Antidepressants reduce depression risk in IBD.

Patients on antidepressant therapies are less likely to develop inflammatory bowel disease, according to research published in Gut.

Gilaad G. Kaplan, MD, MPH, of medicine and community health sciences at the University of Calgary, and colleagues wrote that these treatments were selectively protective against Crohn’s disease and ulcerative colitis, and their findings could impact the management of both depression and IBD.

“Several studies have demonstrated that patients with IBD are more likely to experience depression and that depression worsens the prognosis of IBD,” they wrote. “However, no prior study had evaluated the temporal association between depression and the subsequent diagnosis of IBD, while also investigating the effect of antidepressant use on this risk.”

Researchers analyzed data from a cohort of patients taken from The Health Improvement Network to evaluate the impact of depression on IBD and antidepressant therapies on the development of IBD. They identified 403,665 patients who were diagnosed with new-onset depression between 1986 and 2012. They determined the rate for CD and UC incidence with different antidepressant use, including atypical antidepressants, mirtazapine, monoamine oxidase inhibitors, serotonin norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), serotonin modulators and tricyclic antidepressants (TCA).

Among their cohort, investigators found that patients with depression had a higher risk for developing CD (adjusted HR= 2.11; 95% CI, 1.65–2.7) and UC (aHR = 2.23; 95% CI, 1.92–2.6).

Researchers found that both SSRIs (HR = 0.63; 95% CI, 0.5–0.78) and TCAs were protective against CD, while mirtazapine (HR = 0.34; 95% CI. 0.15–0.77), SNRIs (HR = 0.46; 95% CI, 0.25–0.83), SSRIs (HR = 0.48; 95% CI, 0.42–0.55), serotonin modulators (HR = 0.46; 95% CI, 0.23–0.92) and TCAs (HR = 0.59; 95% CI, 0.51–0.68) were protective against UC.

“Though the absolute risk is low, based, on our findings, we recommend increasing the index of suspicion for a diagnosis of IBD in patients with depression and GI symptoms, and considering introduction of antidepressants,” Kaplan and colleagues wrote.

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