NSAID Use May Hinder Bipolar Disorder Treatment

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Analgesics such as NSAIDs may hinder antidepressant therapy
Analgesics such as NSAIDs may hinder antidepressant therapy

The use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, alone or together, does not appear to affect mood stabilizing treatment with lithium or quetiapine in patients with bipolar disorder. The full findings from the study are published in Depression and Anxiety

Due to increased pain sensitivity, patients with mood disorders may use analgesics such as NSAIDs for treatment, but recent studies have suggested that these agents may hinder antidepressant therapy. In this study, researchers assessed the use of NSAIDs and acetaminophen in patients who were randomized to 6 months of treatment with either lithium or quetiapine; psychopathology was measured using the Clinical Global Impression Scale (CGI-BP) and Bipolar Inventory of Symptoms Scale (BISS). The effects of NSAIDs and acetaminophen on treatment outcome were assessed and adjusted for age, gender, body mass index (BMI), smoking status, exercise, and somatic diseases. 

Of the 482 total study patients, 177 (34.7%) used NSAIDs and/or acetaminophen during the study. With regards to treatment outcome with lithium or quetiapine, NSAID/acetaminophen users did not differ from non-users on the overall CGI-BP (β=0.001 (95% CI: −0.01 to −0.01; = 0.87), BISS (β=0.01, 95% CI: −0.17 to 0.15; = 0.91), or the CGI-BP subscales for depression or mania. Patients who used NSAIDs only, acetaminophen only, and those who used both NSAIDs and acetaminophen demonstrated no statistical difference vs. non-users (P > 0.3 for all).

"This is the first trial to show that use of NSAIDs and [acetaminophen], alone or in combination, does not affect lithium- or quetiapine-based bipolar disorder mood-stabilizing treatment outcomes," concluded Ole Kohler-Forsberg, MD, study author. 

Reference

Köhler-Forsberg O, Sylvia L, Thase M, et al. Nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol do not affect 6-month mood-stabilizing treatment outcome among 482 patients with bipolar disorder. Depress Anxiety. 2017 Jan 30. doi: 10.1002/da.22601. [Epub ahead of print]

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