Effectiveness and tolerance of anti‐inflammatory drugs' add‐on therapy in major mental disorders: a systematic qualitative review

Abstract

Polyunsaturated fatty acids seem to have the best benefit/risk ratio profile but proved their effectiveness only in MDD. A number of anti-inflammatory drugs are available as adjunct treatment for treatment-resistant patients with MDD, schizophrenia and bipolar disorder. If used with caution regarding their possible side-effects, they may be reasonable therapeutic alternatives for resistant symptomatology.

Toward Omics-Based, Systems Biomedicine, and Path and Drug Discovery Methodologies for Depression-Inflammation Research

“…This is corroborated by reports that nutraceuticals with anti-inflammatory and anti-O&NS effects, which multi-target these pathways [e.g. ω3 PUFAs, zinc, N-acetyl cysteine and curcumin] may have a clinical efficacy in depression and reduce depressive-like behaviors in animal models [4,[78][79][80][81].…”

“…Indeed, antidepressants exert at least part of their clinical efficacy by attenuating inflammatory, immune (Th1), O&NS and neuroprogressive pathways [8,12,24,25,41,[47][48][49][50][51][52]. Moreover, the efficacy of antidepressants may be augmented by administration of compounds targeting immune-inflammatory, O&NS and neuroprogressive pathways [4,8]. Nevertheless, for at least 30 years the 5-HT hypothesis of depression has guided research into the pathophysiology of depression and fostered the development of new, usually similar antidepressant drugs.…”

“…Fond et al [4], in their systematic review, conclude that of all possible anti-inflammatory treatments examined in depression ω3 PUFAs have the best benefit/risk ratio profile. Many other nutraceuticals with anti-inflammatory and anti-O&NS effects or their combinations (e.g.…”

“…interleukin (IL)-6, IL-1 and tumor necrosis factor (TNF)α, and signs of an acute phase response [2,3]. Recently, a systematic review and a meta-analysis showed that antiinflammatory drugs may have antidepressant effects [4,5]. The latter authors state that because there is an inflammatory state in depression, anti-inflammatory drugs were examined, and that the results of their meta-analysis are proof of concept that anti-inflammatory drugs are useful in depression.…”

Curcumin for the treatment of major depression: A randomised, double-blind, placebo controlled study

“…Consequently, this has sparked interest in compounds that target these pathways. Examples include anti-inflammatory treatments influencing immuno-inflammation such as cyclooxygensase-2 (COX-2) inhibitors, aspirin, minocycline and polyunsaturated fatty acids (Berk et al, 2013a, Fond et al, 2014, Muller, 2013 and antioxidant therapies to increase antioxidant defences and lower free radical damage such as n-acetyl cysteine, Ebselen, vitamin E and coenzyme-Q 10 (Berk et al, 2013b, Scapagnini et al, 2012. Interestingly, despite pharmaceutical antidepressants originally being heralded as targeting monoaminergic actions, there is also evidence that they can modulate immuno-inflammation, reduce oxidative stress, enhance neurotrophic factors and influence HPA activity (Abdel-Wahab and Salama, 2011, Andrade and Rao, 2010, Hannestad et al, 2011, Kocki et al, 2012, Schule, 2007.…”