Celecoxib: a new augmentation strategy for depressive mood episodes. A systematic review and meta-analysis of randomized placebo-controlled trials.

Objective: The aim of this research was to perform a systematic review to identify all randomized controlled trials (RCTs) evaluating the efficacy and safety of add-on celecoxib for treatment of depressive mood episodes.

Methods: Four electronic databases were systematically searched from their inception to 8 August 2013: PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials), Scopus, and PsychINFO. Pooled difference in means of Hamilton Depression Rating Scale score, pooled odds ratio (OR) of treatment response, and pooled OR of remission were calculated as the main effect size. A random-effects model was used to pool the data across studies.

Results: Five RCTs (four unipolar depression studies and one bipolar depression study) were included in the systematic review for qualitative data synthesis. Moreover, quantitative results of four RCTs (unipolar depression studies) were meta-analyzed. The add-on celecoxib group had a statistically significant decrease in means of the Hamilton Depression Rating Scale score at week 4 (pooled difference in means=3.3, 95%CI [1.2-5.3], p=0.002) and week 6 (pooled difference in means=3.43, 95%CI [1.9-4.9], p<0.0001). The add-on celecoxib group also showed higher response (pooled OR=6.6, 95%CI [2.5-17], p<0.0001) and remission rates (pooled OR=6.6, 95%CI [2.7-15.9], p<0.0001) compared with the placebo group.

Conclusions: Celecoxib can be considered as an effective add-on treatment for unipolar depressive patients. Making conclusion regarding the efficacy and safety for longer duration warrants further studies with a larger sample size and longer follow-up duration.