Changes in leukocytes and CRP in different treatments of major depression

Ammar Abo Hwach; Seda Nur Türker; Franziska Huster; Anastasia Gaspert; Alborz Bastami; Joana Wrasse; Stefan Bleich; Helge Frieling; Thomas Nickl-Jockschat; Hannah Benedictine Maier; Alexandra Neyazi

doi:10.1007/s00702-026-03187-z

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Changes in leukocytes and CRP in different treatments of major depression

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Changes in leukocytes and CRP in different treatments of major depression

Ammar Abo Hwach, Seda Nur Türker, Franziska Huster, Anastasia Gaspert, Alborz Bastami, Joana Wrasse, Stefan Bleich, Helge Frieling, Thomas Nickl-Jockschat, Hannah Benedictine Maier, …

Journal of neural transmission (Vienna, Austria : 1996)

07/02/2026

DOI: 10.1007/s00702-026-03187-z

PMID: 42390535

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Abstract

Neuroinflammatory mechanisms have long been implicated in the pathophysiology of depression, particularly in treatment-resistant depression (TRD). Peripheral immune markers such as monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and neutrophil-to-platelet ratio (NPR) may reflect chronic or acute immune activation and could serve as potential biomarkers for treatment response. We analyzed differential blood cell counts and inflammatory ratios (MLR, NLR, NPR), as well as interleukin-6 (IL-6) and C-reactive protein (CRP) levels, in 196 patients with severe depression. Patients were grouped into unmedicated (UDC), TRD with medication only (TRD-M), and TRD with electroconvulsive therapy (TRD-ECT), and were assessed at baseline and after four weeks. TRD patients showed significantly higher monocyte and MLR levels than non-TRD patients. Within TRD, ECT responders exhibited lower monocyte and MLR values compared to non-responders. NLR levels were significantly higher in the ECT group. A positive correlation was found between NPR changes and symptom improvement based on Beck Depression Inventory-II scores (BDI-II). Our findings suggest that TRD is associated with a chronic inflammatory profile, and that ECT may induce a shift toward acute immune activation, potentially contributing to treatment response. MLR, NLR, and NPR may serve as potential biomarkers and should be evaluated in prospective studies with larger samples and detailed immune phenotyping.

Neutrophil-lymphocyte ratio (NLR)

Monocyte-lymphocyte ratio (MLR)

Neuroinflammation

Neutrophil-to-platelet ratio (NPR)

Treatment-resistant depression (TRD)

Electroconvulsive therapy (ECT)

Details

Title: Subtitle: Changes in leukocytes and CRP in different treatments of major depression
Creators: Ammar Abo Hwach - Department of Psychiatry and Psychotherapy, Otto von Guericke University, Leipziger Straße 44, Magdeburg, 39120, Germany
Seda Nur Türker - Medizinische Hochschule Hannover
Franziska Huster - Otto-von-Guericke-Universität Magdeburg
Anastasia Gaspert - Medizinische Hochschule Hannover
Alborz Bastami - Medizinische Hochschule Hannover
Joana Wrasse - Medizinische Hochschule Hannover
Stefan Bleich - Medizinische Hochschule Hannover
Helge Frieling - Medizinische Hochschule Hannover
Thomas Nickl-Jockschat - University of Iowa
Hannah Benedictine Maier - Medizinische Hochschule Hannover
Alexandra Neyazi - University Hospital Magdeburg
Resource Type: Journal article
Publication Details: Journal of neural transmission (Vienna, Austria : 1996)
DOI: 10.1007/s00702-026-03187-z
PMID: 42390535
ISSN: 0300-9564
eISSN: 1435-1463
Publisher: Springer Nature
Grant note: Otto-von-Guericke-Universitt Magdeburg (3121)
Open Access funding enabled and organized by Projekt DEAL.
Language: English
Electronic publication date: 07/02/2026
Academic Unit: Psychiatry
Record Identifier: 9985180976302771

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