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