Cited by 942Tryptophan and brain disordersTreatment of Major DepressionStress Responses and Cortisol

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Effect of Anti-inflammatory Treatment on Depression, Depressive Symptoms, and Adverse Effects: A Systematic Review and Meta-analysis of Randomized Clinical Trials

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Abstract

IMPORTANCE: Several studies have reported antidepressant effects of anti-inflammatory treatment; however, the results have been conflicting and detrimental adverse effects may contraindicate the use of anti-inflammatory agents. OBJECTIVE: To systematically review the antidepressant and possible adverse effects of anti-inflammatory interventions. DATA SOURCES: Trials published prior to December, 31, 2013, were identified searching Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PsychINFO, Clinicaltrials.gov, and relevant review articles. STUDY SELECTION: Randomized placebo-controlled trials assessing the efficacy and adverse effects of pharmacologic anti-inflammatory treatment in adults with depressive symptoms, including those who fulfilled the criteria for depression. DATA EXTRACTION AND SYNTHESIS: Data were extracted by 2 independent reviewers. Pooled standard mean difference (SMD) and odds ratios (ORs) were calculated. MAIN OUTCOMES AND MEASURES: Depression scores after treatment and adverse effects. RESULTS: Ten publications reporting on 14 trials (6262 participants) were included: 10 trials evaluated the use of nonsteroidal anti-inflammatory drugs (NSAIDs) (n=4,258) and 4 investigated cytokine inhibitors (n=2,004). The pooled effect estimate suggested that anti-inflammatory treatment reduced depressive symptoms (SMD, -0.34; 95% CI, -0.57 to -0.11; I2=90%) compared with placebo. This effect was observed in studies including patients with depression (SMD, -0.54; 95% CI, -1.08 to -0.01; I2=68%) and depressive symptoms (SMD, -0.27; 95% CI, -0.53 to -0.01; I2=68%). The heterogeneity of the studies was not explained by differences in inclusion of clinical depression vs depressive symptoms or use of NSAIDs vs cytokine inhibitors. Subanalyses emphasized the antidepressant properties of the selective cyclooxygenase 2 inhibitor celecoxib (SMD, -0.29; 95% CI, -0.49 to -0.08; I2=73%) on remission (OR, 7.89; 95% CI, 2.94 to 21.17; I2=0%) and response (OR, 6.59; 95% CI, 2.24 to 19.42; I2=0%). Among the 6 studies reporting on adverse effects, we found no evidence of an increased number of gastrointestinal or cardiovascular events after 6 weeks or infections after 12 weeks of anti-inflammatory treatment compared with placebo. All trials were associated with a high risk of bias owing to potentially compromised internal validity. CONCLUSIONS AND RELEVANCE: Our analysis suggests that anti-inflammatory treatment, in particular celecoxib, decreases depressive symptoms without increased risks of adverse effects. However, a high risk of bias and high heterogeneity made the mean estimate uncertain. This study supports a proof-of-concept concerning the use of anti-inflammatory treatment in depression. Identification of subgroups that could benefit from such treatment might be warranted.

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  1. [24]24. Raison C, Rutherford RE, Woolwine B, et al. The tumor necrosis factor-alpha antagonist infliximab reduces depressive symptoms in patients with treatment resistant depression and high inflammation. Brain Behav Immun. 2012;26(suppl 1):S49. doi:10.1016/j.bbi.2012.07.200.W. · DOI
  2. [27]27. Hashemian F, Majd M, Hosseini SM, Sharifi A, Panahi MVS, Bigdeli O. A randomized, double-blind, placebo-controlled trial of celecoxib augmentation of sertraline in the treatment of a drug-naive women with major depression. Klin Psikofarmakol Bul. 2011;21:S183-S184.

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Metadata

Authors
Köhler, O., Benros, M. E., Nordentoft, M., Farkouh, M. E., Iyengar, R. L., Mors, O., & Krogh, J.
Affiliations
  • Research Department P, Aarhus University Hospital, Risskov, Denmark2Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University Hospital, Risskov, Denmark
  • University of Copenhagen (DK)
  • St. George's University (GD)
Venue
JAMA Psychiatry
Published
2014-12-01
Volume
71
Issue
12
Pages
1381
ISSN
2168-622X (ISSN-L)
OpenAlex
W2156150528
Cited by
941
References
56
Citations by year
2026: 48 · 2025: 62 · 2024: 74 · 2023: 81 · 2022: 88 · 2021: 106 · 2020: 94 · 2019: 85 · 2018: 104 · 2017: 85 · 2016: 70 · 2015: 43 · 2014: 1
FWCI
20.40
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
Funders
Lundbeckfonden (R155-2014-1724)
Topics
  • Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords
anti-inflammatory therapy, depression, depressive symptoms, nonsteroidal anti-inflammatory drugs, cytokine inhibitors, celecoxib, COX-2 inhibitors, antidepressant effects, adverse effects, remission, treatment response, adults with depression
MeSH terms
Anti-Inflammatory Agents, Depression, Humans, Randomized Controlled Trials as Topic

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