***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Although adverse effects of severe chronic stress on immunocompetence and physical well-being in older adults have been reported , the immune response to less severe life stress among healthy older adults , particularly among women , is not well understood . Interleukin-6 ( IL-6 ) has been considered a good overall indicator of immune functioning in older adults because of its contribution to the pathogenesis of several age-related conditions such as osteoporosis . Regulation of IL-6 is impaired in elderly adults , and levels of IL-6 increase with stress and depression . This research cross-sectionally examined levels of IL-6 in three groups of healthy older women with varying levels of life stress and mood disturbance and a healthy group of young women . METHODS Subjects included 18 caregivers of Alzheimer 's patients , 17 older women assessed one month before relocation of their residence , 15 nonmoving and noncaregiving older women , and 20 younger women . Subjects completed the  Profile of Mood States ( POMS )  and had early morning blood draws . RESULTS Alzheimer 's caregivers reported significantly greater distress than women of all other groups . IL-6 levels in caregivers were significantly higher than those of all other women . The older women had significantly higher IL-6 than young controls , but there were no significant differences in IL-6 between movers and older controls . Among all women , greater depression and distress were related to higher levels of IL-6 . CONCLUSIONS These findings suggest that in older women , chronic stressors are associated with significant elevations in IL-6 over and above the elevations associated with normal aging , but that moderate stressors may not be related to appreciable elevations in IL-6 Vascular endothelial growth factor ( VEGF ) has been implicated in neuronal survival , neuroprotection , regeneration , growth , differentiation , and axonal outgrowth , which are known to be involved in the pathophysiology of major depressive disorder ( MDD ) . Recently , the VEGF mRNA expression in the peripheral leukocytes from Alzheimer 's disease or cardiovascular disease was reported to be changed . We hypothesized that the expression of the VEGF mRNA in the peripheral leukocytes may be a good c and i date for the biological marker for MDD . Thirty two patients with MDD and age- and sex-matched control subjects were included in this expression study . The VEGF mRNA levels in the peripheral leukocytes from drug-naive MDD patients were significantly higher than those from the control subjects and the magnitude of the decrease of VEGF mRNA after 8-week treatment significantly correlated with clinical improvement . Then , we genotyped two single nucleotide polymorphic markers of VEGF gene , which were reported to be associated with amyotrophic lateral sclerosis and Alzheimer 's disease , in patients with MDD and control subjects ( n=154 , each ) . We did not find any significant association between these markers and MDD or its clinical subtypes . Our investigation indicates that the higher expression levels of VEGF mRNA in the peripheral leukocytes are associated with the depressive state and their recovery after treatment may be associated with the clinical improvement The association between somatic illness and psychiatric illness is well established in adults but is less clear in childhood and adolescence . A cohort of over 700 r and omly selected children in Upstate New York were studied from ages 1 - 10 years in 1975 to young adulthood in 1992 .  Psychiatric and physical health were assessed by means of follow-up youth and parent interviews at 8- , 2 1/2- , and 6-year intervals ( in 1983 , 1985 - 1986 , and 1991 - 1993 ) . Cross-sectional and longitudinal analyses investigated : 1 ) the consistency of the relation between physical illness and mental illness in childhood ; 2 ) the specificity of major depressive disorder ( MDD ) in accounting for the relation ; 3 ) the specificity of immunologically mediated medical disorders in this relation ; and 4 ) whether this relation was attributable to risks associated with low socioeconomic status . Cross-sectionally , ill health was associated with increased risk of psychiatric disorders at all ages , with significant odds ratios ( ORs ) ranging from 1.76 to 3.26 . In prospect i ve analyses , ill health increased the risk of new-onset MDD at all ages ( ORs = 2.05 - 4.48 ) . MDD also predicted subsequent ill health , independent of prior health problems ( ORs = 3.81 and 4.04 ) . Relations were not attributable to familial socioeconomic status . Associations were particularly strong between MDD and medical disorders associated with alterations in immunologic factors ( ORs = 1.83 - 6.41 ) . Theories of common immune-mediated vulnerabilities to medical illness and depression are consistent with these associations Abstract .Acute exacerbations may complicate the course of pregnancy and the postpartum period in patients with relapsing-remitting multiple sclerosis ( RRMS ) . To evaluate relapse rate and the effect of immunomodulatory treatment with intravenous immunoglobulin ( IVIg ) during pregnancy and the postpartum period we retrospectively analysed the data of 108 pregnant RRMS patients . Group I patients were not treated , Group II patients were treated with IVIg 0.4 g/kg body weight/day for 5 consecutive days within the first week after delivery with additional booster doses of 0.4 g/kg body weight/day at 6 and 12 weeks postpartum ( defined as 12 weeks after labor ) , and Group III patients were treated continuously with IVIg during gestation and the postpartum period ( 0.4 g/kg body weight/day for 5 consecutive days within the 6–8 weeks of gestation with additional booster doses of 0.4 g/kg body weight/day once every 6 weeks until 12 weeks postpartum ) . All patients underwent antenatal care and fetal ultrasonographic surveillance examinations . Relapse rate per woman per year during the pregnancy and the postpartum period as well as neonatal outcome data and IVIg related adverse events were analysed . Relapse rate per woman per year for patients treated with IVIg for the whole pregnancy and postpartum period ( Group III , N = 28 ) compared with the untreated Group I patients ( N = 39 ) were as follows : first trimester 0.43 vs. 0.72 , second trimester 0.15 vs. 0.61 , third trimester 0.0 vs. 0.41 , and postpartum period 0.28 vs.1.33 ( p < 0.05 ) . Patients treated with IVIg only during the postpartum period ( Group II , N = 41 ) also showed a decrease in relapse rate compared with untreated Group I patients , 0.58 vs. 1.33 ( p = 0.012 ) . The mean maternal age , disease duration , gestational age at delivery and fetal delivery weight did not significantly differ between the three groups . Mode of delivery , obstetrical complications , the use of epidural analgesia and breast-feeding , did not affect postpartum relapse rate . No severe adverse events were associated with IVIg treatment either during the pregnancy or postpartum period for the patients and newborns . We conclude that in RRMS patients  IVIg treatment could be considered as an optional treatment to reduce the incidence of pregnancy and postpartum-related relapses . Further r and omized double-blind studies are needed to confirm our findings Although tumor necrosis factor-alpha ( TNF-α ) has been recognized to be involved in the pathogenesis of major depressive disorder ( MDD ) for a long time , only few studies so far investigated the effects of antidepressant , venlafaxine on TNF-α and the results are inconsistent . Moreover , the association between plasma TNF-α levels and suicide accompanied with MDD is entirely unknown . To eluci date these relationships , in the present study , 64 first-episode drug-naïve MDD patients and 64 matched healthy controls were recruited . Total 61 MDD patients received 8-week venlafaxine treatment and they were divided into responders and non-responders according to the reduction rate of HRSD-17 . Prior to venlafaxine treatment , both responders and non-responders shared a similar plasma TNF-α ( p=0.33 ) , which was significantly decreased following venlafaxine treatment ( p<0.001 , p=0.03 , respectively ) . Compared to non-responders , the responder group had a greater reduction in TNF-α ( p=0.01 ) , which was associated with the greater reduction rate of HRSD-17 ( B=1.02 , p=0.01 ) . In addition , the plasma TNF-α levels were equally higher in both suicidal and non-suicidal MDD patients ( p=0.84 ) compared to the healthy controls on admission ( p=0.001 , p=0.03 , respectively ) . Together , our data suggest that MDD per se rather than suicide is associated with the elevated plasma TNF-α , which can be inhibited with venlfaxine monotherapy . The extent of TNF-α reduction may be associated with the efficiency of venlafaxine It has been postulated that major depression may be accompanied by significant changes in cell-mediated and humoral immunity related to the pathophysiology or pathogenesis of that illness . We explored the role of 2 cytokines , IL-12 and TGF-beta1 , which represent the cytokines of the Th1 and Th3 types , in the pathophysiology of major depressive disorder ( MDD ) . Cytokine levels were measured in 30 major depressed patients at the time of admission and 6 weeks after effective antidepressant treatment ;  levels were measured once in 30 normal controls . At the time of admission , TGF-beta1 levels of MDD patients showed no differences from normal controls , but IL-12 was significantly higher than in normal controls . However , the IL-12/TGF-beta1 ( Th1/Th3 ) ratios of depressed patients were not different from those of controls . In MDD patients , IL-12 values were significantly decreased after treatment , while TGF-beta1 levels were significantly increased . IL-12/TGF-beta1 ratios of patients were significantly decreased after treatment compared with before treatment . There were no significant correlations between changes in the cytokine levels and changes in scores representing the severity of depression . These findings suggest that major depression is accompanied by immune activation during the acute depressed state , and antidepressant treatments have anti-inflammatory effects BACKGROUND Psychiatric side effects of interferon alfa are frequently observed in the therapy of patients with chronic hepatitis C infection . The goal of the present study was to assess prospect ively the incidence , spectrum , and extent of psychiatric symptoms of patients receiving interferon alfa therapy  as compared with an untreated reference group . METHOD 104 patients with chronic hepatitis C were consecutively enrolled in a prospect i ve longitudinal study . The treatment group ( N = 84 ) received interferon alfa-2b for up to 12 months , and the reference group ( N = 20 ) received no treatment .  Patients who began treatment between November 1996 and August 1998 ( N = 44 ) received interferon alfa-2b , 5 million units 3 times per week . Patients who began treatment in September 1998 or later ( N = 40 ) received a combination of interferon alfa-2b , 3 to 5 million units 3 times per week , and ribavirin , 1000 - 1200 mg/day . Diagnostic scores for depression and anxiety were obtained by means of the psychometric instrument Hospital Anxiety and Depression Scale , and scores for anger/hostility were obtained with the Symptom Checklist-90 Revised . RESULTS In contrast to the untreated reference group , we found significantly increased scores for depression ( p < .001 ) and anger/hostility ( p < .001 ) during interferon alfa therapy in the treatment group . Even before therapy , scores of those in the treatment group were above the respective cutoff values for clinical ly relevant symptoms of depression in 15.5 % of the patients , anxiety in 13.1 % of the patients , and anger/hostility in 11.3 % of the patients . These proportions rose to 35.0 % ( depression ) , 25.6 % ( anxiety ) , and 24.5 % ( anger/hostility ) . The cumulative frequency of clinical ly relevant emotional distress ( depression , anxiety , or anger/hostility ) during interferon alfa therapy was 57.7 % , as compared with 22.5 % before therapy . However , interferon alfa therapy had to be stopped prematurely because of untreatable psychiatric symptoms in only 8.3 % of patients . CONCLUSION In view of the high frequency and extent of psychiatric symptoms with interferon alfa therapy , we recommend a close follow-up of patients receiving this therapy with respect to potential limiting mood changes 
    Output:
    
The presence of major depressive disorder ( MDD ) with suicidal ideation/attempts was associated with differences in inflammatory cytokine profile when compared to that without suicidal ideation/attempts .
Most suicide attempters or subjects with suicidal ideation showed an imbalance of the immune system but this does not imply the existence of a causal link .
Also , not all studies demonstrated a positive correlation between inflammatory cytokines and suicidal behavior .