Abstract and Introduction
Background: Despite high rates of depression and anxiety, little is known about the use of antidepressants amongst individuals diagnosed with inflammatory bowel disease (IBD).
Aims: To evaluate temporal trends in the use of antidepressants; rates of antidepressant initiation and adherence of antidepressant use to international guidelines amongst individuals with IBD.
Methods: This is a study of 14,525 incident IBD cases from 2004 to 2016 compared with 58,027 controls matched 1:4 for age and sex from the Clinical Practice Research Datalink. After excluding tricyclic antidepressants, we performed a Cox regression analysis to determine the risk associated with antidepressant use and logistic regression analysis to determine risk associated with antidepressant undertreatment.
Results: Antidepressant use amongst individuals with IBD increased by 51% during the 12-year study period, who were 34% more likely to initiate antidepressants in the year after IBD diagnosis compared with controls (aHR:1.34, 95% CI 1.21–1.49). In those with IBD starting antidepressants, 67% received treatment lasting less than the duration recommended in international guidelines, of which 34% were treated for 1 month or less.
18–24 year olds were twice as likely to discontinue treatment within 1 month compared with those aged 40–60 years (aHR:2.03, 95% CI 1.40–2.95). Socioeconomic deprivation was also associated with early treatment discontinuation (aHR:1.40, 95% CI 1.07–1.83).
Conclusions: In the year following IBD diagnosis individuals are significantly more likely to start antidepressants compared with controls, but treatment duration fell short of recommendations in the majority. Better integration of services may benefit individuals with IBD and psychiatric comorbidity.
Depression and anxiety are approximately twice as common amongst individuals living with inflammatory bowel disease (IBD) relative to the general population, and these conditions may often go undetected or undertreated.[1–3] The importance of this mental health burden has been starkly highlighted by recent findings indicating an excess risk of suicide in the IBD population. In its active state, IBD manifests with symptoms of abdominal pain, weight loss, diarrhoea and rectal bleeding, which may result in reduced quality of life, social functioning and mental well-being. Conversely, individuals with IBD who suffer from depression and anxiety are more likely to have adverse IBD outcomes and increased contact with healthcare providers.[6–8]
Depression and anxiety are the most common comorbid psychiatric disorders diagnosed amongst individuals with IBD. Antidepressant medications (ADM) are most frequently used to treat these conditions. However, data regarding their use amongst individuals with coexistent IBD is lacking. In order for antidepressants to maintain remission and reduce the risk of relapse of depression and anxiety, international guidelines indicate a treatment course should continue for at least 6 months following symptom resolution.[10–14] Despite these recommendations, no previous studies have examined whether antidepressants are prescribed for an appropriate duration amongst IBD patients. Research is needed to identify risk factors predicting undertreatment with antidepressant medication in order to guide the development of appropriately targeted integrated care pathways.
We, therefore, aimed to: (1) compare rates of antidepressant initiation following IBD diagnosis with a matched control cohort without IBD; (2) determine the duration of antidepressant treatment and assess adherence to international guidelines; (3) examine risk factors associated with sub-optimal antidepressant treatment duration and (4) examine temporal trends in antidepressant prescribing in line with guidelines.
Aliment Pharmacol Ther. 2022;55(10):1330-1341. © 2022 Blackwell Publishing