Effectiveness and tolerance of anti-inflammatory drugs' add-on therapy in major mental disorders: a systematic qualitative review.
OBJECTIVE
To provide a systematic review of the literature regarding the efficacy of anti-inflammatory drugs in three major mental disorders [major depressive disorder (MDD), schizophrenia and bipolar disorders].


METHODS
Four databases were explored, without any year or language restrictions. The baseline search paradigm was limited to open-labelled clinical and randomized controlled trials (RCTs).


RESULTS
Four major classes of anti-inflammatory drugs were identified, namely polyunsaturated fatty acids (PUFAs), cyclooxygenase (COX) inhibitors, anti-TNFalpha and minocycline. Effectiveness and benefit/risk ratio of each class in MDD, bipolar disorders and schizophrenia was detailed when data were available. Several meta-analyses indicated effectiveness of PUFAs in MDD with a good tolerance profile. One meta-analysis indicated that COX-2 specific inhibitors showed effectiveness in schizophrenia. Anti-TNFalpha showed important effectiveness in resistant MDD with blood inflammatory abnormalities. Minocycline showed effectiveness in schizophrenia.


CONCLUSIONS
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.
Pôle de psychiatrie des hôpitaux universitaires H Mondor, University Paris Est-Créteil, INSERM U955, Eq Psychiatrie Génétique, Fondation FondaMental Fondation de coopération scientifique en santé mentale, Créteil, France.
G
G
Fond
N
N
Hamdani
F
F
Kapczinski
W
W
Boukouaci
N
N
Drancourt
A
A
Dargel
J
J
Oliveira
E
E
Le Guen
E
E
Marlinge
R
R
Tamouza
M
M
Leboyer
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology*; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000494:pharmacology*; D001714:Bipolar Disorder / Q000188:drug therapy*; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000494:pharmacology*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005231:Fatty Acids, Unsaturated / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D008911:Minocycline / Q000009:adverse effects / Q000494:pharmacology*; D012559:Schizophrenia / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D016861:Cyclooxygenase Inhibitors; D005231:Fatty Acids, Unsaturated; D014409:Tumor Necrosis Factor-alpha; D008911:Minocycline
anti-inflammatory; bipolar disorders; celecoxib; cyclooxygenase-1; cyclooxygenase-2; depression; infliximab; minocycline; non-steroidal anti-inflammatory drugs; salicylate; schizophrenia; tumor necrosis factor