Anti-inflammatory drugs may be effective for depression

Findings from a systematic review and meta-analysis indicated efficacy of anti-cytokine therapy for depressive symptoms, suggesting potential utility of these drugs for depression and related disorders.

“It's becoming increasingly clear to us that inflammation plays a role in depression, at least for some individuals, and now our review suggests that it may be possible to treat these individuals using some anti-inflammatory drugs. These are not your everyday anti-inflammatory drugs such as ibuprofen, however, but a particular new class of drugs,” study researcher Golam Khandaker, PhD, of the University of Cambridge, United Kingdom, said in a press release.

To assess the potential role of cytokines in pathogenesis and treatment of depression, researchers conducted a systematic review and meta-analysis of 20 clinical trials of chronic inflammatory conditions where depressive symptoms were measured as secondary outcomes.

Random effect meta-analysis of seven randomized controlled trials among 2,370 participants indicated anti-cytokine treatment had a significant antidepressant effect, compared with placebo (standardized mean difference = 0.4; 95% CI, 0.22-0.59).

Anti-tumor necrosis factor drugs were most commonly studied and exhibited a standardized mean difference of 0.33 (95% CI, 0.06-0.6), compared with placebo.

Separate meta-analyses of two randomized clinical trials of adjunctive anti-cytokine treatment and eight non-randomized or non-placebo studies indicated similar effect estimates favoring anti-cytokine treatment, with small-to-medium efficacy.

Adalimumab (Humira, AbbVie Inc.), etanercept (Enbrel, Amgen), infliximab (Remicade, Janssen) and tocilizumab (Actemra, Genentech) exhibited statistically significant improvements in depressive symptoms.

Meta-regression analysis of response predictors indicated an association between antidepressant effect and baseline symptom severity (P = .018) but not primary physical illness, sex, age or study duration.

“The current approach of a ‘one-size-fits-all’ medicine to treat depression is problematic. All currently available antidepressants target a particular type of neurotransmitter, but a third of patients do not respond to these drugs,” Khandaker said in the release. “We are now entering the era of ‘personalized medicine’ where we can tailor treatments to individual patients. This approach is starting to show success in treating cancers, and it's possible that in future we would use anti-inflammatory drugs in psychiatry for certain patients with depression.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.

Findings from a systematic review and meta-analysis indicated efficacy of anti-cytokine therapy for depressive symptoms, suggesting potential utility of these drugs for depression and related disorders.

“It's becoming increasingly clear to us that inflammation plays a role in depression, at least for some individuals, and now our review suggests that it may be possible to treat these individuals using some anti-inflammatory drugs. These are not your everyday anti-inflammatory drugs such as ibuprofen, however, but a particular new class of drugs,” study researcher Golam Khandaker, PhD, of the University of Cambridge, United Kingdom, said in a press release.

To assess the potential role of cytokines in pathogenesis and treatment of depression, researchers conducted a systematic review and meta-analysis of 20 clinical trials of chronic inflammatory conditions where depressive symptoms were measured as secondary outcomes.

Random effect meta-analysis of seven randomized controlled trials among 2,370 participants indicated anti-cytokine treatment had a significant antidepressant effect, compared with placebo (standardized mean difference = 0.4; 95% CI, 0.22-0.59).

Anti-tumor necrosis factor drugs were most commonly studied and exhibited a standardized mean difference of 0.33 (95% CI, 0.06-0.6), compared with placebo.

Separate meta-analyses of two randomized clinical trials of adjunctive anti-cytokine treatment and eight non-randomized or non-placebo studies indicated similar effect estimates favoring anti-cytokine treatment, with small-to-medium efficacy.

Adalimumab (Humira, AbbVie Inc.), etanercept (Enbrel, Amgen), infliximab (Remicade, Janssen) and tocilizumab (Actemra, Genentech) exhibited statistically significant improvements in depressive symptoms.

Meta-regression analysis of response predictors indicated an association between antidepressant effect and baseline symptom severity (P = .018) but not primary physical illness, sex, age or study duration.

“The current approach of a ‘one-size-fits-all’ medicine to treat depression is problematic. All currently available antidepressants target a particular type of neurotransmitter, but a third of patients do not respond to these drugs,” Khandaker said in the release. “We are now entering the era of ‘personalized medicine’ where we can tailor treatments to individual patients. This approach is starting to show success in treating cancers, and it's possible that in future we would use anti-inflammatory drugs in psychiatry for certain patients with depression.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.