A systematic review of anti-inflammatory agents in the treatment of mood disorders

Hou, Ruihua, Cheng, Xiaojing, Li, Renjun, Yang, Ying, Liu, Jintong, Zhang, Jingxuan and Baldwin, David (2017) A systematic review of anti-inflammatory agents in the treatment of mood disorders. Summer Meeting of the British Association for Psychopharmacology, , Harrogate, United Kingdom. 23 - 26 Jul 2017. p. 56 .

Abstract

Introduction: Inflammatory processes have been implicated in the pathophysiology and progressionof mood disorders, and anti-inflammatory drugs have been used to enhance antidepressant treatmentresponse. This systematic review evaluates current knowledge of the effects of anti-inflammatory agentsas adjunctive treatment or in monotherapy for patients with mood disorders. Methods: Literature search(using PubMed and Embase) of randomised controlled trials (RCTs) which investigated the effects of antiinflammatory drugs in mood disorders, published before October 2016, supplemented by manual searches.Screening, data extraction and quality assessment were conducted. The primary outcome measureswere measures of depression and manic symptoms. A sub-analysis was performed based on adjunctivetreatment or monotherapy. Results: Thirty-six completed RCTs (including 1775 participants) withtreatment duration varying from 4 to 28 weeks met study inclusion criteria, were identified and includedin this review, including studies of omega-3 fatty acids (n=15), N-acetylcysteine (n=7), non-steroidal antiinflammatory drugs (n=6), pioglitazone (n=3), statins (n=3), a tumor necrosis factor antagonist (n=1), andantibiotics (n=1). 4 RCTs investigated monotherapy with omega-3 fatty acids, and 32 studies investigatedadjunctive anti-inflammatory agents. At the endpoint of the study period, 20 of the 32 RCTs adjunctiveuse of anti-inflammatory drugs pronounced a significant improvement in depressive symptoms (P <0.05),including 16 RCTs assessed by Hamilton Depression Rating Scale (HDRS) with a score variation range from-3.6 to -19.0 (treatment groups) vs -1.9 to -15.8 (placebo groups); 3 studies evaluated by Montgomery-AsbergDepression Rating Scale (MADRS) with a score decrease range from -10.0 to -18.2 (treatment groups)vs +0.9 to -8.8 (placebo groups); and 1 RCT adopting Geriatric Depression Scale (GDS) as the primaryoutcome measure with a score reduction of -4.5 (treatment group) vs -0.8 (placebo group). With respectto manic symptoms, 4 of the 11 studies on adjunctive anti-inflammatory agents demonstrated a notableamelioration in bipolar disorder (P <0.05), with the reduction of Young Mania Rating Scale (YMRS) scorevaried from -2.0 to -29.8 (treatment groups) vs 0 to -21.8 (placebo groups). Only 1 of the 4 studies estimating monotherapy of omega-3 fatty acids showed a significant antidepressant benefit (P <0.05). Conclusions: Data from eligible RCTs suggest potential beneficial effects for adjunctive anti-inflammatory agents in treatment of mood disorders, especially in depression. Diversity of agents and small sample sizes limited interpretation of the current review. Larger prospective studies are warranted to further elucidate the tolerability and efficacy of anti-inflammatory agents in specific diagnoses and for particular sub-groups of individuals (such as patients with high level of inflammation at baseline).

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Contributors

Author: Ruihua Hou

Author: David Baldwin

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