The effects of combined sertraline and aspirin therapy on depression severity among patients with major depressive disorder: A randomized clinical trial

Sepehrmanesh, Zahra; Fahimi, Hosein; Akasheh, Goudarz; Davoudi, Mohamadreza; Gilasi, Hamid Reza; Ghaderi, Amir

doi:10.19082/5770

Cited by 15 publications

(10 citation statements)

References 33 publications

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“…After screening titles/abstracts and removing duplicate studies, the full texts of 364 potentially eligible studies were obtained. Ultimately, 39 randomized clinical trials ( Akhondzadeh et al, 2009 ; Abbasi et al, 2012 ; da Silva et al, 2008 ; Krause et al, 2017 ; Majd et al, 2015 ; Müller et al, 2006 ; Sepehrmanesh et al, 2017 ; Arana et al, 1995 ; DeBattista et al, 2000 ; Otte et al, 2010 ; Ghanizadeh and Hedayati, 2013 ; Gougol et al, 2015 ; Haghighi et al, 2014 ; Rasgon et al, 2016 ; Sepanjnia et al, 2012 ; Dean et al, 2017 ; Emadi-Kouchak et al, 2016 ; Husain et al, 2017 ; Berk et al, 2014 ; Bot et al, 2010 ; Carney et al, 2009 ; Carney et al, 2019 ; Chang et al, 2020 ; Gertsik, 2012 ; Grenyer et al, 2007 ; Jahangard et al, 2018 ; Jazayeri et al, 2008 ; Jiang et al, 2018 ; Keshavarz et al, 2018 ; Lespérance et al, 2011 ; Marangell et al, 2003 ; Mischoulon et al, 2009 ; Mischoulon et al, 2015 ; Nemets et al, 2002 ; Park et al, 2015 ; Rapaport et al, 2016 ; Rondanelli et al, 2010 ; Shinto et al, 2016 ; Su et al, 2003 ) were included in the quantitative data synthesis. Figure 1 illustrates the systematic literature searching and study selection processes.…”

Section: Resultsmentioning

confidence: 99%

Comparative Efficacy and Acceptability of Anti-inflammatory Agents on Major Depressive Disorder: A Network Meta-Analysis

Hang

Zhang

et al. 2021

Front. Pharmacol.

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Background: With the growing importance of research about the association between neuroinflammation and major depressive disorder (MDD), anti-inflammatory agents have been used as a new antidepressant therapy in clinical practice. We conducted a network meta-analysis (NMA) with up-to-date evidence to compare different anti-inflammatory agents for improving the treatment of MDD patients.Methods: To identify eligible randomized clinical trials, four databases (i.e, the Cochrane Library, Web of Science, PubMed and Embase) were searched from inception date to May 31, 2020. Anti-inflammatory agents were defined as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, cytokine inhibitors, statins, pioglitazone, minocycline, N-acetylcysteine (NAC) and omega-3 fatty acid (Omega-3 FA). The main outcomes of this NMA were efficacy, acceptability and remission rate. Risk ratio (RR) was adopted for dichotomous outcomes, and the confidence interval (CI) was set at 95%. STATA 14.0 and R 3.6.3 were used to conduct the NMA. The study protocol was registered with PROSPERO (CRD42020182531).Results: A total of 39 studies, involving 2871 participants, were included in quantitative data synthesis. For efficacy, NSAIDs (RR=0.50, 95%CI: 0.26-0.73) and pioglitazone (RR=0.45, 95%CI: 0.20-0.84) were more favorable than placebo. With respect to acceptability, NSAIDs were more acceptable than placebo (RR=0.89, 95%CI: 0.77-0.99) and minocycline (RR=1.22, 95%CI: 1.03-1.49). For remission, NSAIDs were more superior than placebo (RR=0.48, 95%CI: 0.27-0.79) and Omega-3 FA (RR=2.01, 95%CI: 1.09-3.90), while NACs were more favorable than placebo (RR=0.39, 95%CI: 0.13-0.99). Based on the surface under the cumulative ranking curve (SUCRA) value, corticosteroids (0.86) were the best anti-inflammatory agent for MDD patients in terms of efficacy, but the head-to-head comparisons for the efficacy of glucocorticoids and other agents were not statistically significant. As for acceptability, NSAIDs (0.81) were much better than other anti-inflammatory agents. Besides, NAC (0.80) was the best anti-inflammatory agent in the terms of remission.Conclusions: In summary, we found that corticosteroids were more superior than other agents in terms of efficacy according to the SUCRA value. However, this result must be interpreted with caution because the head-to-head comparisons for the efficacy of glucocorticoids and other agents did not reach statistical significance. NSAIDs were recommended for acceptability and NAC for remission rate.

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Section: Resultsmentioning

confidence: 99%

Comparative Efficacy and Acceptability of Anti-inflammatory Agents on Major Depressive Disorder: A Network Meta-Analysis

Hang

Zhang

et al. 2021

Front. Pharmacol.

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“…ASA has also been studied in depression. In an 8-week RCT in MD, patients were assigned to 160 mg of aspirin add-on to sertraline ( n = 50) or placebo add-on ( n = 50); the groups were matched for age, gender, and severity of depression (23). After 4 and 8 weeks of treatment, depression scores were significantly lower than at baseline only in the sertraline plus aspirin group.…”

Section: Major Depressionmentioning

confidence: 99%

COX-2 Inhibitors, Aspirin, and Other Potential Anti-Inflammatory Treatments for Psychiatric Disorders

Müller

2019

Front. Psychiatry

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Inflammatory processes associated with persistent (chronic) infection have long been discussed as etiological factors in psychiatric disorders. Studies have found that people with major depression have higher levels of pro-inflammatory cytokines, for example, IL-1, IL-6, and tumor necrosis factor-alpha, and C-reactive protein. In schizophrenia, many reports have described raised levels of cytokines, for example, IL-6; and meta-analyses have confirmed these findings. Microglia cells are important in inflammatory processes, and positron emission tomography studies have shown microglia activation in both depression and schizophrenia.As a consequence of the above findings, immunomodulation is widely discussed as a potential treatment approach in both major depression and schizophrenia. The COX-2 inhibitor celecoxib was found to have a significant positive effect on major depression, not only in single studies but also in meta-analyses. Celecoxib has also been studied in schizophrenia and has shown efficacy, in particular, in early disease stages. The mixed COX inhibitor aspirin (acetylsalicylic acid) seems to have both protective and therapeutic effects on schizophrenia.This paper discusses the hypothesized role of inflammation in major depression and schizophrenia, including markers of inflammation; pertinent studies on celecoxib and aspirin; and additional immunomodulatory therapeutic strategies.

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“…While there are positive randomised controlled trials of statins for the treatment of depression [32][33][34], and meta-analytic evidence for their effectiveness [35], no studies have investigated their therapeutic potential among youth. A pilot study comparing low-dose aspirin added to sertraline with sertraline alone found that the former was superior on the Beck Depression Inventory at the trial endpoint [36].…”

Section: Introductionmentioning

confidence: 99%

Youth Depression Alleviation with Anti-inflammatory Agents (YoDA-A): a randomised clinical trial of rosuvastatin and aspirin

Berk

Mohebbi

Dean

et al. 2020

BMC Med

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Background: Inflammation contributes to the pathophysiology of major depressive disorder (MDD), and antiinflammatory strategies might therefore have therapeutic potential. This trial aimed to determine whether adjunctive aspirin or rosuvastatin, compared with placebo, reduced depressive symptoms in young people (15-25 years). Methods: YoDA-A, Youth Depression Alleviation with Anti-inflammatory Agents, was a 12-week triple-blind, randomised, controlled trial. Participants were young people (aged 15-25 years) with moderate to severe MDD (MADRS mean at baseline 32.5 ± 6.0; N = 130; age 20.2 ± 2.6; 60% female), recruited between June 2013 and June 2017 across six sites in Victoria, Australia. In addition to treatment as usual, participants were randomised to receive aspirin (n = 40), rosuvastatin (n = 48), or placebo (n = 42), with assessments at baseline and weeks 4, 8, 12, and 26. The primary outcome was change in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 12. Results: At the a priori primary endpoint of MADRS differential change from baseline at week 12, there was no significant difference between aspirin and placebo (1.9, 95% CI (− 2.8, 6.6), p = 0.433), or rosuvastatin and placebo (− 4.2, 95% CI (− 9.1, 0.6), p = 0.089). For rosuvastatin, secondary outcomes on self-rated depression and global impression, quality of life, functioning, and mania were not significantly different from placebo. Aspirin was inferior to placebo on the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) at week 12. Statins were superior to aspirin on the MADRS, the Clinical Global Impressions Severity Scale (CGI-S), and the Negative Problem Orientation Questionnaire scale (NPOQ) at week 12. Conclusions: The addition of either aspirin or rosuvastatin did not to confer any beneficial effect over and above routine treatment for depression in young people. Exploratory comparisons of secondary outcomes provide limited support for a potential therapeutic role for adjunctive rosuvastatin, but not for aspirin, in youth depression. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12613000112763. Registered on 30/01/2013.

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The effects of combined sertraline and aspirin therapy on depression severity among patients with major depressive disorder: A randomized clinical trial

Cited by 15 publications

References 33 publications

Comparative Efficacy and Acceptability of Anti-inflammatory Agents on Major Depressive Disorder: A Network Meta-Analysis

Comparative Efficacy and Acceptability of Anti-inflammatory Agents on Major Depressive Disorder: A Network Meta-Analysis

COX-2 Inhibitors, Aspirin, and Other Potential Anti-Inflammatory Treatments for Psychiatric Disorders

Youth Depression Alleviation with Anti-inflammatory Agents (YoDA-A): a randomised clinical trial of rosuvastatin and aspirin

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