Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T13:40:35.520Z Has data issue: false hasContentIssue false
  • English
  • Français

Depressive psychosis associated with a cyclo oxygenase 2 inhibitor (meloxicam)

Published online by Cambridge University Press:  13 June 2014

Daniel White  and
MacDara McCauley
Daniel White*
Affiliation:
St Brigid's Hospital, Ardee, County Louth
MacDara McCauley
Affiliation:
St Brigid's Hospital, Ardee, County Louth, Ireland
*
*Correspondence E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

We describe a 60 year old man who developed a fluctuating depressive psychosis associated with meloxicam, a non-steroidal anti-inflammatory drug (NSAID). The psychological symptoms observed were temporally related to the administration of meloxicam and occurred in the presence of signs of meloxicam intolerance, such as skin rash and raised blood pressure. The depressive reaction resolved quickly following cessation of meloxicam, recurring on re-exposure. The psychiatric manifestations of NSAID intolerance are rare, however 40% of cases have a history of mental illness. Data from adverse event reporting systems suggest that the newer NSAIDs (COX-2 inhibitors) may have a higher propensity to cause psychiatric adverse effects and should be used with caution in individuals with a history of mental illness. This data may be provocative given current research in to the use of COX-2 inhibitors in augmenting neuroleptic treatment in schizophrenia.

Keywords

MeloxicamCOX-2 inhibitorNSAIDsAffective disordersSubstance-inducedAdverse effects
Type
Case Report
Information
Irish Journal of Psychological Medicine , Volume 27 , Issue 3 , September 2010 , pp. 157 - 158
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Prieto, A, De Barrio, M, Martin, Eet al.Tolerability to nabumetone and meloxicam in patients with nonsteroidal anti-inflammatory drug intolerance. J Allergy Clin Immunology 2007; 119: 960–4.CrossRefGoogle ScholarPubMed
2.Kotilinek, LA, Westerman, MAWang, Qet al.Cyclooxygenase-2 inhibition improves amyloid-beta-mediated suppression of memory and synaptic plasticity. Brain 2008; 131: 651–64.CrossRefGoogle ScholarPubMed
3.Myint, AM, Steinbusch, HW, Goeghegan, L, Luchtman, D, Kim, YK, Leonard, BE.Effect of the COX-2 inhibitor celecoxib on behavioural and immune changes in an olfactory bulbectomised rat model of depression. Neuroimmunomodulation 2007; 14: 65–71.CrossRefGoogle Scholar
4.Linnoila, M, Whorton, AR, Rubinow, DR, Cowdry, RW, Ninan, PT, Waters, RN.CS F prostaglandin levels in depressed and schizophrenic patients. Arch Gen Psychiat 1983; 40: 405–6.CrossRefGoogle Scholar
5.Müller, N, Schwarz, MJ.COX- 2 inhibition in schizophrenia and major depression. Curr Pharmaceutical Des 2008; 14: 1452–65.CrossRefGoogle ScholarPubMed
6.Muller, N, Riedel, M, Scheppach, Cet al.Beneficial antipsychotic effects of celecoxib add-on therapy compared to risperidone alone in schizophrenia. Am J Psychiat 2002; 159: 1029–34.CrossRefGoogle ScholarPubMed
7.Riedel, M, Strassnig, M, Schwarz, MJ, Müller, N.COX-2 inhibitors as adjunctive therapy in schizophrenia: rationale for use and evidence to date. CNS Drugs 2005; 19: 805–19CrossRefGoogle ScholarPubMed
8.Müller, N, Ulmschneider, M, Scheppach, Cet al.COX-2 inhibition as a treatment approach in schizophrenia: immunological considerations and clinical effects of celecoxib add-on therapy. Eur Arch Psychiat Clin Neurosci 2004; 254: 14–22.CrossRefGoogle ScholarPubMed
9.http://emc.medicines.org.uk/medicine/293/SPC/Mobic-l-7.5mg+Tablets/Google Scholar
10.Johnson, AG, Day, RO.The problems and pitfalls of NSAID therapy in the elderly. Drugs Aging 1991;20: 701–10.Google Scholar
11.Acute neuropsychiatric events with celecoxib and rofecoxib. Aust Adverse Drug Reactions Bull 2003; 22: 3.Google Scholar
12.Jiang, HK, Chang, DM.Non-Steroidal Anti-Inflammatory Drugs with Adverse Psychiatric Reactions: Five Case Reports. Clin Rheumatol 1999; 16: 339–45.CrossRefGoogle Scholar
13.Coulter, D.Acute psychiatric reactions with COX-2 inhibitors. Prescriber Update 2002; 23: 21.Google Scholar
14.Clark, DWJ, Ghose, K.Neuropsychiatric reactions to nonsteroidal anti-inflammatory drugs (NSAIDs): the New Zealand experience. Drug Safety 1992; 7: 460–5.CrossRefGoogle ScholarPubMed
15.Clunie, M, Crone, LA, Klassen, Let al.Psychiatric side effects of indomethacin in parturients. Can J Anaesthetics 2003; 50: 586–8.CrossRefGoogle ScholarPubMed
16.Onder, G, Pellicciotti, F, Gambassi, Get al.NSAID-Related Psychiatric Adverse Events. Who is at Risk? Drugs 2004; 64: 2619–27.Google ScholarPubMed
17.Müller, N, Schwarz, MJ.A psychoneuroimmunological perspective to Emil Kraepelins dichotomy: schizophrenia and major depression as inflammatory CNS disorders. Eur Arch Psychiat Clin Neurosci 2008;258: 97–106.CrossRefGoogle ScholarPubMed
18.Muller, N, Reidel, M, Schwarz, MJ.Psychotropic effects of COX-2 inhibitors — a possible new approach for the treatment of psychiatric disorders. Pharmacopsychiat 2004; 37: 266–9.CrossRefGoogle ScholarPubMed
19.Van Kammen, DP, Yao, JK, Goetz, K.Polyunsaturated fatty acids, prostaglandins and schizophrenia. Ann NY Acad Sci 1989; 559: 411–23.CrossRefGoogle ScholarPubMed
20.Kaiya, H, Imai, H, Muramatsu, Yet al.Platelet aggregation response in schizophrenia and prostaglandin E1. Psychiatry Res 1983; 9: 309–18.CrossRefGoogle ScholarPubMed
21.Vaddadi, K.Dyskinesias and their treatment with essential fatty acids: a review. Prostaglandins Leukotrienes and Essential Fatty Acids 1996; 55: 89–94.CrossRefGoogle ScholarPubMed
22.Vinogradov, S, Csernansky, JG.Postpartum psychosis with abnormal movements: dopamine supersensitivity unmasked by withdrawal of endogenous estrogens. J Clin Psychiat 1990; 51: 365–618.Google ScholarPubMed