Efficacy and safety of #anti-inflammatory agents for the treatment of major #depressive disorder: a systematic review and meta-analysis of randomised controlled trials

..Four studies explored the antidepressant effects of NSAIDs in addition to traditional antidepressants. In all four studies, celecoxib was added at the same dose (400 mg/day). Traditional antidepressants used were sertraline, fluoxetine and reboxetine.

We combined these studies for a subgroup meta-analysis, finding that antidepressants combined with celecoxib were better than antidepressants alone, leading to a larger reduction in depressive score (four RCTs, SMD −0.76, 95% CI −1.14 to −0.39, p<0.0001). Heterogeneity among studies was insignificant

..Five trials focused on women with MDD. Of these, one assessed the effect of celecoxib added to sertraline, while the other four examined the antidepressive effect of omege-3 FA as monotherapy. Combining the five studies, no difference in score changes was found between groups (SMD −0.49, 95% CI −1.01 to 0.03, p=0.06), with moderate heterogeneity detected among studies

Conclusion
Our systematic review and meta-analysis suggests that anti-inflammatory agents exert an antidepressant effect in the treatment of MDD and were generally safe with rates of adverse effects similar to those of placebo. Adjunctive treatment shows a more remarkable effect with NSAIDs, omega-3 FAs, statins and minocyclines showing significant antidepressant effects for MDD.

Anti-inflammatory agents show promising effects for MDD. However, owing to the chronic course of MDD, quality of life and adverse effects should be further investigated in high-quality randomised clinical trials with long-term follow-up.

https://jnnp.bmj.com/content/early/2019/08/29/jnnp-2019-320912.full