Anti-inflammatories may enhance antidepressant treatment effects

Takeaway

• Anti-inflammatory agents may improve antidepressant treatment effects in patients with major depressive disorder or depressive symptoms.
• Non-steroidal anti-inflammatory drugs (NSAIDs), cytokine-inhibitors, statins, glucocorticoids and minocycline showed superior antidepressant associations vs placebo.

Why this matters

• Findings call for larger randomised trials with longer follow-up to identify optimal doses and subgroups of patients that can benefit from anti-inflammatory intervention.

Study design

• Meta-analysis of 36 randomised controlled studies investigating NSAIDs (N=4214), cytokine-inhibitors (N=3345), statins (N=1576), minocycline (N=151), pioglitazone (N=77) and glucocorticoids (N=59).
• Funding: None.

Key results

• Add-on anti-inflammatory treatment improved depressive symptoms vs placebo in patients with major depressive disorder (standard mean difference [SMD], −0.64; 95% CI, −0.88 to −0.40) and depressive symptoms (SMD, −0.41; 95% CI, −0.60 to −0.22).
• Add-on anti-inflammatory treatment improved response (risk ratio [RR], 1.76; 95% CI, 1.44-2.16) and remission (RR, 2.14; 95% CI, 1.03-4.48).
• Superior antidepressant treatment effects were observed with:
  • NSAIDs (SMD, −0.40; 95% CI, −0.62 to −0.18),
  • cytokine-inhibitors (SMD, −0.56; 95% CI, −0.93 to −0.19),
  • statins (SMD, −0.26; 95% CI, −0.48 to −0.04),
  • glucocorticoids (SMD, −0.90; 95% CI, −1.44 to −0.36) 
  • minocycline (SMD, −0.87; 95% CI, −1.45 to −0.29).

Limitations

• Heterogeneity between studies.