NEW YORK (Reuters Health) – Pooled data suggest that nonsteroidal anti-inflammatory drugs (NSAIDs) can augment antipsychotic treatment and reduce schizophrenia symptom severity, Dutch researchers report in a December 13th on-line paper in the Journal of Clinical Psychiatry.
“We found that NSAIDs used in addition to antipsychotics can ameliorate both psychotic and negative symptoms, which is a promising finding,” Dr. Iris E. Sommer told Reuters Health by email.
Schizophrenia, she added, “consists of psychotic symptoms, such as hallucinations and delusions and negative symptoms, such as lack of motivation and energy. Most patients are treated with antipsychotic medication, which is effective for psychotic symptoms in most of them, but cannot improve negative symptoms.”
Dr. Sommer and colleagues at University Medical Center Utrecht note that the pathogenesis of schizophrenia is still far from elucidated but inflammation may be involved. A study has shown decreased prevalence of schizophrenia in men who have used antiinflammatory agents. Several studies have used NSAIDs to augment antipsychotic treatment.
To help consolidate these findings, the researchers conducted a meta-analysis of 5 double-blind, randomized, placebo-controlled trials, reporting on 264 patients. Four studies used celecoxib and the remaining one employed aspirin in addition to antipsychotic medication.
The primary outcome measure was the mean change in total score on the Positive and Negative Syndrome Scale (PANSS). This was used to calculate the mean standardized difference which was significant at 0.43 and indicated a moderate effect.
Secondary outcome measures included positive and negative symptom subscores of the PANSS. The mean standardized difference for the effect of NSAID augmentation on negative symptoms was 0.26. For positive symptoms, it was 0.34.
Thus, say the investigators, 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 use of acetylsalicylic acid could have the additional benefit of reducing the elevated cardiac and cancer mortality in schizophrenia.
“Many antipsychotic medications induce weight gain,” Dr. Sommer continued, “which is superimposed on an already low energy use 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.”
