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June 2007

An NSAID for Schizophrenia?
Adjunctive celecoxib (Celebrex) may be beneficial for treating schizophrenia.

Psychotropics and Fracture Risk
Patients (especially elderly ones) taking psychiatric medications are at increased risk for fractures.

Riluzole Augmentation for Depression
Preliminary evidence suggests riluzole (Rilutek) may be helpful in treating mood and anxiety disorders.

CBT Beats Zopiclone for Insomnia in Elderly
Cognitive behavioral therapy (CBT) was superior to zopiclone (Ambien) for chronic primary insomnia.

Alternative Medicines Are Commonly Used
Surveys show alternative medicines used by more than half of US population.

Hyponatremia with Antidepressants
Hyponatremia reported in patients treated with escitalopram (Lexapro) or duloxetine (Cymbalta).

In Brief
Dosing Strategies for Risperidone Long-Acting Injection; Deaths Associated with Methadone Treatment for Pain

Prolactin Levels and Associated Side Effects with Risperidone
Initial elevation of prolactin levels with risperidone (Risperdal) returns to normal with long-term treatment.

Mifepristone for Psychotic Depression?
Treatment with mifepristone (Mifeprex) improves psychosis but not depression in patients with psychotic depression.

rTMS: Inferior to ECT?
Repetitive transcranial magnetic stimulation (rTMS) is not as efficacious as electroconvulsive therapy (ECT) in patients referred for ECT.

An NSAID for Schizophrenia?

June 2007

Celecoxib (Celebrex) is a nonsteroidal anti-inflammatory drug (NSAID) which is cyclooxygenase-2 (COX-2) selective. Some have conjectured that inflammatory processes in the brain may contribute to the etiopathology of schizophrenia. This has led to study of anti-inflammatory agents, at least as adjunctive treatments, for this condition. In addition to their role in preventing inflammation, COX-2 inhibitors also prevent kainic acid-induced neuronal death and may have glutamatergic activity. Akhondzadeh and others conducted a prospective, double-blind trial of celecoxib as an adjunctive treatment in schizophrenia.1

Twenty-five women and 35 men, aged 19 to 44 years, who were diagnosed with chronic schizophrenia participated in this trial. They all took risperidone (Risperdal), beginning with 2 mg/day and increased to 6 mg/day. Half received adjunctive placebo, while the other half were assigned to adjunctive treatment with celecoxib, 400 mg/day.

Patients receiving adjunctive celecoxib had significantly greater overall symptom improvement compared with those receiving only risperidone. Celecoxib was well tolerated, with no clinically important side effects in this population.

For now, this work is preliminary. Hoped-for benefits for NSAIDs in Alzheimer's disease have not been borne out. It will be interesting to see if COX-2 inhibitors may come to play a role in the treatment of schizophrenia.

1Akhondzadeh S, Tabatabaee M, Amini H, Ahmadi Abhari SA, Abbasi SH, Behnam B: Celecoxib as adjunctive therapy in schizophrenia: A double-blind, randomized and placebo-controlled trial. Schizophr Res 2007;90:179-185.