Depression and IBD

What this research looked at?

People with Crohn’s or Colitis are more likely to experience depression than the general population. But the relationship between symptoms, use of antidepressants, flares and the impact of bowel surgery on mental health have not been well-understood. 

To find out who might be most at risk of depression, and how it is treated, the researchers aimed to answer the following questions:  

• How common is depression in people with Crohn’s and Colitis? 
• What factors make depression more likely? 

• Does use of antidepressant medicines impact on flares and the need for steroid treatment? 
• What is the relationship between having surgery, particularly a stoma, and developing depression? 

To answer these questions, the team examined the medical records of more than 19,500 people with Crohn’s and Colitis from the Clinical Practice Research Datalink database. 

What this research found?

The research team found that people may experience depression when they have gut symptoms before they receive a diagnosis of Crohn’s or Colitis. But if gut symptoms aren’t present, having depression doesn’t increase the likelihood of Crohn’s or Colitis. 

Access to treatment 1 in 10 people reported symptoms in their gut to their GP 5 years before a diagnosis of Crohn’s or Colitis. Those with a previous diagnosis of depression or Irritable Bowel Syndrome (IBS) were at a higher risk of experiencing a delay in seeing a gastroenterologist. 

Antidepressant use People with Crohn’s or Colitis were 2 to 3 times more likely to use an antidepressant medicine than people without the conditions. 1 in 3 of those who started on antidepressants took the medicine for 28 days or less. These medicines are usually taken  for a minimum of 7 months to be effective and this suggests there is an unmet need for treating depression in people with Crohn’s and Colitis. 

Stoma and antidepressant use People with Crohn’s Disease who had permanent stoma were more likely to use antidepressant medicines after surgery compared with people who had gut surgery but no stoma. A temporary stoma that lasted more than a year also associated with increased antidepressant use, but not if it was less than this.  

Antidepressants and steroid treatment in people with Ulcerative Colitis People with Ulcerative Colitis who continuously used antidepressant medicines required more steroid treatment. This suggested that antidepressant use is a flag for more severe disease and potentially worse clinical outcomes. 

What the researchers think this could mean for people with Crohn's and Colitis? 

Understanding what influences depression in people with Crohn’s and Colitis and the effect depression can have on symptoms will help health professionals address the mental health needs of people with these conditions. This could mean health professionals ask people about their mental health from diagnosis and integrate mental health support alongside physical care.  

Findings highlight the need for effective mental health support for people undergoing operations for permanent, and longer-term temporary stoma. Earlier recognition of potentially more severe Ulcerative Colitis could result from monitoring antidepressant use and so improve outcomes.    

This study also provides evidence of the need to improve pathways to diagnosis of Crohn’s and Colitis from Primary Care.  

Scientific publications resulting from this research project 

Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study (full paper available to read for free) 

Main findings:

• 1 in 10 people with Crohn’s or Colitis waited 5 years for their diagnosis after first reporting symptoms to their doctor. 
• Only 6 in 100 people had an appointment with a gastroenterologist (a specialist doctor in digestive diseases) within 4 weeks – the timeframe set by the UK IBD Standards. 
• People with a previous diagnosis of depression or Irritable Bowel Syndrome (IBS) were at a higher risk of experiencing a delay in seeing a gastroenterologist. 
• There is a pressing need to improve healthcare pathways to speed up the diagnosis of Crohn’s and Colitis. 

Read our news story for more information. ( NEEDS NEW URL)

Stoma formation in Crohn’s Disease and the likelihood of antidepressant use: a population-based cohort study. (full paper available to download for free)  

Main findings:

The study suggests that people living with a stoma for more than one year are at increased risk of mood disorders, such as depression. Health professionals should be aware of this and integrate mental healthcare provision into their practice. 

Permanent stoma 

• People who had a permanent stoma were more than one and a half times more likely to start using an antidepressant medicines after surgery than people who had gut surgery without stoma formation. 

Temporary stoma 

• People with temporary stoma  who lived with the stoma for more than a year before having reversal surgery were nearly twice as likely to start using an antidepressant after surgery than those who had gut surgery without stoma formation. 
• People with a temporary stoma in place for less than one year were no more likely to start antidepressants than patients who had surgery without a stoma. 

Who is leading the research: Dr Richard Pollok, St George’s, University of London  
Award amount: £89,670  
Duration: 18 months   
Official title of the application: Depression and antidepressant medications: their relationship to clinical outcomes in IBD