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NSAIDs Linked to Psychiatric Problems
NSAIDs Linked to Psychiatric Problems -- Posted by Roman Bystrianyk on 02-10-05 04:38
http://www.healthsentinel.com/org_news.php?id=022&title=NSAIDs+Linked+to+Psychiatric+Problems&event=org_news_print_list_item
Roman Bystrianyk, "NSAIDs Linked to Psychiatric Problems", Health
Sentinel, February 9, 2005,
NSAIDs, or Non Steroidal Anti-Inflammatory Drugs, are one of the most
prescribed of all medications, accounting for 5 to 10 percent of all
prescriptions in western countries. Over 100 million prescriptions are
written for NSAIDs in the United States each year with many of these
types of drugs available over the counter. NSAIDs are most commonly
used for arthritic diseases, degenerative joint diseases, and acute or
chronic pain.
NSAIDs are associated with an increased risk of adverse events and can
result in hospitalizations and deaths. In the United States, it is
estimated that over 100,000 hospitalizations and over 16,500 deaths are
attributable to NSAID related gastrointestinal complications in
arthritis patients alone. In the United States, approximately 21% of
all adverse events reported to the FDA are associated with NSAID use.
Usual complications are associated with gastrointestinal bleeding, but
there are also complications relating to the liver, kidneys, and heart.
The December 2004 issue of the journal Drugs, the authors of a study
examine the less common neuropsychiatric adverse effects that may occur
with the use of NSAIDs. Specifically, "these neuropsychiatric
symptoms include changes in cognition, mood and even precipitation or
exacerbation of pre-existing psychiatric conditions."
The authors note that one recent population study examined the New
Zealand Medicine Adverse Reaction Committee over a 20-year period.
During that period, 150 psychiatric adverse events associated with
NSAIDs were reported including: confusion, depression, hallucination,
lethargy, sleep disturbance, and malaise. Other less common events
included: anxiety, amnesia, emotional liability, abnormal thinking,
psychosis, and delirium.
Another study reviewed the records of patients experiencing postpartum
complications over a 5-year period in a Canadian university hospital to
identify adverse drug reactions associated with the NSAID indometacin.
The authors of that study identified psychiatric events in 32 patients.
The most common symptoms were dizziness, agitation, and anxiety. A few
patients reported fear, dyspnoea (difficult or labored respiration),
dysphoria (an unpleasant mood, such as sadness, anxiety, or
irritability), depersonalization, panic, fear of dying, hallucinations,
and abnormal movements.
A 2003 study reviewed the Australian Adverse Drug Reactions Advisory
Committee. That study examined the psychiatric events associated with
the newer selective COX-2 NSAIDs. The committee reported 142
neuropsychiatric events associated with celecoxib (Celebrex) and 49
with rofecoxib (Vioxx). The most common events with Celebrex were found
to be confusion, somnolence, and insomnia. Hallucinations were more
reported with Vioxx than with Celebrex.
The authors note that in all these studies the data was largely based
on voluntary reporting systems. These systems are generally
acknowledged as only reporting a small fraction of the actual adverse
events and as such these studies may not reflect the total number of
events that have occurred.
NSAIDS block the production of prostaglandins by inhibiting the
activity of COX (cyclooxygenase). COX-2 is the most abundant form found
in the central nervous system (CNS) and has specifically been found in
the neocortex, hippocampus, and other locations. COX-2 is upregulated
by nerve activity and is located in cells that are involved in synaptic
signaling. Evidence also suggests that inhibition of prostaglandins by
NSAIDs can increase dopamine levels in the brain.
Additionally, NSAID use and psychiatric disturbances may involve the
role of fatty acids, which are precursors to prostaglandins. "In
particular, depression, affective disorders, attention-deficit
hyperactivity disorder (ADHD), psychological stress and schizophrenia
have been related to fatty acid metabolism."
The authors conclude that, "psychiatric symptoms are a rare but
relevant complication of NSAID use. This effect is probably a
consequence of impairment in the neurotransmission modulated by
prostaglandins when NSAIDs are used by susceptible individuals. These
drugs should be used with caution in high-risk individuals with
pre-existing psychiatric illness and caution may also be advisable in
the postpartum period. Prescribers should consider warning patients of
the possibility of an acute neuropsychiatric event when traditional
NSAIDs or selective COX-2 inhibitors are prescribed."
SOURCE: Drugs; 64 (23) December 2004
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