The role of antidepressants in the management of inflammatory bowel disease (IBD): A short report on a clinical case-note audit

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Abstract

Objective

This study sought to determine the frequency of use and types of antidepressants used in IBD patients and to collect data with respect to any effect of antidepressants on the course of IBD in a usual care setting.

Method

A case-note audit was conducted at an IBD Service in a public tertiary hospital. Included patients were those diagnosed with IBD by a gastroenterologist; and have had contact with the IBD Service in the last 6 months. Descriptive statistics were used to summarise the data.

Results

Overall, 313 patients were eligible and 287 had complete data. Overall, 51 (17.8%) patients were currently taking antidepressants and 71 (24.7%) previously received antidepressants. Eighty-three (28.9%) patients had used an antidepressant at some time. In terms of disease activity while on antidepressants, the majority of patients had inactive disease but presented with what were thought by their clinicians to be functional symptoms.

Conclusion

Antidepressants are commonly prescribed in IBD patients. In our cohort, they appear to be mostly used for functional symptoms. The current data do not allow us to judge whether they improve IBD disease activity. Targeted studies are needed to answer this question and to improve practice and patient outcomes.

Introduction

Inflammatory bowel disease (IBD) is a group of chronic, relapsing inflammatory disorders of the gut, of which Crohn's disease (CD) and ulcerative colitis (UC) are the most common. While the aetiology of IBD is unknown, genetic, immune and environmental factors are all implicated. Recently, a psycho-neuro-immunological view of IBD has developed due to intriguing observations, that psychological status directly influences inflammatory lesions in the gut. Ghia et al. [1] have shown that inducing depression in mice increased their susceptibility to spontaneous intestinal inflammation by interfering with tonic vagal inhibition of pro-inflammatory macrophages. Moreover, treating the depressed state (with antidepressants) was found to not only, restore vagal function but also to reduce the intestinal inflammation. More recently, the same group have demonstrated that in healthy mice in which colitis was chemically induced and then allowed to heal, inflammation was able to be later reactivated via the induction of depression [2]. In humans with IBD, a recent large prospective study (n = 704) [3] showed that, of a number of factors studied, only high “perceived stress” was associated with an increased risk of IBD relapse.

However, with respect to antidepressants use in IBD, to date, there has been little formal research. In a systematic review, it was observed that even though antidepressants appear to improve both mental and somatic status of IBD patients, the low quality of available studies makes it impossible to make a definitive statement on their efficacy [4]. However, the most recent update to this systematic review [5] found that desipramine and fluoxetine reduced the severity of intestinal inflammation in animal models. In a subsequent qualitative interview study, gastroenterologists reported that antidepressants were successful in reducing pain, gut irritability, and urgency of defecation [6]. While such observations increase our confidence in extrapolating such effects to the human situation, more targeted human studies are needed. Thus, the aim of this study was to determine the frequency of use and types of antidepressants currently prescribed to IBD patients and their effect on the course of IBD.

Section snippets

Design and participants

This study was a retrospective case-note audit. Patient details for the audit were collected from the IBD database at a large Australian tertiary public hospital. Patients were included in the case-note audit if:

  • 1)

    they had been diagnosed with IBD by a gastroenterologist;

  • 2)

    were in contact with IBD Service within the preceding 6 months.

Procedure

Case notes of eligible patients were manually searched for information on current and past exposure to antidepressants.

Outcome measures

Outcome measures included frequency, type and

Ethical consideration

This study was approved by the Royal Adelaide Hospital and University of South Australia Research Ethics Committees.

Results

There were 313 patients that had been in contact with the clinic in the last 6 months who consented to be involved in research studies. Of these, 287 had complete data and were available in full to the researchers. Of these, 144 (50.2%) were male, 179 (62.4%) had CD, 134 (46.7%) were married/de facto, and the mean age was 47 (SD = 17) years (Table 1). Patients' current medication is listed in Table 2.

Of 287 patients, 51 (17.8%) were currently taking antidepressants. Of the 287 patients, 71 (24.7%)

Discussion

This study is one of only a few worldwide focused specifically on the use of antidepressants in patients with IBD. The strength of our data lays in the fact that all patients attending our unit within the last 6 months were included, which avoids many inclusion, participation and recall biases. The most significant finding of the study was that nearly 30% of IBD patients have taken antidepressants throughout their lifetime, with many of them taking these medications long-term. This rate is much

Acknowledgements

This study was funded from the University of South Australia, School of Nursing and Midwifery Research Grant Scheme 2010.

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