{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:45:47Z","timestamp":1791359147256,"version":"4.3.1"},"reference-count":75,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T00:00:00Z","timestamp":1619654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Recent research suggests inflammation as a factor involved in the pathophysiology of mood disorders. Neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte (PLR), and systemic immune-inflammatory (SII) index ratios have been studied as peripheral markers of inflammation in bipolar and major depressive disorders. The purpose of this study is to comparatively analyze these inflammatory ratios among manic episodes of bipolar disorder, bipolar depression and unipolar depression. (2) Methods: 182 patients were retrospectively included in the study and divided into three groups: 65 manic patients, 34 patients with bipolar depression, and 83 unipolar depressive patients. White blood cells, neutrophils, monocytes, lymphocytes, and platelets were retrieved from the patients\u2019 database. NLR, MLR, PLR, and SII index were calculated using these parameters. (3) Results: Patients with manic episodes had elevated NLR (p &lt; 0.001), MLR (p &lt; 0.01), PLR (p &lt; 0.05), and SII index (p &lt; 0.001) compared to unipolar depression and increased NLR (p &lt; 0.05) and SII index (p &lt; 0.05) when compared to bipolar depression. NLR (p &lt; 0.01) and SII index (p &lt; 0.05) were higher in the bipolar depression than unipolar depression. NLR is an independent predictor of the bipolar type of depression in depressive patients. (4) Conclusions: The results confirm the role of inflammation in the pathophysiology of mood disorders and suggest the ability of NLR as a marker for the differentiation of bipolar from unipolar depression.<\/jats:p>","DOI":"10.3390\/jcm10091924","type":"journal-article","created":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T10:30:41Z","timestamp":1619692241000},"page":"1924","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":78,"title":["Neutrophil-to-Lymphocyte Ratio, a Novel Inflammatory Marker, as a Predictor of Bipolar Type in Depressed Patients: A Quest for Biological Markers"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0075-0050","authenticated-orcid":false,"given":"Vlad","family":"Dionisie","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Psychiatry, \u2018Prof. Dr. Alexandru Obregia\u2019 Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7447-4925","authenticated-orcid":false,"given":"Gabriela Adriana","family":"Filip","sequence":"additional","affiliation":[{"name":"Department of Physiology, \u2018Iuliu Hatieganu\u2019 University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2492-4529","authenticated-orcid":false,"given":"Mihnea Costin","family":"Manea","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Psychiatry, \u2018Prof. Dr. Alexandru Obregia\u2019 Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert Constantin","family":"Movileanu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, \u2018Prof. Dr. Alexandru Obregia\u2019 Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8138-8622","authenticated-orcid":false,"given":"Emanuel","family":"Moisa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Anaesthesia and Intensive Care Medicine, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u2018Elias\u2019 University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela","family":"Manea","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Psychiatry, \u2018Prof. Dr. Alexandru Obregia\u2019 Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin","family":"Riga","sequence":"additional","affiliation":[{"name":"Department of Stress Research and Prophylaxis, \u2018Prof. Dr. Alexandru Obregia\u2019 Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"},{"name":"Romanian Academy of Medical Sciences, 927180 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2520-5486","authenticated-orcid":false,"given":"Adela Magdalena","family":"Ciobanu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, \u2018Prof. Dr. Alexandru Obregia\u2019 Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"},{"name":"Neuroscience Department, Discipline of Psychiatry, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1016\/S0165-0327(14)70004-7","article-title":"Differential diagnosis of bipolar disorder and major depressive disorder","volume":"169","author":"Hirschfeld","year":"2014","journal-title":"J. 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