Aspirin, other anti-inflammatory drugs may help alleviate depression symptoms, says study

Antidepressants may help only about one-third of patients with major depressive disorder

                            Aspirin, other anti-inflammatory drugs may help alleviate depression symptoms, says study
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Drugs such as aspirin or paracetamol, statins, and antibiotics, may help depressed patients tackle their symptoms better. And when combined with antidepressants, patients stand to benefit more, say scientists.

Depressed patients can safely take such anti-inflammatory drugs, the study suggests.

The standard treatment for depression is antidepressants, which work by increasing the levels of mood-enhancing chemicals in the brain such as serotonin and noradrenaline. These drugs may help only about one-third of patients with major depressive disorder, as per previous studies. Besides, these medications also pose serious side effects.

So scientists began looking at other treatment strategies such as stress, which is known to increase inflammation. Several studies have found that inflammation has a role to play in depression.  

But results from clinical trials, where the efficacy of anti-inflammatory drugs are tested on depressed patients, have been vague. "There was no single, standalone study that had large patient numbers with definitive results. Hence the need for a meta-analysis, combining studies", Matthew Kiernan, Professor at the University of Sydney Medical School, Australia, told MEA WorldWide (MEAWW), explaining the inconclusive results from the earlier clinical trials.

To examine the available evidence, the team pooled information from various studies to check the efficacy of anti-inflammatory agents: whether it worked better than the dummy (placebo) treatment, and whether it was more effective when combined with standard antidepressants.

From these studies, they assessed 30 relevant randomized controlled trials, which reported changes in depression scales, involving 1610 people. Of the 30, they pooled patient information from 26 studies.

The results revealed that anti-inflammatory drugs did a better job at easing depression symptoms than the dummy treatments, with 52% efficacy in reducing symptom severity, overall, and 79% efficacy in eliminating symptoms. And the effects were more pronounced when combined with standard antidepressant treatment.

More detailed analysis indicated that Nonsteroidal anti-inflammatory drugs (NSAIDs), omega 3 fatty acids, statins, and minocyclines were the most effective at reducing major depressive symptoms compared with placebo.

In addition to symptoms, the team also looked at improved quality of life. But none of the patients from previous studies showed any positive effects in quality of life. Though, they reason, this could have been because of the small number of studies that investigated this aspect.

They also looked for reports of side-effects. The team did not find anything concrete, but they saw reports of gut symptoms in those taking statins and N-acetylcysteine (NACs). As the trials lasted only for four to 12 weeks, they couldn't investigate long-term side effects. 

However, results from their analysis suggest that anti-inflammatory agents play a role in alleviating the symptoms of depression in patients with major depressive disorder and are reasonably safe, according to the team.
In the future, "A large clinical trial, with appropriate power and longitudinal assessment of outcome measures is required to bring out conclusive evidence", Kiernan told MEAWW.  

The study has been published in BMJ.

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