Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population‐based study

Jayasooriya, Nishani; Blackwell, Jonathan; Saxena, Sonia; Bottle, Alex; Petersen, Irene; Creese, Hanna; Hotopf, Matthew; Pollok, Richard

doi:10.1111/apt.16820

Cited by 13 publications

(11 citation statements)

References 39 publications

(92 reference statements)

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“…While administrative diagnostic delay is possible, available data indicate that waiting time from referral by general practitioners to examination by a gastroenterologist in most cases does not exceed 12 weeks in Denmark (27). Our findings comply with previous reports of higher use of proton pump inhibitors, antibiotics, and nonsteroidal anti-inflammatory drugs in the 2 years before IBD diagnosis (28); higher use of antispasmodic medications in the 5 years before IBD diagnosis (29); higher use of antidepressants 9 years before diagnosis (30); and a study showing that individuals with IBD are more likely to have gastrointestinal symptoms 18 months before diagnosis (19). More unexpected was the finding of an increased use of almost all types of medications for up to 10 years before diagnosis.…”

Section: Discussionsupporting

confidence: 92%

Medication-Wide Study: Exploring Medication Use 10 Years Before a Diagnosis of Inflammatory Bowel Disease

et al. 2023

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Objectives There is growing interest in the pre-diagnostic phase of inflammatory bowel disease (IBD) and in the overlap of IBD with other diseases. We described and compared use of any prescription medication between individuals with and without IBD in a ten-year period preceding diagnosis. Methods Based on cross-linked nationwide registers, we identified 29,219 individuals diagnosed with IBD in Denmark between 2005 and 2018 and matched to 292,190 IBD-free individuals. The primary outcome was use of any prescription medication in years 1-10 prior to IBD diagnosis/matching date. Participants were considered as medication users if they redeemed ≥1 prescription for any medication in the WHO anatomical therapeutic classification (ATC) main or subgroups before diagnosis/matching. Results The IBD population had a universally increased use of medications compared to the matched population prior to IBD diagnosis. At ten years before diagnosis, the proportion of users was 1.1- to 1.8-fold higher in the IBD population in 12 of 14 ATC main groups of medication, p-value <0.0001. This applied across age, sex, and IBD subtypes, although most pronounced for Crohn’s disease (CD). Two years prior to diagnosis, the IBD population had a steep increase in medication use for several organ systems. When analyzing therapeutic subgroups of medication, the CD population exhibited 2.7, 2.3, 1.9, and 1.9 times more users of immunosuppressants, antianemic preparations, analgesics, and psycholeptics than the matched population ten years prior to diagnosis (p-value <0.0001). Conclusions Our findings demonstrate universally increased medication use years before IBD, especially CD, and indicates multiorgan involvement in IBD.

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Section: Discussionsupporting

confidence: 92%

Medication-Wide Study: Exploring Medication Use 10 Years Before a Diagnosis of Inflammatory Bowel Disease

et al. 2023

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“…In addition, in our study, persistently abnormal or worsening anxiety or depression scores were more prevalent in those with IBD diagnosed within the previous 12 months. These latter findings are supported by observations from 2 large casecontrol studies, which demonstrated a significant association between new initiation of antidepressant therapy or new presentation of a psychiatric disorder in the first year after a diagnosis of IBD (40,41). There have been few other studies examining the effect of fluctuations in mood on natural history of IBD.…”

Section: Inflammatory Bowel Diseasementioning

confidence: 55%

Characteristics and Effect of Anxiety and Depression Trajectories in Inflammatory Bowel Disease

et al. 2022

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INTRODUCTION:Symptoms of common mental disorders, such as anxiety or depression, are associated with adverse clinical outcomes in inflammatory bowel disease (IBD). We report trajectories of these symptoms in IBD, patient characteristics associated with different trajectories, and effects on healthcare utilization and prognosis.METHODS:We collected demographic, symptom, psychological, and quality-of-life data, with questionnaires at 3-month intervals, over 12 months of follow-up. We collected healthcare utilization and IBD outcomes through notes review. We compared characteristics of those with persistently normal or improving anxiety or depression scores with those with persistently abnormal or worsening scores and the number of flares, glucocorticosteroid prescriptions, escalations of therapy, hospitalizations, or intestinal resections due to IBD activity.RESULTS:Among 771 and 777 patients, respectively, worsening or persistently abnormal anxiety or depression scores were associated with increased antidepressant (28.6% vs 12.3% anxiety, 35.8% vs 10.1% depression, P < 0.001) and opiate use (19.0% vs 7.8% anxiety, P = 0.001 and 34.0% vs 7.4% depression, P < 0.001), compared with those with persistently normal or improving scores. These individuals were also more likely to have been diagnosed with IBD in the last 12 months (16.3% vs 5.0% anxiety, P = 0.001, and 15.1% vs 5.5% depression, P = 0.006), to have clinically active disease at baseline (57.1% vs 26.6% anxiety and 71.7% vs 29.1% depression, P < 0.001) and lower quality-of-life scores (P < 0.001). Individuals with worsening or persistently abnormal trajectories of anxiety or depression required significantly more outpatient appointments, radiological investigations, and endoscopic procedures for IBD-related symptoms.DISCUSSION:In this 12-month follow-up study, patients with IBD with worsening or persistently high anxiety or depression scores were higher utilizers of health care but were not at an increased risk of future adverse disease outcomes.

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“… 46 However, a retrospective population-based study in the United Kingdom found that 34% of IBD discontinue antidepressants within 28 days, which may be because of poor tolerability. 47 We, therefore, selected the minimum treatment duration, 8 weeks, as the basis for the subgroup analyses. Antidepressants were effective in both subgroups, it was interesting to note that compared with IBD patients treated for >8 weeks, patients treated for ⩽8 weeks benefited more from antidepressants in alleviating depression and anxiety symptoms.…”

Section: Discussionmentioning

confidence: 99%

Effect of antidepressants on psychological comorbidities, disease activity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

Wang

Liang

Chen

et al. 2023

Therap Adv Gastroenterol

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Background: Patients with inflammatory bowel disease (IBD) are often accompanied by a more significant burden of depression or anxiety, and approximately one-third are prescribed antidepressants. However, previous studies on the efficacy of antidepressants in IBD have shown inconsistent results. Objectives: To evaluate the effect of antidepressants on depression, anxiety, disease activity, and quality of life (QoL) in IBD patients. Design: A systematic review and meta-analysis. Methods: We searched MEDLINE via Ovid, EMBASE via Ovid, the Cochrane Library, CINAHL, PsycINFO, Chinese CBM Database, China National Knowledge Infrastructure, VIP, and Wanfang Database from inception to 13th July 2022 without language restrictions. Results: In all, 13 studies containing 884 individuals were included. Compared with the control group, antidepressants were superior in reducing depression scores [standardized mean difference (SMD) = −0.791; 95% confidence interval (CI): −1.009 to −0.572; p < 0.001], anxiety scores (SMD = −0.877; 95% CI: −1.203 to −0.552; p < 0.001), and disease activity scores (SMD = −0.323; 95% CI: −0.500 to −0.145; p < 0.001). Antidepressants had a positive effect in reaching clinical remission [risk ratio (RR) = 1.383; 95% CI: 1.176–1.626; p < 0.001]. Higher physical QoL (SMD = 0.578; 95% CI: 0.025–1.130; p = 0.040), social QoL (SMD = 0.626; 95% CI: 0.073–1.180; p = 0.027), and Inflammatory Bowel Disease Questionnaire (SMD = 1.111; 95% CI: 0.710–1.512; p < 0.001) were found in the experimental group. No significant differences were observed in clinical response (RR = 1.014; 95% CI: 0.847–1.214; p = 0.881), psychological QoL (SMD = 0.399; 95% CI: −0.147 to 0.944; p = 0.152), and environmental QoL (SMD = 0.211; 95% CI: −0.331 to 0.753; p = 0.446). Conclusion: Antidepressants are effective for ameliorating depression, anxiety, disease activity, and QoL in IBD patients. Due to most studies having a small sample size, further well-designed studies are required.

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Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population‐based study

Abstract: Background: Despite high rates of depression and anxiety, little is known about the use of antidepressants amongst individuals diagnosed with inflammatory bowel disease (IBD).

Cited by 13 publications

References 39 publications

Medication-Wide Study: Exploring Medication Use 10 Years Before a Diagnosis of Inflammatory Bowel Disease

Medication-Wide Study: Exploring Medication Use 10 Years Before a Diagnosis of Inflammatory Bowel Disease

Characteristics and Effect of Anxiety and Depression Trajectories in Inflammatory Bowel Disease

Effect of antidepressants on psychological comorbidities, disease activity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

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