OBJECTIVES To systematically review the efficacy and safety of anti-inflammatory agents for patients with major depressive disorders. METHODS We searched the literature to identify potentially relevant randomised controlled trials (RCTs) up to 1 January 2019. The primary outcome was efficacy, measured by mean changes in depression score from baseline to endpoint. Secondary outcomes included response and remission rates and quality of life (QoL). Safety was evaluated by incidence of classified adverse events. Heterogeneity was examined using the I2 and Q statistic. Pooled standard mean differences (SMDs) and risk ratios (RRs) were calculated. Subgroup meta-analyses were conducted based on type of treatment, type of anti-inflammatory agents, sex, sponsor type and quality of studies. RESULTS Thirty RCTs with 1610 participants were included in the quantitative analysis. The overall analysis pooling from 26 of the RCTs suggested that anti-inflammatory agents reduced depressive symptoms (SMD -0.55, 95% CI -0.75 to -0.35, I2=71%) compared with placebo. Higher response (RR 1.52, 95% CI 1.30 to 1.79, I2=29%) and remission rates (RR 1.79, 95% CI 1.29 to 2.49, I2=41%) were seen in the group receiving anti-inflammatory agents than in those receiving placebo. Subgroup analysis showed a greater reduction in symptom severity in both the monotherapy and adjunctive treatment groups. Subgroup analysis of non-steroidal anti-inflammatory drugs, omega-3 fatty acids, statins and minocyclines, respectively, disclosed significant antidepressant effects for major depressive disorder (MDD). For women-only trials, no difference in changes of depression severity was found between groups. Subanalysis stratified by sponsor type and study quality led to the same outcomes in favour of anti-inflammatory agents in both subgroups. Changes of QoL showed no difference between the groups. Gastrointestinal events were the only significant differences between groups in the treatment periods. CONCLUSIONS Results of this systematic review suggest that anti-inflammatory agents play an antidepressant role in patients with MDD and are reasonably safe.

中文翻译：

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抗炎药治疗重度抑郁症的功效和安全性：随机对照试验的系统评价和荟萃分析。

目的系统评价抗炎药对重度抑郁症患者的疗效和安全性。方法我们检索了文献，以鉴定至2019年1月1日潜在相关的随机对照试验（RCT）。主要结果是疗效，通过抑郁评分从基线到终点的平均变化来衡量。次要结果包括缓解率和缓解率以及生活质量（QoL）。通过分类不良事件的发生率评估安全性。使用I2和Q统计量检查异质性。计算合并标准均值差（SMD）和风险比（RRs）。根据治疗类型，抗炎药类型，性别，赞助者类型和研究质量进行亚组荟萃分析。结果定量分析包括30项RCT，共有1610名参与者。来自26个RCT的总体分析表明，与安慰剂相比，抗炎药可减轻抑郁症状（SMD -0.55，95％CI -0.75至-0.35，I2 = 71％）。与接受抗炎药的组相比，接受抗炎药的组具有更高的缓解率（RR 1.52，95％CI 1.30至1.79，I2 = 29％）和缓解率（RR 1.79，95％CI 1.29至2.49，I2 = 41％）。接受安慰剂。亚组分析显示，单药治疗组和辅助治疗组的症状严重程度均有较大降低。非甾体类抗炎药，omega-3脂肪酸，他汀类药物和米诺环素的亚组分析分别显示了对重度抑郁症（MDD）的显着抗抑郁作用。对于仅限女性的试验，两组之间的抑郁严重程度变化无差异。按发起人类型和研究质量分层的亚分析导致两个亚组的抗炎药使用率均相同。QoL的变化显示两组之间无差异。胃肠道事件是治疗期间各组之间的唯一显着差异。结论这项系统评价的结果表明，抗炎药在MDD患者中起着抗抑郁作用，并且是相当安全的。胃肠道事件是治疗期间各组之间的唯一显着差异。结论这项系统评价的结果表明，抗炎药在MDD患者中起着抗抑郁作用，并且是相当安全的。胃肠道事件是治疗期间各组之间的唯一显着差异。结论这项系统评价的结果表明，抗炎药在MDD患者中起着抗抑郁作用，并且是相当安全的。