Issue 03

Clinical Question

Do antidepressants improve disease course in IBD patients?

Editor’s Bottom Line

Antidepressant therapy reduced healthcare and drug utilization but, because IBD activity was not measured directly, a true anti-inflammatory effect remains unproven.

Reference

Kristensen MS, Kjærulff TM, Ersbøll AK, et al. The Influence of Antidepressants on the Disease Course Among Patients with Crohn’s Disease and Ulcerative Colitis—A Danish Nationwide Register–Based Cohort Study. Inflamm Bowel Dis. Epub Dec 14, 2018; https://doi.org/10.1093/ibd/izy367

Synopsis

This research follows on prior studies that have suggested antidepressant use can alleviate inflammation in patients with IBD. In the current study, researchers examined data from 42,890 patients with IBD registered in the Danish National Patient Register between 2000 and 2017. Roughly 70% of these individuals had ulcerative colitis (UC), while the remainder had Crohn’s disease (CD). Investigators analyzed the link between antidepressant use and health care use and drug utilization, which they considered proxy measures of disease activity.

They found that 28% of the study population had at least one claim for a prescription for antidepressants, with most patients already using antidepressants prior to their IBD diagnosis. CD patients using antidepressants at the most recent follow-up were 25% less likely to have active disease than similar patients who were not using antidepressants (Incidence risk ratio [IRR], 0.75; 95% Confidence interval [CI], 0.68–0.82), while UC patients were 10% less likely to have active disease (IRR, 0.90; 95% CI, 0.84–0.95) than similar patients who were not taking antidepressants. Moreover, CD patients who used antidepressants after IBD diagnosis but not before were 49% less likely to have active disease at most recent follow-up (IRR, 0.51; 95% CI, 0.43–0.62), while UC patients were 33% less likely to have active disease (IRR, 0.67; 95% CI, 0.59–0.75) than similar patients who did not use antidepressants both prior to or after IBD onset. The investigators called for randomized controlled trials to examine the potential of antidepressants as adjunct treatment to conventional IBD therapy.

Details

Study Design: Population-based cohort study using prospectively collected data
Funding: Study based on data from a separate study funded by Merck Sharp & Dohme Corp.
Allocation: Not applicable
Setting: Registry
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.