El rol de los fármacos antiinflamatorios en la depresión

  • Julio Torales Universidad Nacional de Asunción
  • Israel González Universidad Nacional de Asunción
  • Iván Barrios Universidad Nacional de Asunción
Palabras clave: trastorno depresivo mayor; depresión; antiinflamatorios

Resumen

Existen varias teorías con respecto a la patogénesis de la depresión. Actualmente se encuentra en investigación la teoría inflamatoria, con resultados que sugieren una relación de la depresión a la inflamación, de la inflamación a la depresión o, quizá con más precisión, una relación bidireccional entre estas dos entidades.

En este artículo se presenta brevemente una descripción del trastorno depresivo mayor con sus criterios diagnósticos y datos epidemiológicos, una explicación de la teoría inflamatoria de la depresión y una actualización acerca de la evidencia con respecto al uso de fármacos antiinflamatorios como parte del abordaje terapéutico de esta patología.

Biografía del autor

Julio Torales, Universidad Nacional de Asunción

Profesor Asistente de la Cátedra de Psiquiatría. Facultad de Ciencias Médicas, Universidad Nacional de Asunción

Israel González, Universidad Nacional de Asunción

Médico residente de Psiquiatría. Facultad de Ciencias Médicas, Universidad Nacional de Asunción.

Iván Barrios, Universidad Nacional de Asunción

Ayudante de Cátedra. Facultad de Ciencias Médicas, Universidad Nacional de Asunción.

Citas

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: APA Press; 2013.
2. Sadock BJ, Sadock VA, Ruiz P. Mood Disorders. En: Kaplan & Sadock’s Synopsis of Psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2015.
3. Ferrari AJ, Somerville AJ, Baxter AJ, Norman R, Patten SB, Vos T, et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol Med. 2013;43(3):471-481.
4. World Health Organization. Depression Fact Sheet [Internet]. 2017 [citado 2 de febrero de 2018]. Disponible en: http://www.who.int/mediacentre/factsheets/fs369/en/
5. Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL, et al. Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010. PLoS Med. 2013;10(11):e1001547.
6. World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017.
7. Warden D, Rush AJ, Trivedi MH, Fava M, Wisniewski SR. The STAR*D project results: A comprehensive review of findings. Curr Psychiatry Rep. 2007;9(6):449-459.
8. Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JB, deGruy F V, et al. Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA. 1995;274(19):1511-1517.
9. Choi Y-J, Lee W-Y. The prevalence of suicidal ideation and depression among primary care patients and current management in South Korea. Int J Ment Health Syst. 2017;11(1):18.
10. Rouchell A, Pounds R, Tierney J. Depression. In: Wise M, Rundell J, editors. The American Psychiatric Publishing Textbook of Consultation-Liaison Psychiatry: Psychiatry in the Medically Ill. 2th ed. Washington DC: APA Press; 2002. p. 307-338.
11. Seldenrijk A, Vogelzangs N, Batelaan NM, Wieman I, van Schaik DJF, Penninx BJWH. Depression, anxiety and 6-year risk of cardiovascular disease. J Psychosom Res. 2015;78(2):123-129.
12. Elderon L, Whooley MA. Depression and Cardiovascular Disease. Prog Cardiovasc Dis. 2013;55(6):511-523.
13. Seligman F, Nemeroff CB. The interface of depression and cardiovascular disease: therapeutic implications. Ann N Y Acad Sci. 2015;1345(1):25-35.
14. Dong J-Y, Zhang Y-H, Tong J, Qin L-Q. Depression and Risk of Stroke: A Meta-Analysis of Prospective Studies. Stroke. 2012;43(1):32-37.
15. Chang HY, Keyes KM, Mok Y, Jung KJ, Shin Y-J, Jee SH. Depression as a risk factor for overall and hormone-related cancer: The Korean cancer prevention study. J Affect Disord. 2015;173:1-8.
16. Huang T, Poole EM, Okereke OI, Kubzansky LD, Eliassen AH, Sood AK, et al. Depression and risk of epithelial ovarian cancer: Results from two large prospective cohort studies. Gynecol Oncol. 2015;139(3):481-486.
17. Fornaro M, Iovieno N, Clementi N, Boscaro M, Paggi F, Balercia G, et al. Diagnosis of co-morbid axis-I psychiatric disorders among women with newly diagnosed, untreated endocrine disorders. World J Biol Psychiatry. 2010;11(8):991-996.
18. Wang X, Zhang L, Lei Y, Liu X, Zhou X, Liu Y, et al. Meta-analysis of infectious agents and depression. Sci Rep. 2014;4:4530.
19. Krebber AMH, Buffart LM, Kleijn G, Riepma IC, De Bree R, Leemans CR, et al. Prevalence of depression in cancer patients: A meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014;23(2):121-130.
20. Wise MG, Rundell JR. Depression. En: Clinical Manual of Psychosomatic Medicine: A Guide to Consultation-Liaison Psychiatry. 1st ed. Arlington: APA Press; 2005. p. 67-88.
21. Simon GE. Social and economic burden of mood disorders. Biol Psychiatry. 2003;54(3):208-215.
22. Howren MB, Lamkin DM, Suls J. Associations of depression with c-reactive protein, IL-1, and IL-6: A meta-analysis. Psychosom Med. 2009;71(2):171-186.
23. Mastorakos G, Chrousos GP, Weber JS. Recombinant interleukin-6 activates the hypothalamic-pituitary-adrenal axis in humans. J Clin Endocrinol Metab. 1993;77(6):1690-1694.
24. O’Keane V, Frodl T, Dinan TG. A review of Atypical depression in relation to the course of depression and changes in HPA axis organization. Psychoneuroendocrinology. 2012;37(10):1589-1599.
25. Han Q-Q, Yu J. Inflammation: a mechanism of depression? Neurosci Bull. 2014;30(3):5155-23.
26. Hayley S, Poulter MO, Merali Z, Anisman H. The pathogenesis of clinical depression: Stressor- and cytokine-induced alterations of neuroplasticity. Neuroscience. 2005;135(3):659-678.
27. Maciel IS, Silva RBM, Morrone FB, Calixto JB, Campos MM. Synergistic Effects of Celecoxib and Bupropion in a Model of Chronic Inflammation-Related Depression in Mice. PLoS One. 2013;8(9):1-15.
28. Johansson D, Falk A, Marcus MM, Svensson TH. Celecoxib enhances the effect of reboxetine and fluoxetine on cortical noradrenaline and serotonin output in the rat. Prog Neuro-Psychopharmacology Biol Psychiatry. 2012;39(1):143-148.
29. Tyring S, Gottlieb A, Papp K, Gordon K, Leonardi C, Wang A, et al. Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebo-controlled randomised phase III trial. Lancet. 2006;367(9504):29-35.
30. Iyengar RL, Gandhi S, Aneja A, Thorpe K, Razzouk L, Greenberg J, et al. NSAIDs are associated with lower depression scores in patients with osteoarthritis. Am J Med. 2013;126(11):1017.e11-8.
31. Abbasi SH, Hosseini F, Modabbernia A, Ashrafi M, Akhondzadeh S. Effect of celecoxib add-on treatment on symptoms and serum IL-6 concentrations in patients with major depressive disorder: Randomized double-blind placebo-controlled study. J Affect Disord. 2012;141(2-3):308-314.
32. Majd M, Hashemian F, Hosseini SM, Vahdat Shariatpanahi M, Sharifi A. A Randomized, Double-blind, Placebo-controlled Trial of Celecoxib Augmentation of Sertraline in Treatment of Drug-naive Depressed Women: A Pilot Study. Iranian Journal of Pharmaceutical Research : IJPR. 2015;14(3):891-899.
33. Yermakova A, O’Banion MK. Cyclooxygenases in the central nervous system: Implications for treatment of neurological disorders. Curr Pharm Des. 2000;6(17):1755-1776.
34. Santiago RM, Barbiero J, Martynhak BJ, Boschen SL, da Silva LM, Werner MFP, et al. Antidepressant-like effect of celecoxib piroxicam in rat models of depression. J Neural Transm. 2014;121(6):671-682.
35. Kohler O, Krogh J, Mors O, Eriksen Benros M. Inflammation in Depression and the Potential for Anti-Inflammatory Treatment. Curr Neuropharmacol. 2016;14(7):732-742.
36. Müller N, Schwarz MJ, Dehning S, Douhe A, Cerovecki A, Goldstein-Müller B, et al. The cyclooxygenase-2 inhibitor celecoxib has therapeutic effects in major depression: Results of a double-blind, randomized, placebo controlled, add-on pilot study to reboxetine. Mol Psychiatry. 2006;11(7):680-684.
37. Akhondzadeh S, Jafari S, Raisi F, Nasehi AA, Ghoreishi A, Salehi B, et al. Clinical trial of adjunctive celecoxib treatment in patients with major depression: A double blind and placebo controlled trial. Depress Anxiety. 2009;26(7):607-611.
38. Uher R, Carver S, Power RA, Mors O, Maier W, Rietschel M, et al. Non-steroidal anti-inflammatory drugs and efficacy of antidepressants in major depressive disorder. Psychol Med. 2012;42(10):2027-2035.
39. Gallagher PJ, Castro V, Fava M, Weilburg JB, Murphy SN, Gainer VS, et al. Antidepressant response in patients with major depression exposed to NSAIDs: A pharmacovigilance study. Am J Psychiatry. 2012;169(10):1065-1072.
40. Warner-Schmidt JL, Vanover KE. Antidepressant effects of selective serotonin reuptake inhibitors (SSRIs) are attenuated by antiinflammatory drugs in mice and humans. Proc Natl Acad Sci USA. 2011;108(22):9262-9267.
41. Bello A, O’Higgins M, Páez L, Torales J, Arce A. Trastorno depresivo y su asociación con la edad en pacientes de la Cátedra y Servicio de Psiquiatría, FCM-UNA. An. Fac. Cienc. Méd. (Asunción) 2015;48(2):53-63.
42. Páez López L, O’Higgins Roche M, Torales Benítez J. Pérdida económica acorde a años de vida perdidos por discapacidad en pacientes de la Cátedra y Servicio de Psiquiatría de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, Paraguay, años 2011-2012. Revista Paraguaya de Psiquiatría 2013;1(2):24-31.
Publicado
2018-03-01
Sección
ARTÍCULOS DE REVISIÓN