A recent population-based cohort study (MS Kristensen et al. Inflamm Bowel Dis 2019; 25: 886-93) indicates that antidepressants are likely to be beneficial for patients with inflammatory bowel disease and could lower disease activity in addition to improving mood.
This study population, n=42,890, with prospectively collected data comprised all patients in the Danish National Patient Registry from 2000-2017 with ICD diagnoses of ulcerative colitis (UC, 69.5%) or Crohn’s disease (CD, 30.5%). Outcome measures included markers of disease relapse:
- hospitalizations with IBD as primary diagnosis
- surgery with IBD as primary operation code
- step-up medications with corticosteroids or anti-TNF treatment
- After adjusting for confounders, lower incidence rate of disease activity was found among antidepressant users than nonusers.
- For CD, the incidence rate ratio was 0.75 (CI 0.68-0.82).
- For UC, the incidence rate ratio was 0.90 (CI 0.84-0.95).
- For CD patients without prior use of antidepressants before diagnosis of CD, there was markedly lower incidence rate ratio of 0.51 (CI 0.43-0.62).
- 28% of the study population redeemed at least 1 prescription for an antidepressant at some point. This is similar to a Finnish study in which antidepressant use in IBD was 28% compared to 19% in general population
The authors note that anti-depressants may affect the level of pro-inflammatory cytokines which are involved in the pathogenesis of IBD. This study did not assess potential adverse effects of using anti-depressants.
My take: This study is intriguing and suggests that antidepressants may improve the disease course in IBD. Whether this is related to more favorable brain-gut interaction or whether this is related to drug effects on inflammatory agents is unclear.
Related blog post: Psychosocial Problems in Adolescents with IBD
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.