Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Gut. 2019 Sep;68(9):1606-1612. doi: 10.1136/gutjnl-2018-317182. Epub 2018 Oct 18.
Depression is associated with IBD, but the effect of antidepressants on IBD has been sparsely studied. We assessed the impact of depression and antidepressant therapies on the development of IBD.
The Health Improvement Network (THIN) was used to identify a cohort of patients with new-onset depression from 1986 to 2012. THIN patients who did not meet the defining criteria for depression were part of the referent group. The outcome was incident Crohn's disease (CD) or ulcerative colitis (UC). Cox proportional hazards modelling was performed to evaluate the rate of Crohn's disease or UC development among patients with an exposure of depression after controlling for age, sex, socioeconomic status, comorbid conditions, smoking, anxiety and antidepressant use including atypical antidepressants, mirtazapine, monoamine oxidase inhibitors (MAOI), serotonin norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), serotonin modulators; and tricyclic antidepressants (TCA).
We identified 403 665 (7.05%) patients with incident depression. Individuals with depression had a significantly greater risk of developing CD (adjusted HR=2.11, 95% CI 1.65 to 2.70) and UC (adjusted HR=2.23, 95% CI 1.92 to 2.60) after controlling for demographic and clinical covariates. SSRI and TCA were protective against CD, whereas mirtazapine, SNRI, SSRI, serotonin modulators and TCA were protective for UC.
Patients with a history of depression were more likely to be diagnosed with IBD. In contrast, antidepressant treatments were selectively protective for Crohn's disease and UC. These results may impact counselling and management of depression and IBD.
抑郁与 IBD 相关，但抗抑郁药对 IBD 的影响研究甚少。我们评估了抑郁和抗抑郁治疗对 IBD 发展的影响。
利用健康改进网络（THIN）从 1986 年至 2012 年确定了一组新发抑郁症患者。未达到抑郁症定义标准的 THIN 患者为参照组。结果是新发克罗恩病（CD）或溃疡性结肠炎（UC）。采用 Cox 比例风险模型评估在控制年龄、性别、社会经济地位、合并症、吸烟、焦虑和抗抑郁药（包括非典型抗抑郁药、米氮平、单胺氧化酶抑制剂（MAOI）、5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）、选择性 5-羟色胺再摄取抑制剂（SSRIs）、5-羟色胺调节剂；和三环类抗抑郁药（TCA））使用后，患有抑郁症的患者发展为 CD 或 UC 的比率。
我们确定了 403665 名（7.05%）患有新发抑郁症的患者。在控制人口统计学和临床协变量后，患有抑郁症的个体发生 CD 的风险显著增加（调整后的 HR=2.11，95%CI 1.65 至 2.70）和 UC（调整后的 HR=2.23，95%CI 1.92 至 2.60）。SSRIs 和 TCA 可预防 CD，而米氮平、SNRI、SSRIs、5-羟色胺调节剂和 TCA 可预防 UC。
有抑郁史的患者更有可能被诊断为 IBD。相比之下，抗抑郁治疗对 CD 和 UC 具有选择性保护作用。这些结果可能会影响对抑郁和 IBD 的咨询和管理。
