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Life sciences · Journal article
The Brown University Psychopharmacology Update · October 2, 2026
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ave you ever prescribed celecoxib to treat major depression?Me neither (apologies if you are what I expect would be one of the vanishingly few Update readers who answered yes).And yet there is a meta-analysis from the estimable Acta Psychiatrica Scandinavica, published in 2019, showing antidepressant efficacy of celecoxib, particularly when used adjunctively with a selective serotonin reuptake inhibitor (SSRI) (Köhler-Forsberg et al., 2019).The rationale for using celecoxib, a nonsteroidal anti-inflammatory drug (NSAID), is that it targets inflammatory processes that some believe to be central to the pathogenesis of depression.This is not a new idea.Immunological theories of depression have been kicking around since the 1980s, with an early focus on immune suppression transitioning to a greater emphasis on immune activation over the past 25 years.Such theories have always been overshadowed by interest in monoamines, neuroendocrine regulation, genetics, and brain circuitry, which explains why most psychiatrists know little about them.But this stepchild status hasn't stopped intrepid researchers from trying to translate these theories into effective treatments.Our Research Roundup section in this month's Update includes coverage of a brief report describing one such recent effort.In a proof-of-concept randomized double-blind trial, Foley et al. (2026) administered a single intravenous infusion of the interleukin 6 (IL-6) receptor antagonist tocilizumab or placebo to 29 patients who met ICD-10 criteria for moderate to severe recurrent depression despite ongoing adequate antidepressant treatment.All patients were physically healthy but had prominent depressive somatic symptoms and low-grade systemic inflammation (as measured by serum high-sensitivity C-reactive protein [hs-CRP]).By the end of the trial at week 4, tocilizumab patients appeared to show greater improvement in overall depressive symptoms and somatic symptoms, effects that tended to correlate with higher baseline hs-CRP levels.However, no findings reached statistical significance, which the authors stated they expected given the small sample size in this exploratory study.An intriguing but nonsignificant study.Quoting the authors, "limitations … include small sample, short duration, and limited sample diversity.Our results are compatible with anything from no effect to a clinically important effect." (Foley et al., 2026).This ordinarily wouldn't make the cut for the Update.But it was published in JAMA Psychiatry, one of our field's top journals.Why?Let's pause for a moment and return to celecoxib.Why aren't we using that widely prescribed drug to treat depression?That's a question I actually know the answer to.Notwithstanding the favorable meta-analysis by Köhler-Forsberg et al. (2019), or the several more recent ones I didn't cite, most experts in treating depression don't think it works.Limiting many of the ostensibly positive clinical trials supporting its efficacy are small or restricted samples, participants with significant comorbidities, methodological deficiencies, and