Mikocka_edit_Layout 1 28/09/2009 10:34 Page 48
Inflammatory Bowel Disease
Can Antidepressants Influence the Course of Inflammatory Bowel Disease?
The Current State of Research
Antonina Mikocka-Walus,
1,2
David Clarke
2
and Peter R Gibson
3
1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne; 2. School of Psychology, Psychiatry and Psychological Medicine,
Monash University, Clayton; 3. Department of Medicine, Monash University, Box Hill
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
Disclosure: The authors have no conflicts of interest to declare.
Received: 11 June 2009 Accepted: 30 June 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 A recent systematic review concluded that psychotherapy has little
describe a group of chronic and relapsing inflammatory disorders impact generally on the course of disease in IBD, although it may be
of the gastrointestinal tract, of which Crohn’s disease (CD) and beneficial for patients with anxiety and depression.
8
With respect
ulcerative colitis (UC) are the most common. IBD is characterised by to antidepressant medication, to date there has been little
an inappropriate immune response that causes characteristic formal research on its use in IBD, with most published data
inflammatory lesions in the gut wall. The aetiology of IBD is being uncontrolled and anecdotal. However, studies on healthy
unknown. Nonetheless, genetic, immune and environmental factors volunteers have demonstrated that antidepressants can improve
have all been implicated in its causation. Interestingly, stress has immunoregulatory activity.
9
Furthermore, some researchers have
been found to lead to exacerbation of the disease.
1
speculated that pre-existing depression may facilitate the appearance
of IBD, and research on mice with induced UC has demonstrated that
IBD is at present an incurable condition and its course is antidepressants can reverse this susceptibility.
10
A systematic review
unpredictable. As the disease is usually diagnosed in young adults, published in 2006
11
observed that even though antidepressants seem
sufferers must often cope with their disease for many years. Their to improve both the mental and somatic status of IBD patients, the
quality of life and psychosocial wellbeing may be profoundly low quality of the studies makes it impossible to make a definitive
impaired as a consequence of systemic symptoms, surgery statement on this. In the review,
11
12 relevant publications were
(such as installing a stoma), medication side effects and highly identified, all presenting non-randomised studies. In 10 papers,
prevalent fatigue.
2
paroxetine, bupropion and phenelzine were found effective for
treating both psychological and somatic symptoms in patients with
IBD is often associated with irritable bowel syndrome (IBS).
3
Up to IBD. However, since 2006 there have not been any reviews published
60% of IBD patients in remission continue to suffer symptoms of to provide up-to-date information on the current state of research in
IBS.
4
For these patients, quality of life and psychosocial wellbeing this area. Thus, the current study aims to identify and analyse
remain impaired regardless of whether IBD is active or quiescent. available papers on the effect of antidepressants on IBD activity that
Furthermore, in population-based studies more than 50% of IBS were published between 2006 and 2009.
patients have reported psychiatric symptoms.
5
Thus, anxiety and
depression in patients with IBD may be partly explained by Methods
co-existent IBS. In view of the above findings, it is not surprising Inclusion Criteria
that the rate of anxiety and depression in patients with IBD is All research publications of any study design published between
around 30% during remission
6
and as much as 70% during relapse.
7
2006 and 2009 examining the effect of antidepressants on IBD
48 © TOUCH BRIEFINGS 2009
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76