SPECIAL REPORT
897 Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV
Antidepressants have Anti-inflammatory Effects that may be Relevant to Dermatology: A Systematic Review
Shirin ESKELAND 1, Jon Anders HALVORSEN 2 and Lars TANUM 3
1
Department of Psychiatry, 2 Department of Dermatology, Oslo University Hospital, Rikshospitalet, and 3 R & D of Mental Health, Akershus University Hospital, Loerenskog, Norway
There is increasing evidence of clinically relevant antiinflammatory effects of monoaminergic antidepressants. PubMed and Ovid databases were searched systematically for the use and efficacy of antidepressants in association with 5 common inflammatory skin disorders: chronic urticaria, psoriasis, atopic dermatitis, other eczema, and alopecia areata. From January 1984 to June 2016, publications included a total of 1,252 dermatological patients in 28 trials or case reports. These unambiguously reported a reduced burden of dermatological symptoms in relation to treatment with antidepressants. Several randomized controlled trials of first-generation antidepressants have been published, while studies of modern antidepressants are usually open-label, yet more informative, regarding patients’ characteristics and study procedures. These overall positive findings may indicate a rationale, beyond treating comorbid psychiatric disorders, for the use of antidepressants in dermatology. Further research into modern tolerable antidepressants, including selective serotonin re-uptake inhibitors, mirtazapine and bupropion, is required.
Key words: systematic review; antidepressant; dermatological disorder; anti-depressive; anti-inflammatory.
Accepted May 16, 2017; Epub ahead of print May 17, 2017 Acta Derm Venereol 2017; 97: 897 – 905.
Corr: Shirin Eskeland, Department of Psychiatry, Oslo University Hospital, Rikshospitalet, NO-0196 Oslo, Norway. E-mail: shiesk @ ous-hf. no
Antidepressants are a class of psychotropic drugs acknowledged for their antidepressive effects, which are used primarily in the treatment of depression and anxiety disorders. Anti-inflammatory or immune-modulatory effects of antidepressants have been described in rodent models of several chronic disorders, including skin contact allergy and hypersensitivity, rheumatoid arthritis, inflammatory bowel disease and multiple sclerosis( 1 – 4). A growing body of evidence also points to immune-modulatory properties of antidepressants in humans( 5). Treatment with antidepressants in depressed patients with various chronic inflammatory disorders has been linked to improvement in somatic symptoms, with a reduction in complications and the use of steroids or other medical interventions( 6 – 10).
It is acknowledged that, to varying degrees, inflammatory skin disorders have a systemic inflammatory
Learning points
• Inflammation and serious stress may be central to the pathogenesis of depression.
• Systemic correlates of skin inflammation may trigger or reinforce inflammatory processes in the brain.
• Doxepin may be efficacious in the treatment of CU and possibly even in inducible types especially cold urticaria.
• SSRIs have been associated with reduced pruritus and a lower need for systemic treatment in psoriasis.
• Bupropion has been linked with a marked reduction in extension of psoriatic lesions and atopic eczema.
• There is substantial evidence of anti-inflammatory properties in antidepressants; however, the clinical implications of these properties are not established.
component( 11 – 15). In mice, the infusion of bacterial lipopolysaccharides results in systemic inflammation, neuro-inflammation and depression-like symptoms, sometimes referred to as“ sickness behaviour”( 16). An equivalent in humans is the administration of interferon-α for viral hepatitis, promoting systemic inflammation and, not infrequently, depression( 17, 18). Depression and anxiety are prevalent in people with common inflammatory skin disorders, e. g. chronic urticaria( CU) and psoriasis( 19, 20). Therefore, in theory, inflammatory disorders of the skin, especially when accompanied by systemic inflammation, may affect the central nervous system( CNS) and adversely influence mood( 21).
Inflammation is increasingly acknowledged to play a role in the pathophysiology of depression( Fig. 1). The anti-inflammatory actions of antidepressants may be relevant to their anti-depressive effects( 22, Fig. 1). In both mice and humans there is compelling evidence that selective serotonin reuptake inhibitors( SSRIs) attenuate inflammatory processes, as mentioned above, also relieving the“ sickness behaviour” resembling depression and anxiety symptoms( 23, 24). The attenuation of inflammation in animal studies, in vitro human cell lines and patient case reports has been found to involve the modulation of cytokine levels, with a decrease in tumour necrosis factor( TNF)-α and / or an increase in interleukin( IL)-10 levels( 24 – 28).
To avoid confusion with non-medical( e. g. herbal) antidepressive remedies, antidepressant drugs are sometimes
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2702 Acta Derm Venereol 2017; 97: 897 – 905