Evidence from a comprehensive review suggests antidepressants may help some inflammatory bowel disease patients by reducing relapses and steroid use, though findings were mixed and based largely on non-randomized studies. The review also noted an association between certain biologics—such as ustekinumab and vedolizumab—and new-onset depressive symptoms.
Researchers examined the bidirectional relationship between depressive disorders (DDs) and inflammatory bowel disease (IBD), emphasizing shared pathophysiological mechanisms, reciprocal therapeutic effects, and the need for an integrated, multidisciplinary approach to patient care.
Data from observational cohorts, prospective studies, and mechanistic investigations were synthesized, focusing on immune dysregulation, gut microbiota alterations, hypothalamic–pituitary–adrenal axis dysfunction, and genetic susceptibility.
The review examined epidemiological data from multiple international cohorts and surveys, including retrospective and prospective studies on IBD and depressive disorders. In a US cohort of 393 IBD patients without preexisting mental health diagnoses, the incidence of DDs was 20%.
Canadian survey data showed DD prevalence between 14.7% and 16.3%, while European estimates were lower, at 10% in Germany and 10% in France. A meta-analysis reported that approximately one-quarter of IBD patients experience depression, and one-third experience anxiety.
In the Manitoba IBD Cohort, the prevalence of lifetime major depression in patients with IBD was 27.2%, compared with 12.3% in the general population.
A UK prospective cohort study found that IBD was associated with a 23% increased risk of psychiatric disorders, including depression, anxiety, and post-traumatic stress disorder. Notably, Crohn’s disease was more strongly associated with psychiatric comorbidities than ulcerative colitis.
Genetic analyses highlighted shared susceptibility loci across IBD and DDs, including NOD2, P2RX7, IL23R, and PTPN2. Elevated levels of proinflammatory cytokines—such as interleukin-6, tumor necrosis factor-α, and interleukin-1β—were consistently reported in both conditions.
In microbiota analyses of 507 IBD patients and 75 controls, researchers identified 106 differentially abundant taxa. Patients with both IBD and DDs had reduced levels of Faecalibacterium prausnitzii and Roseburia intestinalis and elevated levels of Escherichia coli and Veillonella spp.
Regarding treatment outcomes, patients receiving tumor necrosis factor inhibitors such as adalimumab reported improved depressive symptoms.
In the CHARM trial, the mean Zung Self-Rating Depression Scale score shifted from mild depression to a normal range following adalimumab therapy. However, in clinical trials involving ustekinumab and vedolizumab, depression was reported as one of the most frequent psychiatric adverse events among patients without baseline DDs.
The authors reported no conflicts of interest.
Source: Journal of Clinical Medicine