Pooled data suggest that nonsteroidal anti-inflammatory drugs (NSAIDs) can augment antipsychotic treatment and ease schizophrenia symptoms, according to Dutch researchers.
Dr Iris E Sommer, lead author of a report online December 13 in the Journal of Clinical Psychiatry, told Reuters Health in an email, "We found that NSAIDs used in addition to antipsychotics can ameliorate both psychotic and negative symptoms, which is a promising finding."
Hallucinations and delusions, for example, are considered psychotic symptoms, while lack of motivation and energy are negative symptoms. Antipsychotic medication helps most patients with psychotic symptoms but cannot improve negative symptoms, Dr Sommer said.
She and her colleagues at University Medical Centre Utrecht note that inflammation may play a role in the pathogenesis of schizophrenia. One study showed a lower prevalence of schizophrenia in men who use anti-inflammatory agents, and several groups have reportedly used NSAIDs to augment antipsychotic treatment.
Mean change in Positive and negative syndrome scale
To help consolidate the various findings, the researchers conducted a meta-analysis of five double-blind, randomised, placebo-controlled trials involving 264 patients. Four studies used celecoxib; the other used aspirin along with antipsychotic drugs.
The primary outcome was the mean change in total score on the Positive and Negative Syndrome Scale (PANSS). This was used to calculate the mean standardised difference which was significant at 0.43 and indicated a moderate effect.
Secondary outcome measures included positive and negative symptom sub scores of the PANSS. The mean standardised difference for the effect of NSAID augmentation was 0.26 for negative symptoms and 0.34 for positive symptoms.
Additional aspirin improves schizophrenia symptoms
The investigators say the findings give provisional evidence that "NSAID augmentation has a moderate beneficial effect on total symptom severity as well as on positive symptoms in schizophrenia and a small effect on negative symptoms."
They speculate that aspirin could have the additional benefit of reducing the elevated cardiac and cancer mortality in schizophrenia.
"Many antipsychotic medications induce weight gain," Dr Sommer said, "which is superimposed on an already low energy... because of the negative symptoms. Overweight, diabetes and cardiac diseases are therefore high in schizophrenia. The use of additional aspirin may therefore improve schizophrenia symptoms and also improve somatic health."
The approach, the authors conclude, "appears to be an avenue that deserves more research".
(David Douglas, Reuters Health, January 2012)
Nonsteroidal anti-inflammatory drugs