Anti-inflammatory Drugs May Reduce Schizophrenia Symptom Severity

There is preliminary evidence to suggest that use of an NSAID to augment antipsychotic drugs has a moderate beneficial effect on symptom severity for people with schizophrenia in the short term.

Immune dysfunction and inflammation have been described in patients with schizophrenia. For example, findings from our group suggested that markers for inflammation, including elevated blood levels of C reactive protein and white blood cell count are associated with negative symptoms in patients with schizophrenia. Furthermore, nuclear factor κB activation may play a pivotal role in schizophrenia through interaction with cytokines.

This meta-analysis was based on five double-blind, randomised, placebo-controlled trials with a total number of 264 patients. Four studies examined celecoxib and one used aspirin. The studies included were heterogeneous in terms of the chronicity of illness and the choice of study drugs; in addition, the study time periods were relatively short (up to three months). Despite these limitations, the analysis provided further evidence suggesting that non-steroidal anti-inflammatory drug augmentation treatment could be beneficial in reducing schizophrenia symptoms.

Celecoxib and other cyclooxygenase-2 (COX-2) inhibitors are associated with an elevated risk of cardiovascular disease, which is a serious comorbid medical condition in patients with schizophrenia. The cardioprotective nonselective COX inhibitor aspirin is arguably preferable. However, it is well established that aspirin, especially when used in a relatively high dosage, is associated with a significant risk for gastrointestinal bleeding.

Continued effort should be made to identify potential anti-inflammatory agents with a better side effect profile, and also examine the longer term effect of anti-inflammatory treatment in schizophrenia. Future studies focusing on the early stage of schizophrenia are particularly valuable because pharmacological treatment during the early phase could improve the course and overall prognosis of the disease.

by Xiaoduo Fan, Xueqin Song, Evidence Based Mental Health

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