84:229-236.

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