Non-steroidal anti-inflammatory drugs with adverse psychiatric reactions: Five case reports

Adverse drug reactions of non-steroidal anti-inflammatory drugs (NSAIDs) ar e quite prevalent, but there are few reports about possible adverse psychia tric reactions, which may be ignored or underestimated. We describe here fi ve psychiatric outpatients, two with major depressive disorders, one bipola r disorder, one schizophrenic disorder and one anxiety disorder, who were t reated with NSAIDs for pain due to rheumatoid arthritis, osteoarthritis or other painful neuromuscular conditions. All five patients developed a moder ate to severe depressive state, three patients became obviously paranoid, a nd four had either thoughts of suicide or an attempt while undergoing co-ad ministration of NSAIDs. The psychiatric symptoms remitted when the NSAIDs w ere stopped. The depressive and paranoid symptoms returned on seven occasio ns of re-use or re-challenge with the same or a different type of NSAID in all five patients. When the NSAIDs were stopped again, the patients had ano ther remission of the adverse psychiatric reactions, and eventually recover ed to their baseline mental states in clear temporal relationships. The cas es presented suggest that NSAIDs can induce or exacerbate idiosyncratic rep roducible adverse psychiatric symptoms in certain vulnerable patients, incl uding those with a variety of psychotic or neurotic disorders, and also in elderly persons, but these undesirable side-effects were generally transien t and disappeared on withdrawal of the NSAIDs.