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Nonsteroidal anti‐inflammatory drugs (NSAIDs) and paracetamol do not affect 6‐month mood‐stabilizing treatment outcome among 482 patients with bipolar disorder
Author(s) -
KöhlerForsberg Ole,
Sylvia Louisa,
Thase Michael,
Calabrese Joseph R.,
Deckersbach Thilo,
Tohen Mauricio,
Bowden Charles L.,
McInnis Melvin,
Kocsis James H.,
Friedman Edward S.,
Ketter Terence A.,
McElroy Susan,
Shelton Richard C.,
Nierenberg Andrew A.
Publication year - 2017
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22601
Subject(s) - quetiapine , bipolar disorder , mood , medicine , mania , lithium (medication) , psychopathology , clinical global impression , psychiatry , schizophrenia (object oriented programming) , placebo , alternative medicine , pathology
Background Many mood disorder patients need analgesics due to increased pain sensitivity. Recent studies have suggested that nonsteroidal anti‐inflammatory drugs (NSAIDs) may inhibit antidepressant treatment, which requires replication before clinical recommendations. Methods The Clinical and Health Outcomes Initiatives in Comparative Effectiveness for Bipolar Disorder Study randomized participants to 6 months lithium or quetiapine treatment. Use of NSAIDs and paracetamol was assessed throughout the study period and psychopathology measured with the Clinical Global Impression Scale for Bipolar Disorder (CGI‐BP) and Bipolar Inventory of Symptoms Scale (BISS). The effects of NSAIDs and paracetamol on treatment outcome were examined using mixed effects linear regression adjusted for age, gender, body mass index, smoking status, exercise, and somatic diseases. Results Among 482 participants, 177 (36.7%) used NSAIDs and/or paracetamol during the study. NSAID and paracetamol users did not differ from nonusers with respect to treatment outcome with lithium or quetiapine at any time point during 6 months treatment on the overall CGI‐BP (β = 0.001 (95% CI = −0.01 to −0.01), P = .87), the BISS (β = 0.01 (95% CI = −0.17 to 0.15), P = .91), nor the CGI‐BP subscales for depression or mania. Users of NSAIDs only ( n = 76), paracetamol only ( n = 62), and users of both NSAIDs and paracetamol ( n = 39) showed no statistical difference compared to nonusers (all P > .3). Conclusions This is the first trial to show that use of NSAIDs and paracetamol, alone or in combination, does not affect lithium‐ or quetiapine‐based bipolar disorder mood‐stabilizing treatment outcomes. Prior studies have suggested that NSAIDs may inhibit antidepressant treatment, whereas our results support findings indicating no detrimental effects of NSAIDs or paracetamol on affective disorder treatment.