Effectiveness and tolerance of anti‐inflammatory drugs' add‐on therapy in major mental disorders: a systematic qualitative review
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abstract
ObjectiveTo 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].MethodFour databases were explored, without any year or language restrictions. The baseline search paradigm was limited to open‐labelled clinical and randomized controlled trials (RCTs).ResultsFour 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.ConclusionPolyunsaturated 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.
