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Can Antidepressants Influence the Course of Inflammatory Bowel Disease?
Table 2: Quality Assessment of Reviewed Studies
Varghese et al., Ghia et al., Guemei et al., Mikocka-Walus et al.
2006
10
(Canada) 2008
12
(Canada) 2008
13
(Egypt) 2007 (Australia)
14
Length of treatment 8 weeks 12 days 2 weeks N/A
Follow-up N/A N/A N/A N/A
Clear description Yes Yes, although a procedure was very Yes Yes
of treatment complex and its description could
use graphical presentation to
improve clarity.
Description of Yes Yes Yes Yes, although participants were doctors
participants not patients.
Validated instruments Yes Yes Yes N/A
Limitations None identified. Number of mice in each arm of the Blinding of researchers not Qualitative study presenting a risk of recall
trial not specified in the text. Blinding mentioned. bias from participants.
of researchers not mentioned.
Impact of treatment with Despiramine reduced Desipramine protected against Both desipramine and A minority of gastroenterologists thought
antidepressants on the vulnerability to colitis vulnerability to colitis. fluoxetine significantly antidepressants had influenced the course
IBD activity reduced vulnerability to of IBD. These gastroenterologists used
colitis. Both drugs amitriptyline, nortriptyline, citalopram and
significantly reduced sertraline and reported that these
TNF-α and IL-β. antidepressants helped in controlling
exacerbations of IBD and reduced
its symptoms.
IBD = inflammatory bowel disease.
Studies Relevant to the Problem of the Use of In their controlled trial on mice in sepsis (a model of inflammation),
Antidepressants in Inflammatory Bowel Disease that Brustolim et al.
18
showed that bupropion lowers circulating levels
Did Not Meet the Inclusion Criteria of tumour necrosis factor-α (TNF-α) and other inflammatory
Six other papers relevant to the use of antidepressants in IBD were mediators that play a role in the genesis of IBD and other
identified. One was in a foreign language (in French) and thus only autoimmune diseases. Based on this, Brustolim et al. observed
the abstract was available to the authors.
15
This paper is a case that the finding confirms some practitioners’ decision to
study of a patient with colitis induced by venlafaxine. increasingly use bupropion for induction of remission in CD in the
absence of depression.
Another study
16
was based on two Canadian surveys of people
suffering from IBD and, although it did not focus specifically on the Rook and Lowry,
19
in an opinion paper, discuss the influence of
use of antidepressants, it provided some general data on their antidepressants on inflammation and their potential for treating
usage in these patients. The study found that only 40% of chronic inflammatory diseases including IBD. The authors list in
depressed people with IBD were using antidepressants. However, vitro studies showing anti-inflammatory properties of imipramine,
the researchers observed that even this number may be an
overestimation of treatment for depression as the medication may
be given for other problems.
Anti-tumour necrosis factor treatment,
Shen et al.
17
conducted a cross-sectional study that also included
which potently reduces inflammatory
a review of prospectively collected data relevant to disease
course. The study examined the risk factors for ileal pouch–anal
activity in patients with inflammatory
anastomosis after proctocolectomy in patients with a diagnosis of
bowel disease, improves quality of life
UC. Along with other relevant data, the researchers collected the
information on the usage of antidepressants in their 240 cases (of
and decreases depression and fatigue.
whom 49 were found to have a healthy pouch; 61 antibiotic-
dependent or antibiotic-refractory pouchitis, 39 CD of the pouch,
41 cuffitis and 50 irritable pouch syndrome). Patients were found to clomipramine, trimipramine, desipramine, reboxetine, citalopram,
use citalopram, fluoxetine, paroxetine, sertraline and venlafaxine. fluoxetine, sertraline, trazodone and lithium, as well as in vivo
Among pouchitis patients, nine (14.8%) used antidepressants; studies on amitriptiline. These medications may potentially be
among CD patients, five (12.8%) used antidepressants; and in useful in the management of IBD.
patients with cuffitis, 10 (24.4%) used antidepressants. There
were six (12.2%) patients with healthy pouch who used Finally, Fernandez-Benarez et al.
20
while studying microscopic
antidepressants and as many as 27 (54%) irritable pouch syndrome colitis (lymphocytic and collagenous) found that selective serotonin
patients using antidepressants. Antidepressants were not reuptake inhibitors (SSRIs) (e.g. sertraline, fluoxetine and
significantly related to the risk of pouchitis, CD or cuffitis, whereas paroxetine) increased the risk for colitis. However, the sample size
they were found to increase the risk of having irritable pouch of this case-control study was only 39 cases and also this type of
syndrome by four-fold. colitis is not typically related to IBD.
EUROPEAN GASTROENTEROLOGY & HEPATOLOGY REVIEW 51
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