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Inflammatory Bowel Disease
Table 1: Features of Studies Describing the Effect of Antidepressants on the Course of Inflammatory Bowel Disease
Study Name Design Participants Disease Method Results
Type
Varghese et al., Randomised, Newborn male UC Half of the animals (in both the MS and US Desipramine improved depressive-
2006
10
(Canada) controlled, mouse pups: groups) were given intraperitoneal injections like behaviour and reduced vulnerability
blinded trial MS (n=16) and of 15mg/kg desipramine (DMI) once daily at to colitis in the experimental but not
US (n=16) 23–36 days of age, whereas control animals in the control group.
received equivalent volumes of saline
intraperitoneally. Colitis was induced at 60 days
of age. To examine any direct effect of DMI on
colitis, DMI was administered once daily by
intraperitoneal injections for 1 week before and
during induction of colitis by dextran sulphate
sodium (DSS) in drinking water. Follow-up at
8 weeks of age.
Mikocka-Walus et al., Qualitative 18 CD Gastroenterologists were interviewed Tricyclic antidepressants were more commonly
2007
14
(Australia) interview gastroenterologists and with respect to their attitudes to and used than SSRIs. Tricyclics (amitriptyline,
study UC experiences with using antidepressants dothiepin, prothiaden, doxepin, imipramine,
in patients with inflammatory bowel nortriptyline) were successfully used for pain,
disease. A content analysis was conducted gut irritability and urgency of defecation. Most
to summarise doctors’ responses. doctors did not think antidepressants had any
influence on the course of IBD. Antidepressants
were thought to help IBD patients to manage
their disease, cope with unpleasant symptoms,
improve sleep patterns, reduce pain and gut
irritability and ook after their nutrition and
diet. The benefits of the treatment with
antidepressants might be more visible on
disease activity indices rather than on
inflammatory activity markers. Those
gastroenterologists who thought treatment with
antidepressants had influenced the course of
IBD reported that antidepressants helped in
controlling exacerbations of IBD and reduced
symptoms of IBD. These gastroenterologists
used amitriptyline, nortriptyline, citalopram and
sertraline. CD patients seemed to be treated
with antidepressants for their psychological
problems and pain whereas UC patients were
treated for pain and sleep disturbances.
Ghia et al., Randomised, Newborn male UC Depression was induced by reserpine Desipramine protected against
2008
12
(Canada) controlled mouse pups: MS given for 14 days or was a result of vulnerability to colitis in both mice
trial (experimental group) maternal separation, and colitis was induced with reserpine-induced depression and
and US (controls) by DSS or dinitrobenzene sulphonic acid MS cases, but this was dependent on
(DNBS). Desipramine (DMI) 15mg/kg daily vagal integrity. All parameters of
was used as the antidepressant in the MS inflammation were improved compared
group. A follow-up at 12 days was conducted. with controls.
Guemei et al., Randomised, 48 adult male UC Rats were divided randomly into 6 groups Both desipramine and fluoxetine
2008
13
(Egypt) controlled albino rats (n=8 each): Group 1, normal controls: significantly attenuated the extent
trial sham-operated, received 0.5ml/kg/day IP and the severity of the macroscopic
saline for 2 weeks after sham operation. signs of cell damage. Both drugs
Group 2, acetic acid-induced colitis (AAIC) significantly reduced TNF-α and
untreated control group: received saline IL-β. Desipramine 20mg/kg
0.5ml/kg/day IP for 2 weeks after AAIC. Group 3, produced a greater decrease in TNF-α
AAIC desipramine-treated: received desipramine compared with the smaller dose, but
10mg/kg IP for 2 weeks after AAIC. Group 4, fluoxetine 10mg/kg produced more
AAIC desipramine treated: received desipramine decrease in IL-1β compared with
20mg/kg IP for 2 weeks after AAIC. Group 5, the larger dose.
AAIC fluoxetine treated: received fluoxetine
10mg/kg IP for 2 weeks after AAIC; Group 6, AAIC
fluoxetine treated: received fluoxetine 20 mg/kg
IP for 2 weeks after AAIC.
CD = Crohn’s disease; IBD = inflammatory bowel disease; IL-β = interleukin-β; MS = maternally separated; SSRI = selective serotonin re-uptake inhibitor; TNF-α = tumour necrosis factor-α;
UC = ulcerative colitis; US = unseparated
50 EUROPEAN GASTROENTEROLOGY & HEPATOLOGY REVIEW
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