A new study has shown that two very common groups of drugs, used extensively in the United States, can mix badly when used together. The drugs in question are anti-inflammatory drugs and
antidepressants. The study found that most common over-the-counter anti-inflammatory drugs,
such as aspirin and ibuprofen, reduce efficacy of certain antidepressants.
The antidepressants in question are selective serotonin reuptake inhibitors (SSRIs). SSRIs are widely used with over 20 million Americans reported to be suffering from depression. On the other
hand, over-the-counter anti-inflammatory drugs fall under the group called non-steroidal anti-
inflammatory drugs (NSAIDs).
The study conducted by the Fisher Center for Alzheimer's Disease Research, Rockefeller University,New York City finds "a very strong antagonistic relationship" between SSRIs and NSAIDs. Dr. Paul Greengard, Director, Fisher Center for Alzheimer’s Disease Research, along with co-author of the study Dr. Jennifer Warner-Schmidt administered antidepressant drugs in mice. The antidepressants were given once in presence of anti-inflammatory drugs and then in absence of them. It was found that when treated with antidepressants in presence f anti0inflammatory drugs, the behavioral responses were greatly reduced. The study was then conducted on humans.
According to Dr. Warner-Schmidt, "The work that we did in the animal models was using drugs like ibuprofen, aspirin and naproxen which are commonly taken by many people, and then we were able to take advantage of the human clinical work, where we were able to analyze, after the fact, a data set that was collected in human individuals that had depression, and we looked at whether the anti-inflammatory drugs or analgesic drugs attenuated their response rates."
For the study on humans Dr. Greengard and Dr. Warner-Schmidt took data
titled Sequenced Treatment Alternatives to Relieve Depression (STAR*D) that was conducted over a period of seven years on 4,000 patients suffering from major depressive disorders and belonging to the age group of 18-75.It was found that among patients who were not taking NSAIDs the success rate of the antidepressants was 55%. But the same success rate reduced to 40% among patients who
were taking NSAIDs along with the SSRIs.
Dr. Greengard says, "SSRIs have dramatic therapeutic effects in lots of patients. But we found both in mice and humans, if they have consumed drugs like aspirin or ibuprofen, this attenuates the
therapeutic effects of antidepressants."
To determine why NSAIDs had adverse effects of the functioning of SSRIs, the scientists used genetic techniques in mice. They first demonstrated how SSRIs work. SSRIs raise the levels of p11 proteins.
This increased level of p11 makes more serotonin receptors available on cell surfaces thereby increasing serotonin transmission. In this way, SSRIs help combat depression. But it was found that NSAIDs inhibits the positive effects of p11 and thereby adversely affects the efficacy of SSRIs. However, the study could not ascertain whether the adverse effects are encountered though long
term use of NSAIDs or not.
According to Dr. Greengard, "We’re not in a position to recommend to doctors. The way we phrase it is very carefully. Depending on the intensity of the pain, they (doctors) might want to consider – if it's low-level intensity – taking patients off the anti-inflammatory and the analgesics, and at least just do a trial period with the SSRI, or if that doesn't seem appropriate and the pain level is higher, then have them on a non-SSRI antidepressant."
