Format

Send to

Choose Destination
Acta Psychiatr Scand. 2019 May;139(5):404-419. doi: 10.1111/acps.13016. Epub 2019 Mar 28.

Efficacy of anti-inflammatory treatment on major depressive disorder or depressive symptoms: meta-analysis of clinical trials.

Author information

1
Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark.
2
Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
3
Copenhagen Research Center for Mental Health -CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
4
iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
5
Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen.

Abstract

BACKGROUND:

No study has gathered evidence from all randomized clinical trials (RCTs) with anti-inflammatory drugs measuring antidepressant effects including a detailed assessment of side-effects and bias.

METHODS:

We performed a systematic review identifying RCTs published prior to January 1, 2018, studying antidepressant treatment effects and side-effects of pharmacological anti-inflammatory intervention in adults with major depressive disorder (MDD) or depressive symptoms. Outcomes were depression scores after treatment, remission, response, and side-effects. Pooled standard mean differences (SMD) and risk ratios (RR) including 95% confidence intervals (95%-CI) were calculated.

RESULTS:

We identified 36 RCTs, whereof 13 investigated NSAIDs (N = 4214), 9 cytokine inhibitors (N = 3345), seven statins (N = 1576), 3 minocycline (N = 151), 2 pioglitazone (N = 77), and 2 glucocorticoids (N = 59). Anti-inflammatory agents improved depressive symptoms compared to placebo as add-on in patients with MDD (SMD = -0.64; 95%-CI = -0.88, -0.40; I2  = 51%; N = 597) and as monotherapy (SMD = -0.41; 95%-CI = -0.60, -0.22; I2  = 93%, N = 8825). Anti-inflammatory add-on improved response (RR = 1.76; 95%-CI = 1.44-2.16; I2  = 16%; N = 341) and remission (RR = 2.14; 95%-CI = 1.03-4.48; I2  = 57%; N = 270). We found a trend toward an increased risk for infections, and all studies showed high risk of bias.

CONCLUSION:

Anti-inflammatory agents improved antidepressant treatment effects. Future RCTs need to include longer follow-up, identify optimal doses and subgroups of patients that can benefit from anti-inflammatory intervention.

KEYWORDS:

NSAIDs; anti-inflammatory treatment; cytokine inhibitors; depression; depressive symptoms; glucocorticoids; inflammation; major depressive disorder; minocycline; personalized medicine; pioglitazone; psychoneuroimmunology; statins

PMID:
30834514
DOI:
10.1111/acps.13016

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center