Anti-inflammatory drugs, such as those prescribed for arthritis, could potentially be effective in the treatment of depression, according to a new meta-analysis conducted by researchers at iPSYCH, a Danish research project focused on finding the causes of major mental disorders.
“Our study shows that a combination of anti-inflammatory medicine, which is what arthritis medicine is, and antidepressants can have an additional beneficial effect on patients with a depression,” said Ph.D. student and medical doctor Ole Köhler-Forsberg from Aarhus University in Denmark and Aarhus University Hospital, Psychiatry.
“The effect was also present when anti-inflammatory medicine was compared with a placebo in patients with a physical disease and depressive symptoms.”
The researchers analyzed 36 international studies with a total 9,422 patients who either suffered from depression or had depressive symptoms. In addition to looking into arthritis medicine such as aspirin and naproxen, the researchers also examined the effect of other forms of medication which have anti-inflammatory effects, including glucocorticoids and the antibiotic minocycline, adrenocortical hormone and the statins that are used in the treatment of high cholesterol levels. All of these medications showed antidepressant effects.
“This definitely bolsters our chances of being able to provide personalised treatment for individual patients in the longer term. Of course we always have to weigh the effects against the potential side effects of the anti-inflammatory drugs,” said Köhler-Forsberg.
“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.”
He emphasizes that the greatest challenge with depression is that we still do not know what triggers the disease in a particular individual.
“Some studies suggest that the choice of antidepressant can be decided by a blood sample that measures whether there is an inflammatory condition in the body. Other studies show that the same blood sample can be used as a guideline for whether a depressive patient can be treated with anti-inflammatory medicine that has a better effect when there is inflammation present at the same time as the depression,” Köhler-Forsberg says.
Large-scale and well-executed studies with depression as the primary objective are still needed, because, in many of the studies, the depressive symptoms were a secondary goal.
These studies must also be big enough to assess the most beneficial dose and length of treatment, and also to identify which group of patients with depression are most likely to benefit from a supplementary anti-inflammatory treatment.
“What’s persuasive is that we’ve found that several of the anti-inflammatory drugs have what can be characterised as a medium to a large effect on depression and depressive symptoms, in particular because the results build on almost 10,000 people who have participated in the placebo-controlled studies with anti-inflammatory treatment,” Dr. Michael Eriksen Benros, research director at the Mental Health Centre Copenhagen.
He emphasizes that “the results from the meta-analysis are particularly promising not only because of an effect of the anti-inflammatory medicine on its own, but also due to the supplementary effect when the anti-inflammatory medicine is given simultaneously with the anti-depressants that are used today.
“The hope is that research into the link between the immune system and depression can in the longer term provide more treatment options — including with anti-inflammatory medicine and preferably guided by biomarkers — so we can improve the treatment of depression, which is an area of intensive research at the moment,” said Eriksen Benros.
The new findings are published in the Scandinavian peer-reviewed journal Acta Psychiatrica Scandinavica.
Source: Aarhus University