A pilot, open-label trial involving adult outpatients with MDD (n = 23) with comorbid abdominal obesity (waist circumference >35 inches in women and >40 inches in men) or metabolic syndrome documented that adjunctive pioglitazone significantly improves depressive severity (assessed by the Inventory of Depressive Symptomatology), with a concurrent reduction in insulin resistance and inflammatory markers, as measured by high-sensitive C-reactive protein [117]. Here, CRP is linked to metabolic syndrome.