title: NSAIDs are associated with lower depression scores in patients with osteoarthritis.
abstract: BACKGROUND
  Studies have demonstrated the success of augmentation of antidepressant therapy with nonsteroidal anti-inflammatory drugs (NSAID) in decreasing depressive symptoms; however, little is known about the benefit of NSAID therapy on depressive symptoms.
  
  
  METHODS
  This study pooled data from 5 postapproval trials, each trial a 6-week, multicenter, randomized, double-blinded, placebo-controlled, active-comparator, parallel-group study in subjects with active osteoarthritis. Subjects were randomized to placebo group, ibuprofen 800 mg 3 times daily or naproxen 500 mg twice daily group, or Celebrex 200 mg daily group. Apart from different ethnicities enrolled, these trials had identical study designs. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Outcomes measured were change in PHQ-9 score after 6 weeks of NSAID therapy and change in classification of depression with a PHQ-9 score ≥10 as a marker of depression.
  
  
  RESULTS
  There were 1497 patients included. Median PHQ-9 score was similar in all 3 groups at baseline and after 6 weeks of treatment. Multivariable regression analysis demonstrated a detectable effect in lowering PHQ-9 score in the ibuprofen or naproxen group (-0.31) and Celebrex group (-0.61) (P = .0390). With respect to the change in classification of depression, logistic regression analysis demonstrated a trend towards significant treatment effect of all NSAIDs compared with placebo.
  
  
  CONCLUSIONS
  Our analysis of pooled data from 5 postapproval trials shows that NSAID usage demonstrates a trend towards reduction of depression symptoms in patients with osteoarthritis based upon PHQ-9 scores. Future clinical trials should investigate this association with maximum dosage of drugs, increased treatment duration, and monitoring of social and environmental changes.
authors.affiliation: Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY; School of Medicine, St. George's University, St. George's, Grenada.
authors.forename: Rupa L
authors.initials: RL
authors.lastname: Iyengar
authors.forename: Sumeet
authors.initials: S
authors.lastname: Gandhi
authors.forename: Ashish
authors.initials: A
authors.lastname: Aneja
authors.forename: Kevin
authors.initials: K
authors.lastname: Thorpe
authors.forename: Louai
authors.initials: L
authors.lastname: Razzouk
authors.forename: Jeffery
authors.initials: J
authors.lastname: Greenberg
authors.forename: Serge
authors.initials: S
authors.lastname: Mosovich
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000068579:Celecoxib; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009288:Naproxen / Q000627:therapeutic use*; D010003:Osteoarthritis / Q000150:complications*; D011581:Psychological Tests; D011720:Pyrazoles / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D011720:Pyrazoles; D013449:Sulfonamides; D009288:Naproxen; D000068579:Celecoxib; D007052:Ibuprofen
keywords: Celecoxib; Depression; Nonsteroidal anti-inflammatory drugs (NSAIDs); Osteoarthritis