90. Inflammation control augments antidepressant response in bipolar depression

Abstract

There is an association between stress, stress-related mood disorders and inflammation. Control of inflammation in conjunction with antidepressant therapy may augment antidepressant response and convert treatment-resistant patients to responders. Reports with the use of celecoxib in combination with an antidepressant agent are encouraging based on the hypothesis that inhibition of cyclooxygenase-2 (COX-2) reduces inflammation and enables antidepressant action to occur. We present preliminary data from a study of treatment-resistant bipolar depression. Patients were randomized to receive escitalopram + celecoxib, or escitalopram + placebo. Subjects completed assessments at weeks 0, 1, 2, 4 and 8. Severity of depression and anxiety were quantified using the HAM-D, HAM-A, and MADRS rating scales. Perceived stress was assessed using the PSS-14 scale. There was a statistically significant reduction in HAM-D mean scores in the active group ( p = 0.0005) vs. placebo ( p = 0.145), MADRS scores in the active group ( p p = 0.172) and HAM-A scores in the active group ( p = 0.047) vs. placebo ( p = 0.756). The PSS and HAM-D scores were positively correlated ( r = 0.684, p = 0.02). There was a statistically significant decrease in post-treatment PSS scores in the active group ( p = 0.049) vs. placebo ( p = 0.717). The interim analysis of this ongoing study reveals that scores on scales for symptoms of depression, anxiety, and perceived stress significantly improved when subjects were treated with the combination escitalopram + celecoxib. These data suggest that controlling inflammation augments antidepressant response.