Major depressive disorder (MDD) is accompanied by activation of the immune-inflammatory response system (IRS) and the compensatory immunoregulatory system (CIRS). Fluoxetine, the most commonly used selective serotonin reuptake inhibitor (SSRI), shows anti-inflammatory effects in both MDD patients and depressive-like behaviors in rodents. The present study examines the effects of fluoxetine on immune profiles, such as M1 and M2 macrophages, T helper (Th)1, Th2, Th17, IRS, and CIRS in MDD and healthy controls (HC). Culture supernatant of immunogen-stimulated whole blood of 18 MDD and 18 HC was measured for 48 cytokines using a multiplex assay. The effects of three fluoxetine concentrations (0.1 mM, 0.01 mM, and 0.001 mM) were examined. MDD was characterized by significantly increased M1, M2, Th1, Th2, Th17, IRS, and CIRS profiles under the stimulation of phytohemagglutinin (PHA) and lipopolysaccharide (LPS). Fluoxetine exhibited different effects on immune functions when comparing culture supernatant from MDD to HC. In HC samples, the administration of fluoxetine did not impact the immune system. In MDD samples, fluoxetine administration significantly reduces the stimulated production of Th1, Th17, M2, IRS, Th2, as well as IL-1 and TNF signaling pathways. Fluoxetine significantly attenuated the production of pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6, tumor necrosis factor-α, IL-12, interferon-γ, chemokines (CCL27, CXCL10), growth factors, and colony-stimulating factors. However, this suppressant effect is merely partial, insufficient to normalize the immune sensitization in the culture supernatant from MDD patients. In summary, fluoxetine has highly significant immunoregulatory effects in patients with MDD and not in controls. Unfortunately, these effects only partly attenuate the immune sensitization in MDD.
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