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Can Anti-Inflammatories Treat Depression? – New Research


– Hi, I’m Dr. Tracey
Marks, a psychiatrist; and I make videos on
mental health education and self-improvement. Earlier this year, I did
a video talking about how we look at the cause of depression differently than we did 10 years ago, and how that cause calls
for a different way of treating depression. I got a lot of questions about what are some of the new drugs. There’s lots of drugs that
are still under development that address brain connectivity instead of simply
increasing brain chemicals. What I’m talking about today also addresses that issue of treating depression differently. NSAID stands for non-steroidal
antiinflammatory drugs, and they’re medications that treat inflammation in the body, but they’re not steroids. These are drugs like ibuprofen or Motrin, Naproxen or Aleve, or celecoxib or Celebrex. There’s been a growing
body of research showing that people who are
depressed have higher levels of inflammatory chemicals in the body. Also, people with infection
and autoimmune disorders have an increased risk
of developing depression. Autoimmune means your
body forms antibodies to your own tissues in your body. And examples of autoimmune disorders are rheumatoid arthritis, lupus and multiple sclerosis; even psoriasis, which is a skin disorder, is autoimmune. So groups of people with these disorders have been studied, and we’ve seen a higher incidence of depression in these groups of people. There was a 2019 study that analyzed several randomized controlled trials using antiinflammatory medications to treat depression;
both as an add-on agent, and also as the only
medication that was used. And we call this monotherapy when you only use one medication. The result showed
improvement in depression with the use of NSAIDs, with celecoxib rising to the top as the one that was used the most. And the dose used most in those studies was 200 milligrams twice a day. Here’s how the drug works. NSAIDs block the enzyme cox-2 that makes prostaglandins. Prostaglandins are
chemicals that contribute to arthritis, pain, fever, and pain that’s caused with inflammation. With lower concentrations
of prostaglandins, you get less inflammation, less pain, and less depression. Celebrex blocks the enzyme
that makes prostaglandins, so you get lower concentrations
of these chemicals. We don’t have a complete understanding of how inflammation
actually causes depression or vice versa, and it’s not
clear which comes first. So understanding this
is a work in progress, and this is one of the reasons why antiinflammatory medications isn’t a mainstream
recommendation just yet. Another reason that I think
it hasn’t hit mainstream yet is the side effects that
you can get with NSAIDs. NSAIDs increase the risk of
gastrointestinal bleeding, and this is something that can happen any time during the use of the medication, and not just with chronic use. Even if you don’t get bleeding, you can still get pretty
serious stomach upset. Also, many of the NSAIDs
like Celebrex and Vioxx cause an increase in
strokes and heart attacks. In fact, Vioxx was taken
off the market in 2004 because of this problem. Celebrex has remained on the market, but it and other NSAIDs
have a black box warning about the risk of stroke and heart attack. And this is what the black box warning
looks like for NSAIDs. A black box warning is a warning issued by the FDA and required to go on the package information. It’s just a way to emphasize serious drug side effects to ensure that you’re informed of these risks. Incidentally, there
have been a few studies showing benefit for schizophrenia and bipolar disorder, as well. So what do I think about this? I tend to be on the conservative side of prescribing medications,
and I’m a little skittish about using things that can create a lot of uncomfortable side effects. And even if we get past the risk of stroke and heart attack, chronic use of NSAIDs can be really hard on your digestive tract as
far as developing ulcers or general stomach upset. Now some people with chronic pain problems don’t have much choice,
because they need the medicine to stay out of pain; and in those cases, I say, “Okay, maybe there
can be a double benefit “to taking the pain medication.” Oh, and speaking of bipolar disorder, you wanna be super careful
if you’re taking NSAIDs and you’re on lithium, as NSAIDs can increase lithium levels. So if you’ve sprained your ankle, and you started taking ibuprofen, let your doctor know. And you should probably have
your lithium level checked, depending on how long you’ve
been taking the ibuprofen. Now, to minimize bleeding risks, it’s recommended to taper off the NSAID after six months of continuous use, and this is if you were gonna use it to treat depression. And I think I would be more inclined to give it a try in someone who’s not responding well enough to the standard add-on agents that we usually use, but that’s just me. But this is something
that I wanted you to know, and if you’re interested in this, you can bring it up with your doctor and see if it’s a good idea for you. See you next time.

81 thoughts on “Can Anti-Inflammatories Treat Depression? – New Research

  1. Doctor, please make a video on what happens a person is misdiagnosed and given medication for bipolar disorder for two years . What will happen to him??

  2. Is this why I am seeing people use LDN and seeing improvement in Bipolar Disorder? I use LDN for autoimmune because it decreases inflammation. My son has bipolar disorder and this makes sense…before on medication I remember when I would give him Motrin for say a headache I would swear his behavior was improved.

  3. I have suffered from depression since a child always remember feeling sad and alone, my mother suffered with bad anxiety and she was on Vallim years! so i think its in my genes why i suffer with depression plus had a lot of tragedy in my life has not helped.

  4. Im in love with you call me crazy , I'm a man , I can't help it. I can't stop thinking about you , every time I try stop forgetting you your videos pop up.

  5. Dr. T no one predicts when an empath is going to emerge among populations, nor what degree of good they're going to perform, but empaths with psychiatric disorders probably simply do more than ones from control groups, am I right?

  6. You're aware how the matter of Extraversion and Introversion is not Either/Or, of what I could say of myself I am just really not extravert, though Introversion can be unconventional in it's way, you've heard the psychotic is prone for introversion, I believe I know the reason, they may remain quiet outwardly, have to keep conditions calm environmentally, but the volume of the twisting, tearing apart, and the screaming is so loud within, and there can be little recess

  7. I don’t know about anti inflammatory meds, but Gabapentin/Neurontin changed my life. 300 mg three times a day fixed my appetite and lit my world up better than any SSRI or Wellbutrin ever did.

  8. One more thing, stay away from FLU shots!!!!!!!!! If you have a severe reaction like I did in 2012, you will lose your mind. I recovered, but went through hell.

  9. What would you recommend for general neural distress. There is a cognative fogginess that often accompanies mental illness. I believe my mother to be schizophrenic and she is expresses incoherent speech and thoughts that bleed into delusions. It plays out like the confusion of some one walking up except she doesn't get settled.

  10. Good morning Dr. Marks. Thank you for doing your calendar. Mines is coming Friday. I glad you made that decision. You are so talented. And I love your educational videos. Enjoy your day.

  11. I’m wondering lately if brain disorders are in fact autoimmune? It does make sense that inflammation plays a role! I know a person who eats an autoimmune paleo diet who has been able to go off all meds for bipolar. He has done this for 5 years now! No bipolar symptoms as long as he adheres to the diet.

  12. I'm currently in CBT for Chronic pain and I'm taking Gabapentin, Tramadol, Protonix, Doxepin, Tolterodine, and finally Lamotrigine. I have multiple physical ailments that deeply depress me and keep my anxiety level high for fear of getting worse or eventually leading to not being able to work 😞. I feel like a stick in the mud

  13. Dr Marks Beyond Aspirin by Thomas M. Mewmark & Paul Schulick Is a in depth read on the subject. It has helped me with my back pain.
    I also concur with malik malik.

  14. Thanks for the informative video! I’ve always wondered if MDD and other brain disorders are autoimmunities themselves. Naproxen sodium used to have a calming effect on me when took it for pain but I can’t take it for long due to stomach upset.

  15. Again very useful doctor marks. This is why I love your videos. That really gets me thinking on a couple of things. I have noticed that when I tend to start going manic or psychotic especially in the winter with or without my tooth infections that antibiotics such as amox-clav seem to be the best treatment that I can come up with myself. I have been thinking maybe it was the potassium or the magnesium that I might be benefiting from better than the amoxicillin itself which I seem to be building a tolerance to. I do take a lot of cold medicines in the winter as well to help with the tooth pain from the infections which may or may not have an allergic reaction with my zirconium crown, because it seems like the antihistamine in the liquid Nighttime Cold Medicine helps out more then the daytime medicine. I do tend to take a decent amount of acetaminophen and ibuprofen acetaminophen seems to work better for the headaches associated with the nerve damage from my root canals. and then when the stroke symptoms start to come on it seems the cold medicine mixed with a little bit of rum and alternating cold and warm showers is the only way to alleviate the massive headache and high head fevers. so that's definitely something to take note about and talk to my doctors even though I've been telling them the same thing for years.

    but yet again thank you very much doctor marks. as usual your videos are very interesting, useful and inspiring. They help me out a lot in understanding certain things that other people just can't seem to explain to me well enough to help me recognize / distinguish my bipolar , ADHD , conversion disorder and schizophrenic symptoms.

  16. Thank you so much for thos video. A lot of people with bipolar are not told by their Dr. That they need to watch taking some NSAIDs as you mentioned. Loved this video because you cover both sides and give an unbiased opinion

  17. Good morning Dr Marks,
    Very interesting video I’ve tried the Celebrex for Osteoarthritis arthritis in my back . Needless to say stomach pain G.I. problems . I simply take turmeric now curcumin . Have a great Thanksgiving tomorrow God bless you and your family .
    General repair

  18. I'm in love with psychiatry, I'm a human, I can't help it. I can't stop thinking about mechanisms underlying mental disorders… Every time I try to start living a normal life, your videos pop up and I go back to reading articles I can grab on NCBI.

  19. Good morning Dr. Marks 👋) This was very interesting 'I know that 'i suffer with anxiety and this occur after my grandma passed in 2016. "I never took anything for it because 'I don't like to take medication or any type of pills so 'I just do therapy and 'I love listening to your video. I've always thought that 'I suffer with bipolar also from a child from trauma that "I Witness ! Also I'm scared to get diagnosed because of certain job that "I have and 'I don't want that to be & Factor of employment 👈 ! 'I love you videos there very important and 'I always share with family and friend's. I'm learning something every time "I listen to you and I'll take notes. Thank you as always and have a bless holiday💞

  20. Hello, Doc, many thanks for your excellent presentations on YouTube. FYI I was prescribed Tramadol following hip replacement operations, and the effects on anxiety/depression were remarkable. They were extremely relaxing, reminiscent of pre med shots. Regards and take care – Michael

  21. Does wellbutrin increases the effect of prozac if someone took them together meaning that if I take two pills of prozac along with wellbutrin it is like taking 3 pills of prozac alone……..does wellbutrin increases the effectiveness of prozac?

  22. Good evening Dr.Marks! I've got a question about anxiety. Is it possible that anxiety can cause smell hallucinations? I've had smell hallucinations five times, all times being the same smell. I've visited my doctor and done tests, but all tests have come back negative. I've also been at a psychiatrist office, and done tests for bipolar and schizophrenia. Both coming back negative. They later told me it's caused by anxiety, could you perhaps explain how that happens and how to deal with it? I'm currently on Zoloft and don't get so mentally affected by it now when it comes and goes, but it still causes me distress.

  23. Prior to being diagnosed with ADHD & Type 2 Bipolar Disorder, I was on Celebrex for arthritis and it changed my life. I stopped taking it because I was managing my pain with exercise. I was able to gain mobility when I moved south from upstate NY. I would bet that it was relieving untreated Bipolar symptoms at the time. …Interesting…definitely going to bring it up at my next check in.
    Your content is very helpful! Thank you.

  24. I tore my rotator cuff and am on 15mg of Mobic daily. Scared about heart attack/stroke!!! But it helping depression is interesting!!

  25. Hi! I had problems with pain for 12 years now and sometimes I also get infammations that I treat with NSAID pills & then I have to take some extra blood test to check my lithium levels (as you said in the video). But at 3 times I had to get cortison injections & once I got cortison pills instead. I got really really bad mentally of the cortison though even though I took my lithium as usual, do you know why that is? The pills was worse, probably because I had to take them for 3 weeks (you faze upp and faze out at the end), the injection I only felt for about 5-8 days instead.
    I reacted stronger mentally negativ by the cortison than I have ever done by the NSAID'S, it got really really dark for a time, so bad I really wanted to die at that time. That was really scary, and I nerver read or heard about this happening with cortison when you take lithium, shouldn't there be warnings about it? Doctors have warned me about naproxen together with litium so why not warn about cortison???? Thank you for your videos, they are really helpful & good 😊🙏👏🏽💖

  26. Dr. Tracey which one is worse. Taking 1800 mg of ibuprofen daily or celebrex. I have been on ibuprofen so long til I am ready to try something new. Seems like the Advil jels works better when I am at home however I am in this facility and they give me ibuprofen. I have pain in my left knee and my back due to wear and tear but I am not wanting to do surgery. My email is [email protected]

  27. Hi, Tracey! I was wondering if you could cover (if you haven't already) ARFID?

    I've been in recovery of ARFID for a few years, but I can see symptoms coming back after a stomach bug. Any tips on how to successfully treat it?

    Thanks!

    -Gabe

  28. Hi Tracey thank you for the quality content on Mental Health conditions as always. I have suffered with Pure O Sensorimotor OCD for my entire life and tried several SSRIs which have been hit and miss but all had side effects. Do you think CBD oil could be worth looking into taking ( along with the daily exercise and Meditation I am doing) into reducing the daily anxiety it causes me? Any feedback would be much appreciated.

  29. I have to be careful with NSAIDS. I take Omeprazole twice a day because of a patch of long term use of NSAIDS due to an injury.
    Interesting video!

  30. I know this is a personality disorder but I think it’s been hyped up & as nearly misunderstood as schizophrenia; this pd being D.I.D. (dissociative identity disorder). I am aware there’s a spectrum or subtypes?? Thanks!

    [I met a woman who was sick and believed she was abducted as a child & cant remember it & her name wasn’t her name. As well as her kidnappers were out to get her because they didn’t want her to go to the police since she found out the truth. It made me think of D.I.D. At first I chuckled because it was an unusual thing to hear but I made her feel worse & shame. I just wanted to be able to understand more what it is & what it is like.]

  31. Thank you Dr.Marks. At one time there was panic about the dangers of using Celebrex and Vioxx for the reasons you have stated. It's now much more difficult to get doctors to prescribe these drugs for chronic pain. I notice that UCSF now has a psychiatrist in its dermatology department. It seems to be an acknowledgement that skin diseases may be accompanied by depression or other psychological manifestations.

  32. Thanks Dr Marks. Please could you do a talk on existential depression and whether this feeling is just a negative mindset or actually a manifestation of depression. Many thanks Teri

  33. I wondered the same thing. I was questioning whether anti-inflammatory medications could also cause mania in those with bipolar or if it was just relieving depression and it was the antidepressants now elevating their mood too high.

  34. I've been diagnosed as bipolar depressive but I have crazy moments of anxiety. It's like dropping a thousand feet in an airliner without warning. Just a flood gate of negative emotions and rage I have to shove out amidst ringing ears and blurred vision. I really wish i knew what this is and how to treat it, I just want it to leave me alone -_-.

  35. Love watching your videos. You always give me new insight on things.
    However I am glad that you brought up the fact about NSAIDs making levels of bipolar meds different. I was actually prescribed celabrex for my osteoarthritis. Within 2 weeks, my bipolar was all over the place. I actually thought my meds weren't working or needed adjusted. Turns out when I called my doctor, she told me to stop the NSAID and I was back to normal within 10 days.

  36. I have Crohn's Disease for which I was given a permanent stoma at the age of 21 (I'm now nearly 47). At the end of April this year (2019) I attempted suicide through severe depression and ended up in the psych hospital. I was diagnosed with "Mixed Anxiety & Depressive Disorder" and am now on venlafaxine. mirtazapine and clonazepam. Unfortunately I am seriously allergic to NSAIDS, although not aspirin (my dentist once told me that aspirin, although an anti-inflammatory, is not really from the same "family" of drugs as ibuprofen etc.)

  37. Hei, Tracey! Nice video as always! I would be really interested in hearing about Asperger's syndrome and its comorbidity with other psychiatric illnesses.

  38. Dr. Marks,

    I was diagnosed with Generalized Anxiety Disorder, but I'm really not sure what makes that anxiety disorder different from just the normal anxiety that people experience all the time. Most of the answers I've received are either extremely vague, or they're just someone reading the DSM definition without any context.
    Could you do a video on what makes GAD different from normal anxiety?

  39. Dr. Tracey Marks I just found your YouTube channel and I truly appreciate the work you do thank you. I want to know if "Post tramatic slave disorder" is a recognized psychological disorder by main steam psychology and if so what is your input on the disorder.

  40. Is there such thing as unipolar mania? I’ve heard of unipolar depression, and have been diagnosed with bipolar disorder, but my depressive episodes are few and far between, and extremely mild — and in all honestly may not even exist at all. On the flipside, my manic episodes can lead to dangerous behavior and are quite terrifying to me. Does unipolar mania exist?

  41. There are little information on atypical depression on Youtube, I would like to know what are the main medicine for the treatment, does anyone have this information?

  42. Hi! Just a question, bc I don't think I understand the conclusions of the research. Is the research saying that since folks with chronic pain disorders like MS felt less depressed when taking NSAIDs, that folks WITHOUT those conditions must also have some sort of inflammatory condition and so can also use NSAIDs as an antidepressant? antidepressant?

  43. what about steroidal anti-inflammatories? i have an auto-immune disorder and after taking my medication i feel ALOT better mentally aswell.

  44. Dr. Marks,

    I’m starting to believe that PTSD is a progressive disorder than can be properly managed with treatment and medications but no matter how much treatment one receives the disorder will get worse with time… my theory is as we age we lose energy and thus lose the ability to fight the symptoms internally what are your thoughts?

  45. Just found your channel, and I instantly subbed. I would love if you could speak about ADD and ADHD. As many doesn't really know what it is. Also that ADD is often over shadowed by ADHD, and would like more attention spread onto that topic ^^'

  46. Most clinicians don't understand Buddhist philosophy and I feel they misdiagnose due to their lack of knowledge of far eastern philosophy.

  47. Hey Dr. Marks I have a personal question. I'm not asking you to diagnose I know you can't online but I'm curious your thoughts since I can't really see a Psychiatrist. I have episodes where I feel like nothing is real like I'm in a dream would be the easiest way to explain it everything feels a little off. It's accompanied by a lower level of awareness of my surroundings. I struggle to focus, I forget where I am periodically, I forget what I'm doing and if travelling I forget where I'm going periodically. It usually goes on for 20-30 minutes before I feel normal and happens maybe twice a week. I haven't found a pattern that triggers it and it goes away on it's own. I've had it happen while talking to family, talking to friends, I've been on the bus to work, I've been at work etc. When talking to someone during these episodes I just kind of ramble and have no idea what I'm talking about or any sense of the conversation on my end but to whom I'm talking to it seems normal they can't tell I'm having an episode from what I've been told. I should also note that I'm somewhat aware of it happening and that adds a little paranoia to it and stress. It takes everything in me to remain functioning and do simple task. But i still do function during these episodes and come off normal when I feel not normal at all. Any idea what I could associate this with and recommendations?

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