Ulcerative Colitis: Antidepressant Use and Risk of Steroid Dependency

Pavankumar Kamat


June 07, 2021


  • In patients with ulcerative colitis (UC), continuous use of serotonin selective reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) was associated with a significantly increased risk of corticosteroid dependency compared with non-use.

Why this matters

  • Findings suggest that clinicians could consider antidepressant use as a predictor of potentially worse clinical outcomes in the natural history of UC.

Study design

  • This population-based study included 6373 patients with incident UC with ≥3 years of follow-up, identified from the UK Clinical Practice Research Datalink (2005-2016).

  • All patients were divided into 3 categories based on their use of SSRIs and TCAs in the 3 years following diagnosis: continuous users, intermittent users, and non-users.

  • Funding: Living with IBD Research Programme at Crohn’s & Colitis UK.

Key results

  • Overall, 5230 (82%) patients with UC had no prescription for either SSRIs or TCAs.

  • Of 6373 patients with UC:

    • 5464 (85.7%) were SSRI non-users, 627 (9.8%) were intermittent SSRI users and 282 (4.4%) were continuous SSRI users.

    • 6064 (95.1%) were TCA non-users, 246 (3.9%) were intermittent TCA users and 63 (1%) were continuous TCA users.

  • Intermittent SSRI users (adjusted OR [aOR], 1.19; 95% CI, 0.95-1.50) and TCA users (aOR, 1.14; 95% CI, 0.78-1.66) vs non-users had similar risks of corticosteroid dependency.

  • Continuous SSRI users (aOR, 1.62; 95% CI, 1.15-2.27) and TCA users (aOR, 2.02; 95% CI, 1.07-3.81) vs non-users had a significantly increased risk of corticosteroid dependency.


  • Corticosteroid prescriptions in secondary care were not included. 


Blackwell J, Alexakis C, Saxena S, Creese H, Bottle A, Petersen I, Hotopf M, Pollok RCG. Association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: a population-based study. BMJ Open Gastroenterol. 2021;8(1). doi: 10.1136/bmjgast-2020-000588. PMID: 34045238.  View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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