What are anti-inflammatory medications for bipolar disorder?

Growing evidence suggests that inflammatory processes may contribute to the development of mental disorders. Pro-inflammatory cytokines interleukin (IL) 4, tumor necrosis factor alpha (TNF-a), soluble IL-2 receptor (sIL-2R), IL-1b, IL-6, soluble receptor of TNF-a type 1 (STNFR1), and C-reactive protein (CRP) have been shown to be elevated in people with bipolar disorder compared to healthy controls. This suggests a potential role for anti-inflammatory agents in the treatment of bipolar disorder. These agents primarily include non-steroidal anti-inflammatory agents (e.g., aspirin, celecoxib), but also omega-3 polyunsaturated fatty acids, N-acetylcysteine (a glutemate modulator) and pioglitazone (an antidiabetic) have some anti-inflammatory properties.

What is the evidence for anti-inflammatory medications?

Moderate to high quality evidence finds adjunctive omega-3 to be more effective than placebo for depression, but not for mania symptoms. There is good evidence of some benefit of adjunctive celecoxib over placebo for mania symptoms. Moderate quality evidence finds some benefit of adjunctive N-acetylcysteine over placebo for depression, with no differences in adverse events. The finding for depression was not consistently found across reviews due to slight differences in included studies. Moderate to low quality evidence finds no benefit of adjunctive aspirin for depression, and low quality evidence is unable to determine any benefits of pioglitazone.

November 2021

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Last updated at: 4:27 pm, 29th November 2021
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