NSAIDs May Reduce Depression

Nonsteroidal anti-inflammatories (NSAIDs) are often used to treat the pain and inflammation of osteoarthritis, but they may have another effect: relieving depression.

Depression is 2 to 3 times more prevalent in patients with osteoarthritis than in other groups. Recent research has suggested that NSAIDs—via an association between cytokine release and prostaglandin synthesis in depression—may have a role to play in relieving symptoms of depression. For instance, studies have shown a benefit of NSAIDs as augmentation therapy in patients taking concurrent antidepressant therapy.

Researchers from Mount Sinai School of Medicine in New York City; St. George’s University in Grenada; University of Toronto in Canada; Case Western Reserve University in Cleveland, Ohio; and New York University in New York City looked at data from 5 trials that involved 1,497 patients who had osteoarthritis. Each multicenter, double-blind, placebo-controlled trial was 6 weeks long. Patients were randomly assigned to placebo, ibuprofen 800 mg 3 times daily, naproxen 500 mg twice daily, or celecoxib 200 mg daily. All patients were screened at baseline for depression using the Patient Health Questionnaire-9 (PHQ-9) and were assessed at weeks 2 and 6. The outcome measured was a change in PHQ-9 score at week 6 or early termination.

At baseline and week 6, the median PHQ-9 score was similar in all 3 groups. After 6 weeks of treatment, the researchers observed a significant trend toward lower scores among patients on ibuprofen or naproxen (– 0.31) and celecoxib (– 0.61) (P = .039). They also found a trend toward significant treatment effect of all NSAIDs compared with placebo.

Although their findings are “intriguing” and support the putative connection between depression and inflammation, the researchers don’t recommend routine population-based screening for depression and prophylactic NSAID use in those at high risk for depression. They do, however, underscore the importance of NSAID therapy in osteoarthritis, especially since the benefits may go beyond reducing inflammation.

Source
Iyengar RL, Gandhi S, Aneja A, et al. Am J Med. 2013;126(11):1017.e11-1017.e18.
doi: 10.1016/j.amjmed.2013.02.037.