Issue 20

Clinical Question

Does depression and antidepressant use affect the risk of IBD?

Editor’s Bottom Line

Antidepressant therapy may offset an increased risk of IBD among patients diagnosed with depression. This provides even more reason for clinicians to help susceptible patients to access the mental health services they need.

Reference

Frolkis AD, Vallerand IA, Shaheen A, et al. Depression increases the risk of inflammatory bowel disease, which may be mitigated by the use of antidepressants in the treatment of depression. Gut. 2019;68:1606–12; http://dx.doi.org/10.1136/gutjnl-2018-317182.

Synopsis

Given recent evidence that antidepressants can reduce inflammatory cytokine production, investigators in Calgary set out to correlate depression and use of antidepressants with risk of inflammatory bowel disease (IBD). They examined data from the Health Improvement Network (THIN), a database of more than 12 million UK residents. Incident cases of Crohn’s disease (CD) or ulcerative colitis (UC) diagnosed between 1986 and 2012 were compared among individuals with new-onset depression diagnosed during the same period, and individuals whose records did not indicate depression. Analyses controlled for variables such as age, sex, socioeconomic status, comorbid conditions, smoking and anxiety.

The researchers found that among the 7% of patients with incident depression in the database, there was a significantly higher risk of developing CD (adjusted Hazard Ratio [aHR] = 2.11, 95% Confidence Interval [CI], 1.65–2.70) and UC (aHR = 2.23, 95% CI 1.92–2.60) during the study period and after controlling for possible confounding variables. The incidence of CD among those with incident depression who received selective serotonin reuptake inhibitors and tricyclic antidepressants was numerically lower than among those who did not receive an antidepressant (0.05% vs. 0.07%; P not significant), while use of a broader range of antidepressants was associated with a significantly lower risk of UC (0.12% vs. 0.2% for antidepressant use vs. no use; P<0.0001).

Details

Study Design: Retrospective population-based cohort
Funding: Canadian Institutes of Health Research
Allocation: Not applicable
Setting: Database
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.