title: Treatment with immunosuppressive therapy may improve depressive symptoms in patients with inflammatory bowel disease.
abstract: BACKGROUND
  Recent research suggests a relationship of inflammatory bowel disease (IBD) and depression. Our objective was to evaluate for improvement of depressive symptoms with treatment of IBD using immunosuppressive medications.
  
  
  METHODS
  A retrospective study of consecutive patients with IBD started on immunosuppressive agents [anti-tumor necrosis factor (anti-TNF) or immunomodulator therapy] was conducted. Patients were evaluated if disease activity indices using Harvey Bradshaw Index for Crohn's disease (CD) and Simple Clinical Colitis Disease Activity Index for ulcerative colitis (UC) and depressive indices using Patient Health Questionnaire-9 (PHQ-9) scores were obtained before and at least 30 days after initiation of therapy.
  
  
  RESULTS
  Sixteen patients with UC and 53 patients with CD (all with active disease symptoms) were evaluated over a 60 day median follow-up evaluation (range 30, 140 days). Twenty-two patients started on immunomodulator therapy, and 47 patients started on anti-TNF therapy. Crohn's disease patients had significantly decreased PHQ-9 scores at follow-up [median 9 (range 3, 14) to 4 (1, 8)], with significant decreases only in those started on anti-TNF therapy. Changes in PHQ-9 and CRP were correlated (ρ = 0.38, p < 0.05). In patients with UC, PHQ-9 scores [5 (3, 9) to 2 (0, 5)] were significantly decreased. Percentage at risk of moderate to severe depression (PHQ-9 scores ≥10) was lower after treatment [Crohn's disease 51-18 % (p < 0.05), ulcerative colitis 18-0 %].
  
  
  CONCLUSIONS
  Depressive scores decreased significantly in patients with IBD treated with immunosuppressive therapy and the number at risk for moderate to severe depression improved significantly.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA, sara.n.horst@vanderbilt.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Horst
authors.forename: Andrew
authors.initials: A
authors.lastname: Chao
authors.forename: Michael
authors.initials: M
authors.lastname: Rosen
authors.forename: Anne
authors.initials: A
authors.lastname: Nohl
authors.forename: Caroline
authors.initials: C
authors.lastname: Duley
authors.forename: Julianne H
authors.initials: JH
authors.lastname: Wagnon
authors.forename: Dawn B
authors.initials: DB
authors.lastname: Beaulieu
authors.forename: Warren
authors.initials: W
authors.lastname: Taylor
authors.forename: Lawrence
authors.initials: L
authors.lastname: Gaines
authors.forename: David A
authors.initials: DA
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000523:psychology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000378:metabolism; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha