celecoxib (Celebrex)

Antiinflammatory (NSAID, COX-2 inhibitor, decreases prostaglandins)

Dosing

200mg bid in depression.

Management

Main risks are long-term (renal, gastritis/ulcer, cardiac) so best to give for 6 months to get them better and then try to stop. Caution with lithium interactions. Recommend to take with a proton-pump inhibitor to prevent ulceration/GI bleed (Pantoprazole is go-to, but also omeprazole, lansoprazole, dexlansoprazole, esomeprazole, rabeprazole).

Best-studied anti-inflammatory med in depression. One of few meds that worked in treatment-resistant bipolar depression, and may work better when hs-CRP is ≥ 3. May redice manic symptoms (does not cause them).

EMR Text