Could Aspirin Someday Have Role in Mental Health Care?

The only way to know whether such an approach is truly an effective depression-prevention strategy, of course, is to conduct a randomized, placebo-controlled trial. “We are hoping to undertake such a trial, and we expect preliminary results in three to four years,” Alemeida told Psychiatric News.

When asked how older men can learn whether they have high plasma homocysteine levels, Alemeida noted that only a blood test can provide this information, but such a test is not part of a routine examination.

He pointed out in addition that there is no reason to believe that aspirin might prevent depression in older men without high homocysteine levels. “Our data would not support such a hypothesis—the effect of aspirin on the risk of depression among older people with normal homocysteine was simply nonexistent.”

“Broadly, this appears to be a competent and reasonably done study, but really should be viewed as hypothesis-generating rather than as something that should guide clinical decisions,” Warren Taylor, M.D., an associate professor of clinical psychiatry at Vanderbilt University and a geriatric psychiatrist, said in an interview.

“I think that there are a lot of good reasons why older men might benefit from aspirin, but based on the current study, I can’t say that taking an aspirin a day would prevent depression. Aspirin—although widely used—does have risks of bleeding, so it’s not like this is a risk-free intervention. That being said, we know that there’s a relationship between high levels of homocysteine and vascular disease and between cardiovascular disease and depression. Many individuals with vascular disease may need an anticoagulant like aspirin. If it benefits their physical health, and has a possible benefit for their mental health, then even better.”

“This is an intriguing study,” Olivia Okereke, M.D., a geriatric psychiatrist and an assistant professor of psychiatry at Harvard Medical School, commented. “There is a strong conceptual basis to the links between high homocysteine and risk of depression. So, looking at whether there is something that can modify that risk is worthwhile. [But] cross-sectional studies like this one always have important caveats. For example, one cannot tell whether there is a temporal association between taking aspirin and having depression among persons with high homocysteine.”

“[Also,] details were not included on the dosing of aspirin,” Okereke noted. “It would be interesting to see whether there is a dose-response connection between aspirin and depression among people with high homocysteine. A key question is, ‘What dose of aspirin is needed to observe these findings?’ This is important because aspirin can have dangerous side effects, including risk of bleeding. Regular use of higher doses of aspirin is not an option for many people.”

She added that “the authors wisely remind readers that their results need to be followed up with a randomized trial.”

The study was funded by the National Health and Medical Research Council of Australia.