Can paracetamol safely curb major depressive symptoms?

Although researchers abroad claim that anti-inflammatory agents such as aspirin or paracetamol can safely and effectively curb the symptoms of major depression, doctors here dispute the claim.

According to Rajnish Kumar, Neurologist, Paras Hospital in Gurugram, usage of anti-inflammatory drugs to curb symptoms of depression is still controversial.

"We haven't seen any such cases where anti-inflammatory drugs like aspirin, paracetamol or brufen have helped a patient. A lot of studies are taking place around the world regarding this but none of them had shown 100 per cent cure," Kumar told IANS.

"We cannot say anti-inflammatory drugs will tackle the issue. These drugs will have more counter-productive action as compared to curbing the depression symptoms. So, these agents won't be that beneficial," Kumar stressed.

For undertaking the study on the curative aspects of anti-inflammatory agents, researchers trawled databases to find suitable studies published up to January 2019. They have found 30 relevant randomised controlled trials, involving 1,610 people, which reported changes in depression scales.

They pooled the data from 26 of these studies.

The study, published in the US in the Journal of Neurology Neurosurgery and Psychiatry, suggested that anti-inflammatory agents were better than placebo and enhanced the effects of standard antidepressant treatment.

The effects were even greater when one or other of these agents were added to standard antidepressant treatment.

"The study claims that OTC drugs like aspirin and brufen can be used in depressive disorders. However it's premature to accept this in routine clinical practice as yet," said Tarun Sahni, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospitals in Delhi.

"The danger is that this may lead to self-diagnosing and medication for such illnesses and therefore the risk of delay in it with increased morbidity," Gupta added.

However, Rahul Gupta, Director of Department of Neurosurgery, Fortis Hospital in Nodia, said that anti-inflammatory medicine like aspirin in low doses can be effective in Psychiatric illnesses like bipolar disorder.

"In bipolar disorder, there is evidence of chronic inflammation and elevated pro-inflammatory cytokines. Aspirin, by its capacity to inhibit COX 1 enzyme, can reduce the inflammatory process in the brain. It down-regulates the brain arachidonic acid (AA) cascade to reduce neuroinflammation and excitotoxicity of neurons," Gupta explained.

"This has been hypothesised to reduce the symptoms in bipolar disorder. Also, it augments the effect of conventional anti-depressants in major depressive disorder and is helpful in resistant cases," Gupta told IANS.

"The doses of conventional medicines can be reduced and side effects like nausea, insomnia, weight gain, and suicidal thoughts can be reduced," he concluded.