Adjuvant therapy with antidepressants for the management of inflammatory bowel disease

Abstract

Background Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD). Antidepressants are taken by approximately 30% of people with IBD. However, there are no current guidelines on treating co-morbid anxiety and depression in people with IBD with antidepressants, nor are there clear data on the role of antidepressants in managing physical symptoms of IBD. Objectives The objectives were to assess the efficacy and safety of antidepressants for treating anxiety and depression in IBD, and to assess the effects of antidepressants on quality of life (QoL) and managing disease activity in IBD. Search methods We searched MEDLINE; Embase, CINAHL, PsycINFO, CENTRAL, and the Cochrane IBD Group Specialized Register from inception to 23 August 2018. Reference lists, trials registers, conference proceedings and grey literature were also searched. Selection criteria Randomised controlled trials (RCTs) and observational studies comparing any type of antidepressant to placebo, no treatment or an active therapy for IBD were included. Data collection and analysis Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. We used the Newcastle-Ottawa Scale to assess quality of observational studies. GRADE was used to evaluate the certainty of the evidence supporting the outcomes. Primary outcomes included anxiety and depression. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) or the Hamilton Anxiety Rating Scale (HARS). Depression was assessed using HADS or the Beck Depression Inventory. Secondary outcomes included adverse events (AEs), serious AEs, withdrawal due to AEs, quality of life (QoL), clinical remission, relapse, Adjuvant therapy with antidepressants for the management of inflammatory bowel disease (Review)

Depression and anxiety in patients with active ulcerative colitis: crosstalk of gut microbiota, metabolomics and proteomics

“… 7–9 The treatment designated for one could be effective for the other. 10 , 11 However, clinicians have not paid enough attention to the assessment and treatment of depression and anxiety in patients with UC. About one third of patients with UC and depression and two thirds of patients with UC and anxiety have not been diagnosed, and most patients with UC have not received an adequate and efficient psychological treatment in time.…”

Multidisciplinary team meetings appear to be effective in inflammatory bowel disease management: an audit of process and outcomes

“…This information is used to tailor medical therapy and surgical options. Allied health professionals, including nurse specialists, dieticians and psychologists, are also needed to address the high rate of mental health issues, poor nutrition and reduced quality of life …”

Factors Associated with Poor Quality of Life in a Canadian Cohort of Patients with Inflammatory Bowel Disease: A Cross-sectional Study

“…In a meta-analysis inclusive of fourteen randomized control trials, psychological therapies were found to have beneficial effects on depression scores and QoL in IBD, though the benefits appeared to be lost in the long term ( 38 ). Likewise, in another meta-analysis by Mikocka-Walus et al, pharmacotherapy for depression and anxiety in IBD patients did not have a clear benefit toward improvement in depression scores ( 39 ). Future avenues of research into the how best to approach IBD patients with anxiety and depression as current strategies may not be sufficient.…”