Antidepressants in inflammatory bowel disease: a systematic review

Background: Antidepressants are commonly used to treat symptoms of anxiety and depression in inflammatory bowel disease (IBD). Recent studies suggest a link between IBD activity and an individual’s emotional state which raises the possibility that antidepressants may potentially modify the disease course of IBD. This systematic review thus primarily aims to evaluate the efficacy of antidepressants on IBD activity, and secondarily, on anxiety and depression.
Methods: MEDLINE, EMBASE, Cochrane (IBD Group), CINAHL, AMED, PsycINFO and Open Grey were searched from 1990 onwards with no restrictions on study design. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also conducted.
Results: Fifteen eligible studies included in the review (1 RCT, 2 cohorts, 1 case-control, 1 cross-sectional survey, 1 qualitative, 2 audits, 1 case-series and 6 case reports) examined a range of antidepressants. Twelve studies suggested antidepressants have a positive impact on IBD course. Nine studies reported anxiety and depression as an outcome, of these eight reported beneficial effects of antidepressants. Most of the studies were deemed to be at low risk of bias, apart from the case reports, which were at high risk of bias.
Conclusions: The current research indicates antidepressants may have a beneficial effect on IBD course. However, it is currently not possible to determine their efficacy for certain due the lack of randomised trials. Further trials using objective measures of IBD activity, longer follow-up periods and larger sample sizes are needed.