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Anti-Inflammatory Drugs May Help Treat Depression

There is new evidence suggesting that anti-inflammatory drugs like Aspirin may help improve depression. This comes as a surprise, considering a few years ago (2011), a study was conducted that suggested anti-inflammatory drugs may reduce the effectiveness of antidepressants. In 2012, researchers found evidence suggesting that anti-inflammatory drugs do not reduce the efficacy of antidepressants – this contradicted the earlier study and essentially muddied the waters.

Now, an even newer study that was conducted by Danish researchers found that anti-inflammatory medications actually reduce depressive symptoms. This newer study suggests that for certain individuals, taking an anti-inflammatory drug could help combat clinical depression as well as depressive symptoms. Researchers went as far as to suggest that anti-inflammatory medications may be great adjunct treatments for certain people taking antidepressants.

New Study: Anti-Inflammatory Drugs Treat Depression

In Denmark, approximately 15% of the population will end up suffering from depression at some point in life. Depression is among the leading causes of reduced quality of life and reductions in life expectancy. Currently, there is an increasing need for new, innovative treatment options for patients suffering from depression. Many do not respond to traditional antidepressants and making lifestyle changes doesn’t fix the problem.

In more recent years, researchers have been noticing parallels between physical health and mental health. Particularly, in cases of chronic pain and other debilitating conditions, mental health problems such as depression are often interconnected. Specific drugs like Cymbalta (an SNRI) have even been created based on the concept of targeting both depression (a mental illness) and physical pain.

A new study conducted by Danish scientists discovered that your everyday anti-inflammatory drugs and over-the-counter painkillers (NSAIDs) may be helpful for those dealing with depression. The study was conducted by researchers at Aarhus University who gathered data on over 6,262 total participants across 14 international studies. All participants had been previously diagnosed with major depression and/or had specific depressive symptoms.

  • Source: http://archpsyc.jamanetwork.com/article.aspx?articleid=1916904

How the study worked (specifics)…

Despite preliminary connections between anti-inflammatory agents eliciting an antidepressant-like response, preexisting evidence has been controversial. Some past studies suggest that NSAIDs are effective at reducing depressive symptoms, while other studies counter these claims. The goal of researchers at Aarhus University was to conduct a review of evidence (meta-analysis) to reveal whether anti-inflammatory drugs serve to benefit those with depression.

They gathered data from an array of relevant sources including: Cochrane Central Register of Controlled Trials, PubMed, PsychINFO, etc. They only included studies that were both randomized and placebo-controlled. All of the selected studies examined the efficacy as well as any adverse reactions to anti-inflammatory medications in adults with depression and/or depressive symptoms.

Results: NSAIDs and Cytokine Inhibitors Treat Depression

Of the 14 studies examined, 10 specifically examined NSAIDs (nonsteroidal anti-inflammatory drugs) and the remaining 4 involved cytokine inhibitors. In comparison to a placebo, the results suggest that anti-inflammatory drugs significantly reduce depressive symptoms. The researchers found no specific differences based on the type of anti-inflammatory drug (NSAIDs vs. cytokine inhibitors) other than one particular cytokine inhibitor “Celecoxib.”

Contrary to evidence suggesting that anti-inflammatory drugs may lead to gastrointestinal damage and/or cardiovascular problems, researchers found no problems after 6 weeks compared to a placebo. Nor did they find any evidence of infections after 12 weeks compared to a placebo. It is important to keep in mind that 6 weeks isn’t necessarily a long period of time to account for these effects.

Authors of the study noted that based on their research, anti-inflammatory agents decrease symptoms of depression without any risk of adverse effects. They did note that there was a “high risk of bias” and “high heterogeneity” which contributed to uncertainty surrounding mean estimates. It’s not usually a good sign when the internal validity of a study could be compromised by these factors.

This new study confirmed older reports that anti-inflammatory agents may be useful for depression. They specifically noted that Celecoxib may be the most effective option at alleviating depression compared to others.

  • Source: http://www.gastrojournal.org/article/S0016-5085(14)00768-9/abstract

Do antidepressants work with anti-inflammatory drugs?

In the past there was some thought that anti-inflammatory drugs reduce the efficacy of antidepressants. A study involving participants who took Celexa vs. those who took Celexa plus an NSAID medication found that those being treated with only Celexa experienced greater remission in their depression. This initial evidence published in 2011 suggested that you’d be better off if you only take an antidepressant without an anti-inflammatory.

A follow-up study with over 800 participants discovered that there was no major difference between those taking an antidepressant and an anti-inflammatory vs. those taking an antidepressant as a standalone treatment. This was a 2012 study and it contradicted the 2011 study by stating that the combined usage of both an antidepressant and an anti-inflammatory need not be avoided.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22114886
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22391106

Should I take an anti-inflammatory drug with an antidepressant?

Some have suggested the idea of taking anti-inflammatory as an antidepressant augmentation strategy. In other words, those who are on an antidepressant drug may want to supplement a specific anti-inflammatory medication to boost the antidepressant response. Unfortunately, the degree to which anti-inflammatory drugs may work as an adjunct option has not been established.

Researchers specifically note that it may be worth exploring the populations that would most benefit from targeting depression with anti-inflammatory drugs. They speculate that individuals who have depression with comorbid inflammation may gain the most benefit from the combination. However, due to potential gastrointestinal effects as a result of interactions, long-term safety of this combination is poorly documented.

Contradicting previous research…

An author of the study named Ole Köhler was quoted as saying, “The meta-analysis supports this correlation and also demonstrates that anti-inflammatory medication in combination with antidepressants can have an effect on the treatment of depression.” The problem with this quote is that another (2011) study suggests that anti-inflammatory medications reduce the efficacy of antidepressants.

Additionally, a separate (2012) study found that anti-inflammatory drugs don’t affect the efficacy of antidepressants, but they also don’t improve the efficacy to a significant extent. Therefore, it is difficult to process the results from this particular study. If anything, the possibility that Celecoxib could reduce depressive symptoms seems viable.

The new (2014) study’s author Ole Köhler stated that combining an antidepressant with an anti-inflammatory agent: “Strengthens the possibility of being able to provide the individual patient with more personalized treatment options.” Although most trust meta-analyses as being highly accurate, it is difficult to assume that this study is completely accurate.

Clarification of dosing and side effects

Assuming that anti-inflammatory drugs are effective options for treating depression, it is important to understand whether the dosing plays a role and understand the potential long-term risks. If a person is taking an antidepressant in combination with an anti-inflammatory medication, it is important to be aware of potential contraindications and other adverse interactions. Authors discussed the implications of these findings and suggest that certain people will benefit from using anti-inflammatory drugs more than others for their depression.

Determining who would benefit from anti-inflammatory drugs

For example, someone with a chronic pain condition from arthritis may need to take an anti-inflammatory, but may also have some depressive symptoms. A doctor may want to work with them and determine whether the anti-inflammatory is improving their mood. Some believe that blood samples could be utilized to determine whether someone with depression would benefit from anti-inflammatory drugs. Researchers speculate that the greatest benefit would be derived from individuals who have depression as well as inflammation.

Authors also discuss the fact that among some individuals, inflammation may be the biggest contributing cause of a person’s depression. Treating the inflammation therefore would take away the depressive symptoms. Does this mean that people without inflammation wouldn’t benefit from taking an NSAID? Not necessarily, but it is thought that those who have inflammation and comorbid depression would reap more benefits.

Synopsis: So what does all of this information mean?

This new study and existing information suggests that people may find that an anti-inflammatory drug reduces their symptoms of depression. Currently there is conflicting evidence regarding the concurrent usage of an antidepressant with an anti-inflammatory agent. Newer data suggests that the combination is safe and that the anti-inflammatory agent will not reduce the efficacy of the antidepressant.

Prior data suggested that anti-inflammatory agents reduce the efficacy of antidepressants. All older evidence did not support the idea that anti-inflammatory drugs enhance the efficacy of antidepressant medications.

Further research is warranted to verify findings

Although the researchers found that anti-inflammatory medications can help reduce depressive symptoms, their study was simply archival. They essentially pooled all data from studies that were double-blind, placebo-controlled – this gave their results credibility. However, previous studies that directly tested anti-inflammatory agents on those with depression found that they actually decrease the efficacy of antidepressants.

So which research can be trusted? Before getting excited thinking that anti-inflammatory agents can treat depression, it is best to err on the side of caution. This is the only cohesive data suggesting that anti-inflammatory drugs reduce depressive symptoms. It should be speculated that not everyone will experience benefit from anti-inflammatory drugs in regards to their depression.

Individuals with depression and comorbid inflammation problems may benefit from the combination of an antidepressant and an anti-inflammatory. If you are on this combination or are considering it, be sure to talk to your doctor about dosing and potential interactions. Also keep in mind that the medication Celecoxib was found to be superior in efficacy compared to other anti-inflammatory drugs.

The drug Celecoxib should also be investigated as a standalone treatment for depression just to gauge its efficacy. If you have taken anti-inflammatory drugs and have depression or depressive symptoms, did you notice any effect? Did these medications help improve your symptoms? Feel free to share your thoughts and experiences in the comments section below.

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