Review Article

Modulating Neuroinflammation to Treat Neuropsychiatric Disorders

Table 2

Clinical studies on use of anti-inflammatory drugs in treatment of psychiatric disorder. : proband number, : time frame, PANSS: Positive and Negative Symptom Score, SANS: Schedule for the Assessment of Negative Symptoms, and CGI score: clinical global impression score.

TreatmentPsychiatric disorderProbandsTrial designOutcomeAuthors

Aspirin 1000 mg/day plus 40 mg/day pantoprazole, in addition to antipsychotic treatmentSchizophreniaPatients with at least moderate symptom burden and a DSM-IV diagnosis for schizophrenia spectrum disorder for under 10 years
Randomized controlled trial
months
Mixed model improvement in overall psychopathology and in positive symptoms as measured by PANSS
No differences in negative symptom or general scores
Laan et al., 2010 [158]

Aspirin 1000 mg/day plus 40 mg/day pantoprazole, in addition to antipsychotic treatmentSchizophreniaPatients with moderate or above on CGI score, moderate score on two of PANSS items: delusions, hallucinatory behaviors, conceptual disorganization or suspiciousness/persecution, and/or a total PANSS negative symptoms score above 18
Post hoc analysis of randomized controlled trial
weeks
Improvements in patients with high CRP levelsWeiser et al., 2014 [159]

Celecoxib 200 mg bid in addition to 2–6 mg/day risperidoneSchizophreniaPatients with acute exacerbation of schizophrenia
Double-blind, Randomized Placebo-controlled
weeks
Significant improvement of positive symptomsMüller et al., 2002 [160]

Celecoxib in addition to olanzapineSchizophreniaPatients with acute exacerbation of schizophrenia
Open-label, prospective, controlled
weeks
Improvement of positive, negative, and general psychopathology and total scores as measured by PANSSBaheti et al., 2013 [161]

Celecoxib (200 mg bid) in addition to risperidone (200 mg/day)Schizophreniainpatients diagnosed with active phase schizophrenia
Double-blind randomized placebo-controlled
weeks
Significant improvement regarding positive symptoms as measured by PANSSAkhondzadeh et al., 2007 [162]

CelecoxibSchizophreniaPatients with a first manifestation of schizophrenia
Double-blind randomized placebo-controlled
weeks
Significant improvement regarding positive and negative symptoms as measured by PANSSMüller et al., 2010 [163]

Celecoxib (400 mg/day) in addition to antipsychotic treatmentSchizophreniaOutpatients with a DSM-IV diagnosis of schizophrenia, experiencing persistent symptoms despite treatment for 3 months
Double-blind, randomized, placebo-controlled,
weeks
No difference in outcome, as measured by PANSSRapaport et al. 2005 [164]

Concomitant intake of NSAID or paracetamolSchizophreniaSchizophrenia patients
Retrospective investigationHigher risk for relapse to active psychosisKöhler et al., 2016 [165]

Previous NSAID useSchizophreniaPatients prescribed antipsychotics
82 cases, 359 controls
Case-control trial of antipsychotics prescriptionSignificant reduction of risk to develop psychosis when NSAID had been taken, but only in male individualsLaan et al., 2007 [166]

Use of COX-2 inhibitorsSchizophreniaCase events indicating schizophrenia exacerbation in patients using antipsychotics
Nested case-control study
previous 93 days
No increase of risk for schizophrenia exacerbationStolk et al., 2007 [167]

Minocycline in addition to usual treatmentSchizophreniaPatients with early-stage schizophrenia
Double-blind, randomized, placebo-controlled
year
Significant improvement of negative symptoms as measured by PANSSChaudhry et al., 2012 [168]

Minocycline (200 mg/day) in addition to risperidoneSchizophreniaPatients with DSM-IV diagnosis of early-phase (less than 5 years) schizophrenia who had been on a steady dosage of risperidone
Double-blind, randomized, placebo-controlled
weeks
Significant improvement in treatment response in the Scale for the Assessment of Negative Symptoms (SANS) total scores and PANSS for negative symptomsLiu et al., 2014 [169]

Minocycline (200 mg/day)SchizophreniaPatients with DSM-IV diagnosis of schizophrenia, no treatment with therapeutics for one week before start of trial
Randomized, placebo-controlled
weeks
Significant decrease of SANS score after 8 weeks (though not 4 weeks) of treatmentGhanizadeh et al., 2014 [170]

Minocycline (up to 200 mg/day) in addition to risperidone (up to 6 mg/day)SchizophreniaChronic schizophrenia patients
Double-blind, randomized, placebo-controlled
weeks
Significant improvement of negative symptom as measured by PANSSKhodaie-Ardakani et al., 2014 [171]

MinocyclineSchizophreniaEarly-phase schizophrenia patients
Double-blind, randomized, placebo-controlled
months
Significant improvement of negative symptoms and general outcome measured by PANSS, Clinical Global Impression (CGI) and insight score, and improvements of cognitive executive functionsLevkovitz et al., 2009 [172]

NSAID and paracetamolBipolar disorderDSM-IV-TR diagnosis of bipolar disorder I or II and at least mild symptoms
Secondary analysis from the Bipolar CHOICE study
months
No difference as measured by CGI-BP Köhler-Forsberg et al., 2017 [173]

AspirinBipolar disorderPatients taking lithium with erectile dysfunction
Double-blind, randomized, placebo-controlled
weeks
No differences in mania or depressive symptoms, significant improvement of erectile dysfunctionSaroukhani et al., 2013 [174]

Aspirin, low-dose of 30 or 80 mg per day and for an unspecified time or for more than 1, 45, 90, or 180 days, in addition to lithiumBipolar disorderPatients with at least five previous prescriptions for lithium and at least 1-year drug history
Pharmacoepidemiological study on the PHARMO Record Linkage System (RLS) in the Netherlands
year period
Significantly fewer events of mood-stabilizer treatment alterationStolk et al., 2010 [175]

Celecoxib (400 mg/day)Bipolar disorderDSM-IV diagnosis of bipolar disorder during a depressive or mixed episode of the disease
Double-blind, randomized, placebo-controlled
weeks
Improvement of depressive symptoms (as measured by Hamilton Depression Rating Scale) found in the first weekNery et al., 2008 [176]

Celecoxib in addition to sodium valproateBipolar disorderPatients with diagnosis of acute bipolar mania with manic episode without psychotic features
Double-blind, randomized, placebo-controlled
weeks
Significantly higher remission rates as measured by young mania rating scaleArabzadeh et al., 2015 [177]

Concomitant NSAID use in addition to escitalopram or nortriptylineDepressionPatients with major depression disorder treated in the GENDEP study
Retrospective on the GENDEP study
up to 12 weeks
No change of serotonin reuptake inhibitor treatmentUher et al., 2012 [178]

Previous aspirin use as anti-platelet treatmentDepressionMen of older age (69–87 years)
Retrospective analysis of aspirin use after assessment of mood disorder symptoms
last 5 years
Significantly higher risk for depression in individuals who had used aspirin as antiplatelet agent drug in the past, but had stopped the treatment before the mood assessment (measured by Geriatric Depression scale)Almeida et al., 2010 [179]

Regular aspirin or statin use in the pastDepressionDepression patients
Population-based study
last 6 months
No higher risk for development of depressionGlaus et al., 2015 [180]

Celecoxib in addition to antidepressantsDepressionPatients with depressive episodes
Meta-analysis of 4 randomized controlled trialsImprovements in Hamilton Rating Scale for Depression scores, remission and response rateNa et al., 2014 [181]

Diclofenac (50 mg bid) versus celecoxib (200 mg bid)DepressionOutpatients with breast cancer and concomitant depression
weeksSignificant improvements by HDSR score in both, celecoxib significantly more successful than diclofenac, analgesic effect comparableMohammadinejad et al., 2015 [182]

Celecoxib (200 mg bid)DepressionPatients with depression due to brucellosis
Double-blind, randomized, placebo-controlled
weeks
Significant improvements on HDRSJafari et al., 2015 [183]

Celecoxib (200 mg bid) or sodium naproxen (220 mg bid)DepressionIndividuals older than 70 years and with a family history of Alzheimer’s disease (though without any cognitive dysfunction)
Alzheimer’s Disease Anti-Inflammatory Prevention Trial
Yearly follow-up
No significant change in individual or overall depression score measured by 30-item Geriatric Depression ScaleFields et al., 2012 [184]

Minocycline (150 mg/day) as adjunctive therapy to fluvoxamine, paroxetine, or sertralineDepressionInpatients with a DSM-IV diagnosis of major depression with psychotic features
Open-label study
weeks
Significant improvement of depressive and psychotic symptoms as measured by Hamilton Depression Rating Scale and Brief Psychiatric Rating ScaleMiyaoka et al., 2012 [185]

100 mg bid minocyclineDepressionHIV positive patients with mild-to-moderate scores of depression
Double-blind, randomized, placebo-controlled
weeks
Significant reduction of depression score (Hamilton Depression Rating Scale)Emadi-Kouchak et al., 2016 [186]

Celecoxib 200 mg bid in addition to fluvoxamineOCDOCD outpatient
Double-blind, randomized, placebo-controlled
weeks
Significant improvement of symptomsShalbafan et al., 2015 [187]

N-Acetylcysteine (up to 2400 mg/day)OCDOCD patients, nonresponsive to serotonin reuptake inhibitors
Double-blind, randomized, placebo-controlled
weeks
15% higher response rateAfshar et al., 2012 [188]

Minocycline (100 mg/day) in addition to serotonin reuptake inhibitorOCDTreatment-resistant outpatients with OCD
Open-label study
weeks
No significant improvements in outcome in cohort as a whole, more than 30% reduction of the Yale–Brown Obsessive Compulsive ScaleRodriguez et al., 2010 [189]

Minocycline (100 mg bid) as add-on to fluvoxamine (100 mg/day for the first two 200 mg/day for the remaining 6 weeks of the trial)OCDOCD patients
Double-blind, randomized, placebo-controlled
weeks
Significantly higher treatment response rate (either complete or partial) measured by the Yale-Brown Obsessive compulsive scale. Specifically patients scored significantly lower in total and on the obsessive subscaleEsalatmanesh et al., 2016 [190]

Celecoxib (up to 300 mg/day) in addition to risperidoneAutismChildren with autistic disorder
Double-blind, randomized, placebo-controlled
weeks
Significant improvements of scores in irritability, social withdrawal, and stereotypyAsadabadi et al., 2013 [191]

Minocycline (1.4 mg/kg body weight)AutismChildren with autism spectrum disorder
Open-label
months
No clinical improvements (Clinical Global Impression Severity Scale, Clinical Global Impression Severity Scale Improvement, and Vineland Adaptive Behavior Scales)Pardo et al., 2013 [192]