Aspirin Does Not Prevent Late Life Depression, Despite Link to Inflammation

Although depression has been linked to increased inflammation, low dose aspirin does not appear to offer improvements in the prevention of depression in older adults, according to a large placebo-controlled study published in JAMA Psychiatry.

Depression has been linked to elevated markers of inflammation, and aspirin, a nonsteroid, anti-inflammatory medication, can irreversibly inhibit cyclooxygenase-1 and 2. As a result, researchers have taken an interest in examining aspirin’s potential antidepressant qualities.

The Aspirin in Reducing Events in the Elderly (ASPREE) trial included 19,114 healthy older adults from Australia (over the age of 70 years) and the United States (over the age of 65 years). Michael Berk, MBBCH, PhD, of Deakin University School of Medicine, the Institute for Mental and Physical Health and Clinical Translation Strategic Research Centre, Geelong, Victoria, Australia, and colleagues randomly assigned participants to receive either daily 100 mg enteric coated aspirin (n=9525) or matching placebo (n=9589).

The mean ages in the aspirin and placebo groups were 75.2 years and 75.1 years, respectively. There was a median follow-up period of 4.7 years. A proxy measure of major depressive disorder, which was defined as a ≥8 score on the Center for Epidemiologic Studies Depression 10-item (CES-D-10) scale, comprised the primary outcome.

A mean of 4.2 CES-D-10 measurements were taken per participant, and 79,886 annual CES-D-10 measurements were taken in total. Depression symptoms were more prevalent at annual visits than they were at baseline in both the aspirin and placebo groups. At each annual visit, there were no differences between the aspirin and placebo groups in terms of the proportions of CES-D-10 scores ≥8. In the aspirin and placebo groups, the incidence rate of new CES-D-10 scores of ≥8 were 70.4 events vs 69.1 per 1000 person-years, respectively (hazard ratio, 1.02; 95% CI, 0.96-1.08; P =.54).

The study was limited in that it included patients with a high baseline quality of life, which may have impacted the findings and may reduce generalizability across groups of older adults with a poorer quality of life.

According to the investigators, the findings from this trial “do not support the hypothesis that low-dose aspirin can prevent late-life depression.” They noted that the absence of evidence for any efficacy for aspirin is made worse by the increased risk of bleeding events from prior studies.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Berk M, Woods RL, Nelson MR, et al. Effect of aspirin vs placebo on the prevention of depression in older people: A randomized clinical trial [published online June 3, 2020]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2020.1214.