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Non-steroidal anti-inflammatory drugs and efficacy of antidepressants in major depressive disorder

Published online by Cambridge University Press:  06 March 2012

R. Uher ,
S. Carver ,
R. A. Power ,
O. Mors ,
W. Maier ,
M. Rietschel ,
J. Hauser ,
M. Z. Dernovsek ,
N. Henigsberg  and
D. Souery
...Show all authors
R. Uher*
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
S. Carver
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
R. A. Power
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
O. Mors
Affiliation:
Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
W. Maier
Affiliation:
Department of Psychiatry, University of Bonn, Germany
M. Rietschel
Affiliation:
Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, Mannheim, Germany
J. Hauser
Affiliation:
Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poland
M. Z. Dernovsek
Affiliation:
University Psychiatric Clinic, Ljubljana, Slovenia
N. Henigsberg
Affiliation:
Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia
D. Souery
Affiliation:
Laboratoire de Psychologie Médicale, Université Libre de Bruxelles and Psy Pluriel – Centre Européen de Psychologie Médicale, Belgium
A. Placentino
Affiliation:
Psychiatric Unit (UOP 23), Department of Mental Health, Spedali Civili Hospital of Brescia, Italy; Biological Psychiatry Unit, IRCCS-FBF, Brescia; Faculty of Psychology, University of Milano-Bicocca, Italy
A. Farmer
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
P. McGuffin
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: Dr R. Uher, P080, SGDP, Institute of Psychiatry, 16 De Crespigny Park, SE5 8AF, London, UK. (Email: rudolf.uher@kcl.ac.uk)
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Abstract

Background

It has been proposed that non-steroidal anti-inflammatory drugs (NSAIDs) may interfere with the efficacy of antidepressants and contribute to treatment resistance in major depressive disorder (MDD). This effect requires replication and a test of whether it is specific to serotonin-reuptake inhibiting (SRI) antidepressants.

Method

We tested the effect of concomitant medication with NSAIDs on the efficacy of escitalopram, a SRI antidepressant, and nortriptyline, a tricyclic antidepressant, among 811 subjects with MDD treated for up to 12 weeks in the GENDEP study. Effects of NSAIDs on improvement of depressive symptoms were tested in mixed-effect linear models. Effects on remission were tested in logistic regression. Age, sex, baseline severity and centre of recruitment were considered as potential confounding factors.

Results

Ten percent (n=78) of subjects were taking NSAIDs during the antidepressant treatment. Older subjects were significantly more likely to take NSAIDs. After controlling for age, sex, centre of recruitment and baseline severity, concomitant medication with NSAIDs did not significantly influence the efficacy of escitalopram [β=0.035, 95% confidence interval (CI) −0.145 to 0.215, p=0.704] or nortriptyline (β=0.075, 95% CI −0.131 to 0.281, p=0.476). Although slightly fewer subjects who took NSAIDs reached remission [odds ratio (OR) 0.80, 95% CI 0.49–1.31, p=0.383], this non-significant effect was reversed after controlling for age, sex, baseline severity and recruitment centre effects (OR 1.04, 95% CI 0.61–1.77, p=0.882).

Conclusions

NSAIDs are unlikely to affect the efficacy of SRI or other antidepressants. Concurrent use of NSAIDs and antidepressants does not need to be avoided.

Keywords

Antidepressant medicationdrug interactionsinflammationmajor depressive disordernon-steroidal anti-inflammatory drugsoutcome prediction
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 10 , October 2012 , pp. 2027 - 2035
Copyright
Copyright © Cambridge University Press 2012

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