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Letter to the Editor   |    
Treatment of Alzheimer’s Disease
CHARLES H. BROWNING, M.D.
Am J Psychiatry 1998;155:1460a-1461.
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Letters to the Editor

To the Editor: Research on the use of nonsteroidal anti-inflammatory drugs to delay the onset or slow the progression of Alzheimer’s disease was noted in the APA practice guideline R4015510CEBBDFAD. The use of these drugs for a possible neuro­protective effect against Alzheimer’s disease was not recommended for now because the evidence for such protection is primarily epidemiological, with one pilot study. The side effects of nonsteroidal anti-inflammatory drugs were not mentioned.

Gastrointestinal and renal complications are the best-known and -researched side effects of these drugs. While there have been a few case reports of psychiatric side effects induced by nonsteroidal anti-inflammatory drugs, there have never been systematic studies of these side effects R4015510CEBDJFCD. I reported recently on four male psychiatric patients (one with a diagnosis of bipolar affective disorder, two with recurrent major depression, and one with paranoid schizophrenia) who developed severe depression and, in some instances, suicide ideation and paranoia with use of nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen, and naproxen). These were reproducible syndromes, stopping when the drugs were discontinued and recurring on rechallenge (except for one patient who declined a rechallenge) R4015510CEBCCIEG.

Given the epidemiological findings, clinical trials of nonsteroidal anti-inflammatory drugs in delaying the onset or slowing the rate of progression of Alzheimer’s disease will be proposed. This is an opportune time to include in these trials assessment of possible psychiatric side effects of the drugs. If these assessments are not done, we may run the risk of patients beginning long-term treatment with nonsteroidal anti-inflammatory drugs without our understanding further the risk/benefit ratio of these drugs.

American Psychiatric Association: Practice Guideline for the Treatment of Patients With Alzheimer’s Disease and Other Dementias of Late Life. Am J Psychiatry 1997; 154(May suppl)
 
Kertesz A: Neurological complications of nonsteroidal anti-inflammatory drugs, in NSAIDs: A profile of adverse effects. Edited by Borda IT, Koff RS. Philadelphia, Hanley and Belfus, 1993
 
Browning CH: Nonsteroidal anti-inflammatory drugs and severe psychiatric side effects. Int J Psychiatry Med  1996; 26:25–34
[PubMed]
[CrossRef]
 
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References

American Psychiatric Association: Practice Guideline for the Treatment of Patients With Alzheimer’s Disease and Other Dementias of Late Life. Am J Psychiatry 1997; 154(May suppl)
 
Kertesz A: Neurological complications of nonsteroidal anti-inflammatory drugs, in NSAIDs: A profile of adverse effects. Edited by Borda IT, Koff RS. Philadelphia, Hanley and Belfus, 1993
 
Browning CH: Nonsteroidal anti-inflammatory drugs and severe psychiatric side effects. Int J Psychiatry Med  1996; 26:25–34
[PubMed]
[CrossRef]
 
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