A Randomized, Double-Blind Placebo-Controlled Trial on Effectiveness and Safety of Celecoxib Adjunctive Therapy in Adolescents with Acute Bipolar Mania

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These authors contributed equally to this work.

This trial was registered at the Iranian registry of clinical trials (www.irct.ir; registration number: IRCT2015080423478N1).

Address correspondence to: Shahin Akhondzadeh, PhD, FBPhS, Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran 13337, Iran, E-mail: [email protected]

Introduction

Bipolar disorder (BD) is a chronic psychiatric illness resulting in significant function impairment and decreased quality of life. Current treatments for this disorder benefit only about half of the patients and a significant number do not respond adequately to available alternatives (Gershon and Soares 1997). In recent decades, numerous studies have provided evidence in support of the role of altered inflammatory responses in the etiopathogenesis of major mental illnesses, most notably major depressive disorder and schizophrenia (Muller and Schwarz 2008; Muller et al. 2011, 2012; Mohammadinejad et al. 2015). Some studies have shown an increase in circulating proinflammatory cytokines (e.g., IL-1, IL-6, and tumor necrosis factor [TNF-α]) in individuals with BD compared with healthy volunteers. Elevated peripheral levels of TNF-α and upregulation of its receptors (i.e., TNF-R1 and TNF-R2) are common findings during depressive and manic states and may even persist when a patient becomes euthymic (Breunis et al. 2003). In keeping with the view that a neurotoxic process occurs in mood syndromes, numerous studies have explored the potential effects of different conventional pharmacological treatments such as lithium and antipsychotics on BD in regard to production of proinflammatory cytokines as well as their gene expression.

Taken together, psychotropic medications used in the treatment of BD have the capacity to alter...