Inflammatory processes are shown to play a role in depression. Inflammatory mediators like PG E2 is increased in depression.Antidepressants can reduce PGE2 synthesis.Lamotrigine is shown to reduce Cox 2 enzyme expression in brain. All these suggest the idea that cyclooxygenase 2 (COX-2) inhibitors may have a role in treating depression.
Would adding celecoxib, a Cox 2 inhibitor, to antidepressants improve response in acute depression?
Farhad Faridhossein et al reviewed the evidence so far on this question in this article. They included RCTs of celocoxib addition to antidepressants in adults with unipolar depression. OR was used to compare response and remission rates.
4 studies were included (with 160 participants) in the meta analysis. Three studies showed statistically significant improvement with addition.
Pooled OR (for response) after adjusting for publication bias was 3.66, 95% CI ( 1.33-10). 400mg/day was used in three of the RCTs. Reported adverse events wee similar to that in placebo.
Conclusion: Meta analysis of four relatively small studies indicate that celecoxib would increase the response rate when added to antidepressants . Approximately 4 people will benefit for every one that does not benefit. Cautious use suggested in those with cardiovascular problems.
Summary of the article:
Celecoxib: a new augmentation strategy for depressive mood episodes. A systematic review and meta-analysis of randomized placebo-controlled trials . Farhad Faridhosseini ,Ramin Sadeghi2, Layla Farid1 and Meysam Pourgholami. Hum. Psychopharmacol Clin Exp 2014; 29: 216–223. online publication 2014.March.