Eur JGastroenterolHepatol. 2024Jul1;36(7):850860.doi:10.1097/MEG.0000000000002768. Epub 2024 Apr 29.

Frances Weston ¹, Ben Carter ², Nick Powell ³, Allan H Young ^1 4, Calum D Moulton ^1 5 6

Author information

¹Centre for Affective Disorders.

²Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London.

³Department of Digestion, Metabolism and Reproduction, Imperial College London.

⁴National Affective Disorders Service, South London and Maudsley NHS Foundation Trust.

⁵Division of Psychiatry, Department of Brain Sciences, Imperial College.

⁶Psychological Medicine Unit, St Mark's Hospital, London, UK.

Abstract

Around 25% of patients with inflammatory bowel disease (IBD) have depressive symptoms, yet antidepressants have been poorly studied in IBD. We systematically searched IBD studies testing antidepressants in four databases. Outcomes were depressive symptoms, anxiety, IBD disease activity, quality of life (QoL) and adverse events. For randomized controlled trials (RCTs), we performed random-effects meta-analysis of the standardized mean difference (SMD) in posttreatment scores between antidepressant and placebo groups. Risk of bias was assessed using the Cochrane Common Mental Disorders Depression Anxiety and Neurosis Group tool (clinical trials) and Newcastle-Ottawa scale (cohort studies). We included 11 studies ( n = 327): three placebo-controlled RCTs, two nonrandomized trials, and six other study types. In the pooled analysis, antidepressants improved depressive symptoms [SMD = -0.71 (95% confidence interval (CI) -1.32 to -0.10), P = 0.02, I2 = 51%] and QoL [SMD = 0.88 (95% CI 0.30-1.45), P = 0.003, I2 = 44%] more than placebo. Serotonin and noradrenaline reuptake inhibitors (SNRIs) alone improved depressive symptoms [SMD = -0.95 (95% CI -1.45 to -0.45, P < 0.001, I2 = 11%], anxiety [SMD = -0.92 (95% CI 1.72 to -0.13), P = 0.023, I2 = 65%] and QoL [SMD = 1.14 (95% CI 0.66-1.62), P < 0.001, I2 = 0%]. The three RCTs were of good quality. In conclusion, based on three small but good-quality studies, antidepressants improve depressive symptoms and QoL compared to placebo in IBD. SNRI antidepressants may also improve anxiety. A fully powered study of antidepressants in IBD is needed.