"It doesn't do any harm, but patients feel better": a qualitative exploratory study on gastroenterologists' perspectives on the role of antidepressants in inflammatory bowel disease

Background: Interest in psychological factors in patients with inflammatory bowel disease (IBD)
has increased in recent years. It has even been proposed that treating psychological co-morbidities
with antidepressants may control disease activity and improve quality of life. Despite this, there is
no data on gastroenterologists' attitudes to, and experiences with, antidepressant therapy in
patients with IBD.
Methods: We conducted semi-structured interviews with 18 gastroenterologists associated with
metropolitan teaching hospitals. Qualitative content analysis was used to examine their responses.
Results: Seventy-eight percent of gastroenterologists had treated IBD patients with
antidepressants for pain, depression and/or anxiety, and insomnia. Antidepressants were reported
to be useful in improving psychosocial well-being, quality of life, and self-management of the disease
by patients. However, in this group of gastroenterologists, there appears to be skepticism towards
psychological disorders themselves or antidepressant therapy having a central role in either the
causation of IBD or its clinical course. Nevertheless, these gastroenterologists were receptive to
the idea of conducting a trial of the role of antidepressants in IBD.
Conclusion: While the majority of specialists have treated IBD patients with antidepressants,
there is considerable skepticism with regard to efficacy of antidepressive therapy or the role of
psychological factors in the outcome of IBD patients.