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

Abstract

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.

Efficacy and Safety of Antidepressants in Patients With Comorbid Depression and Medical Diseases

“…Based on these descriptive data, we identified the largest systematic reviews within each medical disease. Data on primary and secondary outcome measures for these 73 systematic reviews are presented in eTable 7 in Supplement 2 for treatment of depression and in eTable 8 in Supplement 2 for prevention of depression.…”

Antidepressant treatment in inflammatory bowel disease: a systematic review and meta-analysis

“…For example, patients with IBD frequently have active gastrointestinal symptoms, chronic pain, elevated systemic inflammation and can have impaired intestinal absorption [ 5 ], emphasising the need for clinical trials of antidepressants specifically in IBD. Whilst a recent meta-analysis found benefit of antidepressants for depression in IBD, its findings were primarily based on studies with a high risk of bias [ 7 ]. Our findings, therefore, advance the literature by showing that antidepressants are more effective in IBD when meta-analysing based on RCTs.…”

“…A recent meta-analysis found antidepressants to be effective in patients with IBD. The findings of this synthesis, however, were based primarily on studies where randomisation or blinding procedures were not reported [ 7 ], thereby seriously undermining the validity of the findings. Furthermore, the authors did not analyse by antidepressant class, meaning it remains unclear which specific antidepressants are likely to be most beneficial in patients with IBD.…”