Efficacy of adjunctive celecoxib treatment for patients with major depressive disorder: a meta-analysis.
BACKGROUND
Numerous studies have reported that inflammation is closely associated with depression, and adjunctive non-steroidal anti-inflammatory drug (NSAID) treatment has been suggested as a novel therapeutic approach for depression.


METHODS
We searched electronic databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials. We only included randomized controlled trials comparing adjunctive NSAIDs with placebos for treating depressive episodes.


RESULTS
Of the 654 retrieved entries, we identified four relevant studies with a total of 150 patients (75 NSAID patients and 75 placebo patients) with depressive episodes. All four studies used celecoxib as the NSAID. The patients receiving adjunctive celecoxib had significantly higher mean changes in the Hamilton Rating Scale for Depression scores between baseline and endpoint measurements compared with those receiving placebo (weighted mean difference=3.26, 95% confidence interval; CI=1.81 to 4.71). The adjunctive celecoxib group also showed better remission (odds ratio; OR=6.58, 95% CI=2.55 to 17.00) and response rates (OR=6.49, 95% CI=2.89 to 14.55) than the placebo group. The all-cause drop-out rate was more favorable for the celecoxib group than for the placebo group (OR=0.45, 95% CI=0.18 to 1.13), although the statistical significance was not statistically significant (p=0.09).


CONCLUSIONS
Adjunctive treatment with NSAIDs, particularly celecoxib, can be a promising strategy for patients with depressive disorder. Future studies with a larger sample size and longer study duration are needed to confirm the efficacy and tolerability of NSAIDs for depression.
Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Kyoung-Sae
KS
Na
Kang Joon
KJ
Lee
Ji Sung
JS
Lee
Young Sung
YS
Cho
Han-Yong
HY
Jung
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000068579:Celecoxib; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D011720:Pyrazoles / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib
BDNF; CENTRAL; CNS; Cochrane Central Register of Controlled Trials; DSM-IV; DSM-IV, text revision; DSM-IV-TR; Depression; Diagnostic and Statistical Manual for Mental Disorders, fourth edition; GENDEP; Genome-Based Therapeutic Drugs for Depression; HRSD; Hamilton Rating Scale for Depression; IDO; IFN-α; IL-1β; IL-6; Inflammation; LPS; MADRS; MDD; Major Depressive Disorder; Meta-analysis; Montgomery–Asberg Depression Rating Scale; NSAID; PRISMA; Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT; Randomized controlled trials; SSRI; STAR*D; Sequenced Treatment Alternatives to Relieve Depression; TNF-α; WHO; WMD; World Health Organization; brain-derived neurotrophic factors; central nervous system; high sensitivity C-reactive protein; hs-CRP; indoleamine 2,3-dioxygenase; interferon-alpha; interleukin-1beta; interleukin-6; lipopolysaccharide; non-steroidal anti-inflammatory drug; randomized controlled trial; selective serotonin reuptake inhibitor; tumor necrosis factor-alpha; weighted mean difference