Nonsteroidal Anti-Inflammatory Drugs and Severe Psychiatric Side Effects

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Abstract
Objective: Nonsteroidal anti-inflammatory drugs (NSAIDS) are used extensively in the treatment of pain. This study explored the possibility that psychiatric side effects may be both more frequent and more severe than thought previously. Method: Four psychiatric outpatients, three with affective disorders and one with schizophrenia, were treated with NSAIDS for a complaint of pain. The NSAIDs were withdrawn, then restarted for three patients, and then withdrawn again one or more times. The patients were evaluated while on and off NSAIDs. Results: All four patients developed moderate to severe depression and one became severely paranoid while on NSAIDs initially. When the NSAID was withdrawn there was remission of the depressive symptoms and in one case the accompanying paranoia. The depressive symptoms were reproduced when the NSAID was restarted in five instances (involving only 3 of the patients) and remitted when the NSAID was discontinued. One of these three patients also became paranoid in two instances. The paranoia remitted when the NSAID was discontinued. Conclusions: These findings suggest that NSAIDs can induce or exacerbate reproducible symptoms (depression, paranoia) in patients with either affective disorder or schizophrenia. These adverse effects may be more severe and frequent than thought previously. NSAID-treated patients should be studied for NSAID-induced psychiatric side effects.

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