Antidepressant Use Short-Lived for Many Patients With IBD

The majority of patients with inflammatory bowel disease (IBD) who initiate antidepressant treatment fail to complete an adequate course before stopping, according to a study published in Alimentary Pharmacology and Therapeutics.

Depression and anxiety are approximately twice as common among people with IBD and are associated with worse IBD outcomes, researchers explained.

“Despite the heavy burden of depression and anxiety amongst individuals diagnosed with IBD, the duration of antidepressant treatment falls short of recommended international guidance in more than two thirds,” wrote lead and corresponding author Nishani Jayasooriya of the department of gastroenterology at St. George’s University, London, and coauthors. “This raises concern since individuals discontinuing antidepressant treatment continue to have a risk of relapse even when continued long term.”

The study looked at antidepressant use among 14,525 people with incident IBD between 2004 and 2016 matched 1:4 for age and sex with 58,027 people without IBD who served as controls.

Over the 12-year study period, antidepressant use among patients with IBD increased 51%, according to the study. Patients with IBD were 34% more likely to initiate an antidepressant the year after IBD diagnosis, compared with controls.

However, 67% of patients with IBD who started an antidepressant stopped short of the treatment course recommended by international guidelines — at least 6 months after resolution of symptoms. A third received just a single prescription.

Compared with patients aged 40 years to 60 years, patients aged 18 years to 24 years were twice as likely to stop antidepressant treatment within 1 month, the study showed. Patients living in areas with higher socioeconomic deprivation were also at higher risk of early antidepressant discontinuation.

“Moreover, only a quarter of 10,000 IBD patients surveyed reported being asked about their mental health or emotional wellbeing in the clinic,” researchers wrote. “In order to improve antidepressant adherence, psychological well-being, and IBD outcomes, there is a need for better integration of IBD and mental health services at the point of diagnosis and beyond.”

Reference:
Jayasooriya N, Blackwell J, Saxena S, et al. Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population-based study. Aliment Pharmacol Ther. 2022;55(10):1330-1341. DOI: 10.1111/apt.16820