This news release summarizes a published review of 20 clinical trial studies of anti-inflamatory drugs used to treat conditions such as rheumatoid arthritis and psoriasis. Data also was collected on the effects of these drugs on depression. The review found that drugs that affect cytokines in the body appear to reduce depressive symptoms more than would be expected simply from mitigation of the underlying primary disease being treated. The study authors suggest that these new drugs could be used to treat patients with depression who are not currently helped by anti-depressive drugs.
The news release provides background information, but little data, on the suggestion that inflammation may play a role in depression, and emphasizes that anti-cytokine treatments might be useful in just a sub-set of patients. It includes a quote from an author cautioning about the “serious side effects” of these drugs, and that much more work needs to be done before the drugs can be used in clinical practice. (Note: We also reviewed a CNN.com story on this topic.)
According to the researchers, “About a third of patients who are resistant to antidepressants show evidence of inflammation.” If these patients are not helped by existing anti-depressant drugs, but would be helped by drugs that reduced inflammation by reducing cytokines, then these patients could have improvement in their mental state. A new set of drugs to treat depression would provide hope for those who have currently untreatable depression.
There is no mention of the cost of any of these drugs. A Consumer Report article puts many of these drugs in the range of on average $2,000 a month when treating rheumatoid arthritis. It is unclear if the same doses would treat depression. This was also an issue in CNN’s story.
There is no indication of how much these anti-inflammatory drugs help relieve depression because the anti-depressive effect was a secondary effect of these clinical trials. It would be nice to know how they rated the effects on depression, but that information is not included.
The researchers note that “some existing drugs can have potentially serious side effects, which would need to be addressed.” Because each of these drugs differ, consideration of the side effects of each would be something a patient should consider based on the benefits and evidence.
The side effects of anti-inflammatory medications can be serious. They may increase cancer risk and through suppression of the immune system, increase susceptibility to infection. The release would have been stronger had it offered more specifics about potential harms.
The news release notes at the very beginning that the information comes from a review of 20 clinical trials. While the release could have done more to discuss the limitations as well as the strengths of the meta-analysis, it does include a pretty clear statement about what the study can and can’t tell us.
“It’s too early to say whether these anti-cytokine drugs can be used in clinical practice for depression, however,” adds Professor Peter Jones, co-author of the study. “We will need clinical trials to test how effective they are in patients who do not have the chronic conditions for which the drugs have been developed, such as rheumatoid arthritis or Crohn’s disease.”
We’ll reward that cautionary note with a Satisfactory grade.
The release doesn’t engage in disease mongering. Untreatable depression is a mental disease that impacts quality of life as well as physical health.
The funding of the review article are clearly stated in the release. However, the potential conflicts of interest among researchers involved in the studies included in the review are not mentioned. Some of the researchers received honoraria from drug companies. That should have been noted in the release.
The release make clear that these drugs would be aimed at patients currently not helped by any existing drugs, so a comparison with those other medications would not be very helpful here. The release could have included some non-pharmaceutical alternatives.
While this meta-analysis was done on clinical trials data, all of the drugs involved are currently available for treatment of autoimmune diseases such as rheumatoid arthritis and psoriasis, and the release makes this clear.
The implication is that the meta study is one of the first to look across the board at the secondary results of anti-inflammatories on depression. However, this has been an active area of research for at least a decade.
There is no unjustifiable language used in the release.