Psychotherapy may help relieve depression in pediatric Crohn's disease

Last Updated: 2015-04-15

By Will Boggs MD

NEW YORK (Reuters Health) - Psychotherapy, particularly cognitive behavioral therapy (CBT), may be useful for treating depression in youth with Crohn's disease, according to a new report.

"Adolescents with Crohn's disease are vulnerable to depression due both to disease-related factors, such as inflammation, and factors not directly associated with inflammatory bowel disease," said lead author Dr. Eva Szigethy from the University of Pittsburgh School of Medicine, Pennsylvania.

"Psychotherapy, regardless of the modality, can be a useful adjunct to medical treatment in treating clinically significant depression in the entire cohort," she told Reuter Health by email. "For teens with mild to moderate inflammation, cognitive behavioral therapy has a statistically and clinically significantly greater impact on somatic depressive symptoms and the underlying inflammation compared to support therapy and thus should be preferentially considered in this subgroup."

Dr. Szigethy and colleagues, in a secondary analysis of a recent randomized trial, evaluated the effects of 12 weeks of CBT versus supportive nondirective therapy (supportive listening, SNDT) in 161 youth aged 9 to 17 years.

Overall, both treatments brought similar improvements in Children's Depression Rating Scale-Revised (CDRS-R) scores, with no significant difference between CBT and SNDT groups.

Neither treatment had an effect on somatic depressive symptoms among patients with inactive Crohn's disease, but CBT led to significantly greater improvements in somatic symptoms in patients with active disease, the researchers report in Inflammatory Bowel Diseases, online March 27.

Both treatments were associated with significant improvements in Pediatric Crohn's Disease Activity Index (PCDAI) scores over time, with patients who received CBT faring better than patients who received SNDT.

In the subgroup of youth not taking systemic steroids, CBT produced significantly greater improvements in somatic depressive symptoms, CDRS-R scores and PCDAI scores than did SNDT.

"Crohn's disease is a life-long disease and with repeated flares, can lead to the need of surgical resection of the diseased intestines," Dr. Szigethy explained. "A learning-based therapy such as CBT can help reduce emotional distress but may also have a protective effect on the inflammatory disease process."

"If youth are on higher-dose steroid medications, which can have independent mood-altering effects on the brain and are also a proxy for severe inflammation, psychotherapy at this stage of the disease cycle does not appear as helpful and thus medical attention and rest are more critical," Dr. Szigethy concluded.

SOURCE: http://bit.ly/1CMYJfa

Inflamm Bowel Dis 2015.