NSAIDs Are Associated with Lower Depression Scores in Patients with Osteoarthritis

This study looked at whether or not NSAIDs, as an addition to antidepressant therapy, could decrease depressive symptoms in patients with osteoarthritis.  The study was a multicenter, double-blind, placebo-controlled study with patients who have active osteoarthritis.  Each participant was put into one of three groups: placebo group, ibuprofen 800 mg (three times a day) or naproxen 500 mg (two times a day) group, or Celebrex 200 mg (one time a day) group.  The patients were tested for major depression using the standard health questionnaire-9 (PHQ-9) scale.  Each person was tested at baseline, after two weeks of treatment and after six weeks of treatment.

The results showed that all three groups had similar average PHQ-9 scores at the baseline screening and at the last screening, after six weeks of treatment.  However, there was a detectable difference in change of PHQ-9 score between the groups with the ibuprofen/naproxen group and the Celebrex group having lower scores of .31 and .61 respectively.

The study concludes that NSAID usage in patients with osteoarthritis shows a trend of reduction in depressive symptoms.  I, however, do not believe there was enough evidence in the trial to conclude this.  Additionally, I believe they mistook correlation with causation.  Each group, in addition to a decrease in depression, also saw a decrease in pain.  As we have learned in class, pain can cause depression.  So while NSAID usage may correlate with decreased depression, it may have to do with the pain relief and not the specific mechanism of action of NSAIDs.  To disprove this, NSAIDs should also be compared to other pain relievers with different mechanisms of action.

Rupa IL, Gandhi s, Aneja A, et al. NSAIDs Are Associated with Lower Depression Scores in Patients with Osteoarthritis. Am J Med. 2013;126(11).

http://www.amjmed.com/article/S0002-9343(13)00358-6/abstract

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