Background:
Abundant evidence suggests that inflammatory cytokines contribute to the symptoms of major depressive disorder (MDD) by altering neurotransmission, neuroplasticity, and neu-roendocrine processes. Given the unsatisfactory response and remission of monoaminergic antidepres-sants, anti-inflammatory therapy is proposed as a feasible way to augment the antidepressant effect. Recently, there have been emerging studies investigating the efficiency and efficacy of anti-inflammatory agents in the treatment of MDD and depressive symptoms comorbid with somatic diseases.
Methods:
In this narrative review, prospective clinical trials focusing on anti-inflammatory treatment
for depression have been comprehensively searched and screened. Based on the included studies, we
summarize the rationale for the anti-inflammatory therapy of depression and discuss the utilities and
confusions regarding the anti-inflammatory strategy for MDD.
Results:
This review included over 45 eligible trials. For ease of discussion, we have grouped them into
six categories based on their mechanism of action, and added some other anti-inflammatory modalities,
including Chinese herbal medicine and non-drug therapy. Pooled results suggest that anti-inflammatory
therapy is effective in improving depressive symptoms, whether used as monotherapy or add-on therapy. However, there remain confusions in the application of anti-inflammatory therapy for MDD.
Conclusion:
Based on current clinical evidence, anti-inflammatory therapy is a promisingly effective
treatment for depression. This study proposes a novel strategy for clinical diagnosis, disease classifica-
tion, personalized treatment, and prognostic prediction of depression. Inflammatory biomarkers are
recommended to be assessed at the first admission of MDD patients, and anti-inflammatory therapy
are recommended to be included in the clinical practice guidelines for diagnosis and treatment. Those
patients with high levels of baseline inflammation (e.g., CRP > 3 mg/L) may benefit from adjunctive
anti-inflammatory therapy.