TNF and treatment resistant depression: TNF-α is integral for homeostatic synaptic plasticity, which could contribute to the negative effects of TNF-α antagonists in patients that do not get elevated inflammatory markers, as reported by Raison et al. [139] Moreover, results from Weinberger et al. [134] suggested that administration of infliximab in patients with TRD and high inflammation could improve sleep continuity independently of depressive symptoms.