Aspirin and celecoxib may help to rectify a neurotransmission imbalance in bipolar disorder.

Abstract

BACKGROUND:

Mood stabilizers with disparate chemical structures are approved for treating bipolar disorder, but their mechanisms of action are not agreed on. However, when administered to unanesthetized rats at clinically relevant doses, they modulate neurotransmission involving arachidonic acid and brain activity of COX-2, which oxidizes arachidonic acid within the arachidonic acid metabolic cascade.

HYPOTHESIS:

Inhibiting COX-2 directly might enhance mood stabilizer effects in bipolar disorder patients.

OBSERVATIONS:

This paper reviews randomized controlled trials that showed that celecoxib, a selective COX-2 inhibitor, or low-dose aspirin, which inhibits COX-1 and inhibits/acetylates COX-2, reduced bipolar symptoms in patients on mood stabilizers. More convincing are two population based pharmacoepidemiological studies that each demonstrated that chronic low dose aspirin reduced bipolar severity markers in patients on mood stabilizers.

CONCLUSIONS:

This clinical evidence is consistent with the hypothesis that low-dose chronic aspirin and celecoxib, which can inhibit COX-2 and enter brain, can be repurposed in bipolar disorder to enhance mood stabilizer effects on arachidonic acid metabolism and neurotransmission.

• Authors: Stanley I Rapoport
• Journal: Medical hypotheses (Med Hypotheses) Vol. 149 Pg. 110536 (Apr 2021) ISSN: 1532-2777 [Electronic] United States
• PMID: 33618245 (Publication Type: Journal Article, Review)
• Copyright: Published by Elsevier Ltd.

Chemical References

• Antimanic Agents
• Celecoxib
• Aspirin

Topics

• Animals
• Antimanic Agents (therapeutic use)
• Aspirin (therapeutic use)
• Bipolar Disorder (drug therapy)
• Celecoxib (therapeutic use)
• Humans
• Rats
• Synaptic Transmission