1. Aspirin use before diagnosis of primary malignancy is associated with decreased risk of developing depression, anxiety and stress-related disorders post-diagnosis.
2. Use of Non-aspirin NSAIDs were associated with a higher rate of depression, anxiety, and stress-related disorders.
Evidence Rating Level: 2 (Good)
Inflammation appears to contribute to the development of psychiatric disorders by affecting neurocircuitry and neurotransmitters. A recent meta-analysis suggested that non-steroidal inflammatory drugs (NSAIDs) may have a role in treating in patients with major depressive disorder and are relatively safe to take. Furthermore, there is often increased systemic inflammation in cancer patients, who are at a highly increased risk of having psychiatric comorbidities. In this retrospective cohort study, patients who were taking NSAIDs up to a year before diagnosis of a primary malignancy were followed for up to a year to determine the risk of developing new psychiatric illness including depression, anxiety and stress-related disorders. Patients were identified through the Swedish Cancer Register (n=316904) and statistical analysis adjusted for factors such as comorbidity, sociodemographic factors, cancer characteristics and indications for NSAID use. Aspirin use was associated with a lower rate of the above psychiatric illnesses (HR 0.88, 95% CI 0.81-0.97). Subgroup analyses also revealed a greater reduction in psychiatric disorders if the patient was a current user of aspirin versus a former user (HR 0.84, 95% CI 0.75-0.93 vs. HR 1.01, 95% CI 0.88-1.17, respectively), with a low dose of aspirin versus medium or high (HR 0.88, 95% CI 0.80-0.98 vs. HR 0.96, 95% CI 0.77-1.19 vs. HR 1.17, 95% CI 0.73-1.86, respectively), and in long-term users versus short-term (HR 0.84, 95% CI 0.76-0.94 vs. 1.07, 0.92-1.25). Non-aspirin NSAID use, however, was associated with a higher rate of depression, anxiety, and stress-related disorders (HR 1.24, 95% CI 1.15-1.32). One major limitation this study faced was that the Prescribed Drug Register used to track NSAID use could not account for over-the-counter NSAID use; however, this is unlikely to affect the results on aspirin use as low-dose aspirin is mostly prescribed in Sweden. Ultimately, aspirin use, especially current, long-term and low-dose, may be associated with decreased risk of development of depression, anxiety and other stress-related disorders after cancer diagnosis. Further research, however, must be done to clarify these mechanisms through potential randomized controlled trials.
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