Can Antidepressants Influence the Course of Inflammatory Bowel Disease? The Current State of Research
European Gastroenterology & Hepatology Review, 2009;5:48-53
Abstract
A previous systematic review conducted in 2006 indicated that antidepressants may have the potential to improve the course of inflammatory bowel disease (IBD). The current study is an update of this review, aiming to identify and summarise available data on the effect of antidepressants on IBD activity published between 2006 and 2009. Electronic databases were searched to identify all relevant publications issued between 2006 and 2009 in English. Four studies met the inclusion criteria: three randomised controlled trials (RCTs) and one qualitative interview study. Six other papers with relevance to the subject that did not meet inclusion criteria were also identified. Desipramine was found to reduce vulnerability to colitis and to improve all examined inflammatory markers in the three animal RCTs; fluoxetine was found to protect against colitis in one RCT. Overall, the sudies suggest a positive impact of antidepressants on inflammation in IBD. However, good-quality human data are lacking and more RCTs are needed.
Keywords
Inflammatory bowel disease, antidepressants, anti-inflammatory, depression, desipramine, fluoxetine
Inflammatory bowel disease, antidepressants, anti-inflammatory, depression, desipramine, fluoxetine
Disclosure
The authors have no conflicts of interest to declare.
Received:
June 11, 2009 Accepted
June 30, 2009
Correspondence:
Antonina Mikocka-Walus, Department of Epidemiology and Preventive Medicine, Monash University, 89 Commercial Rd, Melbourne 3004, VIC, Australia. E: antonina.mikocka-walus@med.monash.edu.au
Inflammatory bowel disease (IBD) is a generic term used to describe a group of chronic and relapsing inflammatory disorders of the gastrointestinal tract, of which Crohn’s disease (CD) and ulcerative colitis (UC) are the most common. IBD is characterised by an inappropriate immune response that causes characteristic inflammatory lesions in the gut wall. The aetiology of IBD is unknown. Nonetheless, genetic, immune and environmental factors have all been implicated in its causation. Interestingly, stress has been found to lead to exacerbation of the disease.1
IBD is at present an incurable condition and its course is unpredictable. As the disease is usually diagnosed in young adults, sufferers must often cope with their disease for many years. Their quality of life and psychosocial wellbeing may be profoundly impaired as a consequence of systemic symptoms, surgery (such as installing a stoma), medication side effects and highly prevalent fatigue.2
IBD is often associated with irritable bowel syndrome (IBS).3 Up to 60% of IBD patients in remission continue to suffer symptoms of IBS.4 For these patients, quality of life and psychosocial wellbeing remain impaired regardless of whether IBD is active or quiescent. Furthermore, in population-based studies more than 50% of IBS patients have reported psychiatric symptoms.5 Thus, anxiety and depression in patients with IBD may be partly explained by co-existent IBS. In view of the above findings, it is not surprising that the rate of anxiety and depression in patients with IBD is around 30% during remission6 and as much as 70% during relapse.7
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