Anti-inflammatory add-on treatment is beneficial for patients with major depressive disorder (MDD) or depressive symptoms, according to a meta-analysis published in the May issue of Acta Psychiatrica Scandinavica.

Ole Köhler-Forsberg, from Aarhus University Hospital in Denmark, and colleagues performed a systematic review of randomized clinical trials (RCTs) studying antidepressant treatment effects and side effects of pharmacological anti-inflammatory interventions in adults with MDD or depressive symptoms. Data were included for 36 RCTs, of which 13 investigated nonsteroidal anti-inflammatory drugs (4,214 patients), nine cytokine inhibitors (3,345 patients), seven statins (1,576 patients), three minocyclines (151 patients), two pioglitazones (77 patients), and two glucocorticoids (59 patients).

The researchers found that compared with placebo, anti-inflammatory agents improved depressive symptoms as an add-on in patients with MDD (standardized mean difference [SMD], −0.64) and as monotherapy (SMD, −0.41). Response and remission were improved with an anti-inflammatory add-on (risk ratios, 1.76 and 2.14, respectively). A trend toward increased risk for infections was seen; a high risk for bias was observed in all studies.

"What's persuasive is that we've found that several of the anti-inflammatory drugs have what can be characterized as a medium to a large effect on depression and depressive symptoms, in particular because the results build on almost 10,000 people who have participated in the placebo-controlled studies with anti-inflammatory treatment," a coauthor said in a statement. "The results from the meta-analysis are particularly promising not only because of an effect of the anti-inflammatory medicine on its own but also due to the supplementary effect when the anti-inflammatory medicine is given simultaneously with the antidepressants that are used today."

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