COX-2 inhibitors are a type of nonsteroidal anti-inflammatory drug that directly affects COX-2, an enzyme involved in inflammation and associated pain. The use of COX-2 inhibitors was evaluated in patients with cancer related to the development of palmar-plantar erythrodysesthesia (PPE) skin effects and as a potential treatment for oral mucositis. Celecoxib, a type of COX-2 inhibitor, has also been studied for its impact on symptoms of depression in patients with cancer.
Alamdarsaravi, M., Ghajar, A., Noorbala, A.A., Arbabi, M., Emami, A., Shahei, F., . . . Akhondzadeh, S. (2017). Efficacy and safety of celecoxib monotherapy for mild to moderate depression in patients with colorectal cancer: A randomized double-blind, placebo controlled trial. Psychiatry Research, 255, 59–65.
To assess the safety and efficacy of celecoxib single therapy on depressive symptoms of patients with colorectal cancer who underwent chemotherapy.
Parallel-group, randomized, double-blind, placebo-controlled trial, randomized to either 400 mg per day celecoxib or placebo for 6 weeks.
PHASE OF CARE: Active anti-tumor treatment
Parallel-group, randomized, double-blind, placebo-controlled trial
Hamilton Depression Rating Scale, Visual Analog Scale to measure pain intensity, at week 2, 4, and 6 post-treatment. Adverse events were evaluated at each point using a checklist. Medication adherence was measured with weekly capsule counts with participant reports of medication intake.
HRDS scores were significantly greater in the celecoxib treatment group at week 2 and remained higher until week 6 (p = 0.028). There was not a significant difference between mean VAS scores between the groups at week 2, 4, and 6 (p = 0.459). Gastrointestinal side effects that have been attributed to celecoxib, such as abdominal pain and diarrhea, were not significantly different between the intervention groups. No symptoms of cardiovascular adverse event or serious adverse event occurred.
Celecoxib monotherapy is potentially safe and effective treatment for mild to moderate depression in patients with colorectal cancer undergoing chemotherapy.
Small sample (< 100)
Oncology nurses are in a key position to screen for psychological distress in patients undergoing chemotherapy. Celecoxib has been shown in this study to be effective for mild to moderate depression in patients with colorectal cancer. Celecoxib may also be effective in patients with other malignancies although further research is needed. Oncology nurses should discuss with physicians the use of celecoxib for any patients with colorectal cancer exhibiting mild to moderated depression as evidenced on psychological distress screening.
Mohammadinejad, P., Arya, P., Esfandbod, M., Kaviani, A., Najafi, M., Kashani, L., . . . Akhondzadeh, S. (2015). Celecoxib versus diclofenac in mild to moderate depression management among breast cancer patients: A double-blind, placebo-controlled, randomized trial. Annals of Pharmacotherapy, 49, 953–961.
To compare celecoxib versus diclofenac in mild to moderate depression in patients with breast cancer
Patients with breast cancer with mild to moderate depression and pain were randomized to receive celecoxib or diclofenac over a six-week period. Depression was evaluated at baseline, three weeks, and six weeks.
Fifty-two patients randomized with similar characteristics showed a significant reduction in HDRS score in celecoxib group by week six; however, none achieved a remission of symptoms. There was no significant difference in VAS score.
There was a greater antidepressant effect for celecoxib than for diclofenac by week 6.
It is important to recognize that symptoms often present in clusters (pain/depression), and treatment of all symptoms are important to often achieve relief of any symptom.