Patients with osteoarthritis — a condition in which the cartilage wears down around the hands, lower back, knees or other joints — have over double the risk for depression. To help manage the pain, arthritis patients often take nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen or naproxen.
“This work suggests that anti-inflammatory agents may play a role in reducing the burden of depression,” said senior author Dr. Michael E. Farkouh of Mount Sinai School of Medicine in New York.
The research includes data from five previous trials of over-the-counter NSAIDs and the prescription drug Celebrex. In each of these studies, participants with osteoarthritis were randomly assigned to take one of those medications or a drug-free placebo pill for six weeks.
Almost 1,500 people not taking antidepressants participated in the studies, which included several depression questionnaires.
Each treatment group, including those on placebo, tended to report fewer depression symptoms at the end of the trials than at the beginning, according to findings published in The American Journal of Medicine.
Depression scores, however, dropped 0.3 more points in the over-the-counter NSAID groups and by 0.6 more points in the Celebrex groups compared to those on placebo.
At the beginning of the studies, arthritis patients had an average depression score of 3 — far below the threshold of 10 used for a depression diagnosis.
“The relationship between depressive symptoms and chronic pain is complex, and important,” said Dr. David A. Walsh, director of the Arthritis Research UK Pain Centre in Nottingham.
He noted that survey responses which are used to diagnose depression can sometimes be explained by physical pain, leading to results that are difficult to interpret. For example, having trouble staying asleep or concentrating can be symptoms of either depression or physical pain.
Although the researchers tried to account for these other factors, it’s difficult to completely untangle the effects of pain on mood, said Walsh. So the apparent influence of NSAIDs on depression may have just been due to a lessening of osteoarthritis pain, he said.
The study does offer evidence that at least one form of pain medication may help reduce depression among people with osteoarthritis, Walsh said. It also “raises an interesting mechanistic question as to whether NSAIDs may have direct effects on mood, independent of their analgesic activity.”
But based on these results, depressed people with osteoarthritis shouldn’t be selectively given NSAIDs with the purpose of relieving depression just yet, he said.
Farkouh said future research should investigate the connection between NSAIDs and depression, as it could help researchers understand whether inflammation plays a role in the disease.
Source: The American Journal of Medicine