Anti-inflammatory effects of antidepressant and atypical antipsychotic medication for the treatment of major depression and comorbid arthritis: a case report

Abstract

Introduction: This case report describes the effects of psychotropic treatment, quetiapine in particular, on systemic inflammation, pain, general functioning and major depression in the treatment of a woman with arthritis.

Case presentation: A 49-year-old Caucasian Australian woman with arthritis, pain and depression was treated with a course of escitalopram, mirtazapine and quetiapine. Pain levels, general functioning and degree of depressive symptoms were evaluated with a visual analogue scale. Systemic inflammation had been assessed by C-reactive protein serum levels since 2003. C-reactive protein levels, physical pain, symptoms of arthritis and depression decreased significantly during the past 12 months of treatment with quetiapine, while treatment with selective serotonin reuptake inhibitors and mirtazapine remained the same.

Conclusions: We suggest that the treatment particularly with quetiapine may have anti-inflammatory effects in arthritis and comorbid major depression, which eventually led to a remission of pain and depression and to normal general function.

Figure 1

Development of Arthritis Pain, Depressed Mood and Level of Activity over time. The graph describes the course of levels of arthritis pain, depressive symptoms and physical activity over an extended period between Nov. 2003 and Oct. 2008 depending on DMARD and psychotropic medication. The psychiatric intervention in Oct. 2007 through the mood disorder clinic and the subsequent change in DMARD and psychotropic medication indicates a significant change in symptom presentation with a decline in pain and depressive symptoms while the activity levels increased continuously.