title: Do antidepressants influence the disease course in inflammatory bowel disease? A retrospective case-matched observational study.
abstract: BACKGROUND
  Depression, like adverse events and psychological stress, can trigger relapse in inflammatory bowel disease (IBD); however, the effects of psychoactive drugs on disease course are unclear.
  
  
  METHODS
  Using retrospective electronic case note review, after exclusion of five patients on low-dose tricyclic antidepressants we compared the course of IBD in 29 patients (14 ulcerative colitis and 15 Crohn's disease), during the years before (year 1) and after (year 2) they were started on an antidepressant for a concomitant mood disorder to that of controls matched for age, sex, disease type, medication at baseline, and relapse rate in year 1.
  
  
  RESULTS
  Patients had fewer relapses and courses of steroids in the year after starting an antidepressant than in the year before (1 [0-4] (median [range]) vs. 0 [0-4], P = 0.002; 1 [0-3] vs. 0 [0-4], P < 0.001, respectively); the controls showed no changes between years 1 and 2 in relapses (1 [0-4] vs. 1 [0-3], respectively) or courses of steroids (1 [0-2] vs. 0 [0-3]). Although there were no differences in the use of other relapse-related medications, outpatient attendances, or hospital admissions, the number of endoscopies fell significantly in the antidepressant group in year 2 compared with year 1 (P < 0.01). No such changes were seen in the controls.
  
  
  CONCLUSIONS
  Antidepressants, when used to treat concomitant mood disorders in IBD, seem to reduce relapse rates, use of steroids, and endoscopies in the year after their introduction. These results suggest the need for a prospective controlled trial to evaluate their effects on disease course in patients with IBD.
authors.affiliation: Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Barts and London School of Medicine and Dentistry, London, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Goodhand
authors.forename: F I S
authors.initials: FI
authors.lastname: Greig
authors.forename: Y
authors.initials: Y
authors.lastname: Koodun
authors.forename: A
authors.initials: A
authors.lastname: McDermott
authors.forename: M
authors.initials: M
authors.lastname: Wahed
authors.forename: L
authors.initials: L
authors.lastname: Langmead
authors.forename: D S
authors.initials: DS
authors.lastname: Rampton
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D003863:Depression / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000928:Antidepressive Agents