In the Journals

Anti-inflammatory drugs may improve depression

Patients with major depressive disorder who received anti-inflammatory medication demonstrated improvements in symptoms, according to findings published in Acta Psychiatrica Scandinavica.

“To date, several meta-analyses have gathered the evidence on the antidepressant effects of NSAIDs, statins, and cytokine inhibitors; however, several of these studies only investigated specific agents, did not assess the risk for side effects, only included patients with major depressive disorder while excluding patients with a somatic disease and depressive symptoms, or failed to perform a thorough bias assessment,” Ole Köhler-Forsberg, MD, from the psychosis research unit at Aarhus University Hospital, Denmark, and colleagues wrote.

To address this gap in knowledge, Köhler-Forsberg and colleagues conducted a systematic review of 36 randomized controlled trials that evaluated the effects of antidepressant treatment with anti-inflammatory medications in adults with major depressive disorder or depressive symptoms. They measured depression scores after treatment, remission, response and side effects.

The anti-inflammatory drugs assessed included NSAIDs (n = 4,214), cytokine inhibitors (n = 3,345), statins (n = 1,576), minocycline (n = 151), pioglitazone (n = 77) and glucocorticoids (n = 59).

The researchers found that compared with placebo, patients with major depressive disorder treated with anti-inflammatory agents as both an add-on therapy (SMD = –0.64; 95% CI = –0.88 to –0.4; I² = 51%) and a monotherapy (SMD = –0.41; 95% CI, –0.6 to –0.22; I² = 93%) showed greater improvements in depressive symptoms.

Specifically, NSAIDs (SMD = –0.4; 95% CI, –0.62 to –0.18; I²= 82%), cytokine inhibitors (SMD = –0.56; 95% CI, –0.93 to –0.19; I² = 95%), statins (SMD = –0.26; 95% CI, –0.48 to –0.04; I² = 65%), glucocorticoids (SMD = –0.9; 95% CI, –1.44 to –0.36; I² = 0%) and minocycline (SMD = –0.87; 95% CI, –1.45 to –0.29; I² = 63%) demonstrated superior antidepressant treatment effects.

Using anti-inflammatory medications as an add-on also improved response (RR = 1.76; 95% CI, 1.44–2.16; I² = 16%) and remission (RR = 2.14; 95% CI, 1.03–4.48; I² = 57%).

Anti-inflammatory medications were associated with a higher risk for infections.

“This [study] definitely bolsters our chances of being able to provide personalized treatment for individual patients in the longer term,” Köhler-Forsberg said in a press release. “Of course, we always have to weigh the effects against the potential side-effects of the anti-inflammatory drugs. We still need to clarify which patients will benefit from the medicine and the size of the doses they will require. The findings are interesting, but patients should consult their doctor before initiating additional treatment.” – by Alaina Tedesco

 

Disclosure: The authors report no relevant financial disclosures.

Patients with major depressive disorder who received anti-inflammatory medication demonstrated improvements in symptoms, according to findings published in Acta Psychiatrica Scandinavica.

“To date, several meta-analyses have gathered the evidence on the antidepressant effects of NSAIDs, statins, and cytokine inhibitors; however, several of these studies only investigated specific agents, did not assess the risk for side effects, only included patients with major depressive disorder while excluding patients with a somatic disease and depressive symptoms, or failed to perform a thorough bias assessment,” Ole Köhler-Forsberg, MD, from the psychosis research unit at Aarhus University Hospital, Denmark, and colleagues wrote.

To address this gap in knowledge, Köhler-Forsberg and colleagues conducted a systematic review of 36 randomized controlled trials that evaluated the effects of antidepressant treatment with anti-inflammatory medications in adults with major depressive disorder or depressive symptoms. They measured depression scores after treatment, remission, response and side effects.

The anti-inflammatory drugs assessed included NSAIDs (n = 4,214), cytokine inhibitors (n = 3,345), statins (n = 1,576), minocycline (n = 151), pioglitazone (n = 77) and glucocorticoids (n = 59).

The researchers found that compared with placebo, patients with major depressive disorder treated with anti-inflammatory agents as both an add-on therapy (SMD = –0.64; 95% CI = –0.88 to –0.4; I² = 51%) and a monotherapy (SMD = –0.41; 95% CI, –0.6 to –0.22; I² = 93%) showed greater improvements in depressive symptoms.

Specifically, NSAIDs (SMD = –0.4; 95% CI, –0.62 to –0.18; I²= 82%), cytokine inhibitors (SMD = –0.56; 95% CI, –0.93 to –0.19; I² = 95%), statins (SMD = –0.26; 95% CI, –0.48 to –0.04; I² = 65%), glucocorticoids (SMD = –0.9; 95% CI, –1.44 to –0.36; I² = 0%) and minocycline (SMD = –0.87; 95% CI, –1.45 to –0.29; I² = 63%) demonstrated superior antidepressant treatment effects.

Using anti-inflammatory medications as an add-on also improved response (RR = 1.76; 95% CI, 1.44–2.16; I² = 16%) and remission (RR = 2.14; 95% CI, 1.03–4.48; I² = 57%).

Anti-inflammatory medications were associated with a higher risk for infections.

“This [study] definitely bolsters our chances of being able to provide personalized treatment for individual patients in the longer term,” Köhler-Forsberg said in a press release. “Of course, we always have to weigh the effects against the potential side-effects of the anti-inflammatory drugs. We still need to clarify which patients will benefit from the medicine and the size of the doses they will require. The findings are interesting, but patients should consult their doctor before initiating additional treatment.” – by Alaina Tedesco

 

Disclosure: The authors report no relevant financial disclosures.