Anti-inflammatory Agents for the Treatment of Depression in the Light of Comorbid Cardiovascular Disease

A growing body of evidence supports the role of inflammation as a common etiological factor of the pathophysiology of depression and cardiovascular diseases. Recent clinical studies have indicated that different anti-inflammatory agents may yield antidepressant treatment effects, both as add-on and monotherapy. However, cardiac side effects emphasize cautious use of several agents, whereas other agents might have beneficial effects on both depression and cardiovascular disease. The current chapter aims to review the most promising anti-inflammatory agents that have been studied in depressed individuals and other patient groups including their potential underlying mechanisms. The most frequently investigated agents are nonsteroidal anti-inflammatory drugs (NSAIDs), monoclonal antibodies, and polyunsaturated fatty acids, but antidepressant properties were also observed for statins, minocycline, pioglitazone, cortisol, modafinil, and angiotensin-2 receptor antagonists. In addition, this chapter will discuss important clinical aspects for identifying patient groups which will be most likely to benefit of anti-inflammatory treatment, such as biological markers potentially predicting antidepressant treatment effects of anti-inflammatory intervention, timing and duration of anti-inflammatory intervention, and targeting specific depressive symptoms. Finally, we will discuss which anti-inflammatory agents, e.g., statins and low-dose acetylsalicylic acid, may represent relevant add-on treatment strategies in patients suffering of comorbid depression and cardiovascular diseases.