Anti-inflammatory agents for the treatment of depression in the light of comorbid cardiovascular disease

Abstract

A growing body of evidence supports the role of infl ammation as a common etiological factor of the pathophysiology of depression and cardiovascular diseases. Recent clinical studies have indicated that different anti-infl ammatory agents may yield antidepressant treatment effects, both as add-on and monotherapy. However, cardiac side effects emphasize cautious use of several agents, whereas other agents might have benefi cial effects on both depression and cardiovascular disease. The current chapter aims to review the most promising anti- infl ammatory agents that have been studied in depressed individuals and other patient groups including their potential underlying mechanisms. The most frequently investigated agents are nonsteroidal anti-infl ammatory drugs (NSAIDs), monoclonal antibodies, and polyunsaturated fatty acids, but antidepressant properties were also observed for statins, minocycline, pioglitazone, cortisol, modafi nil, and angiotensin-2 receptor antagonists. In addition, this chapter will discuss important clinical aspects for identifying patient groups which will be most likely to benefi t of anti-infl ammatory treatment, such as biological markers potentially predicting antidepressant treatment effects of anti-infl ammatory intervention, timing and duration of anti-infl ammatory intervention, and targeting specifi c depressive symptoms. Finally, we will discuss which anti-infl ammatory agents, e.g., statins and low-dose acetylsalicylic acid, may represent relevant add-on treatment strategies in patients suffering of comorbid depression and cardiovascular diseases.