Inflammation, anxiety and depression

Rossi and colleagues have published an interesting report on CNS inflammation in multiple sclerosis as it relates to anxiety and depression that may be more relevant to resource-limited tropical settings than one might imagine. Their paper makes an important contribution to the growing body of clinical data supporting the importance of CNS inflammation-induced anxiety and depression in persons with neurologic disorders. The potential for these psychiatric symptoms to serve as a possible warning sign of ongoing CNS inflammation warrants further study and the range of conditions for which this might be relevant is extensive.

In 2006 during the antiretroviral therapy (ART) roll out in rural Zambia, we undertook a study of the neurologic and psychiatric status of people initiating ART and patient outcomes at 1 year1. Mortality was 20% at a median of 80 days (IQR 44-139) after treatment initiation. After adjusting for World Health Organization HIV Disease Stage, the only predictor of mortality was the Shona Symptom Score, an instrument developed in Zimbabwe to quantify anxiety and depression symptoms. More recently, we evaluated predictors of mortality among people with HIV and new onset seizure. After advanced imaging, EEG and extensive cerebrospinal fluid (CSF) studies to identify opportunistic infections2, the highest mortality was seen among those patients in who we could find no cause for the underlying seizure. Clearly CSF studies of CNS inflammation in this population, and likely others, are needed.


  1. Birbeck GL, Kvalsund MP, Byers PA, et al. Neuropsychiatric and socioeconomic status impact antiretroviral adherence and mortality in rural Zambia. Am J Trop Med Hyg 2011;85:782-789.
  2. Siddiqi OK, Elafros MA, Bositis CM, et al. New-onset seizure in HIV-infected adult Zambians: A search for causes and consequences. Neurology 2017;88:477-482.
Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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