Table 1

Features of 12 studies describing the effect of antidepressants on the course of inflammatory bowel disease in order of the quality significance

Study name

Design

Participants

Disease type

Method

Results


Kast and Altschuler 2001 (USA)

Case report

2:

Female, 44 y.o., 10 years with CD, CDAI: 202, mesalamine 500 mg (2 a day), once a year a relapse treated with steroids, depression treated with fluoxetine (40 mg) not effectively

Male, 45 y.o., 20 years with CD, CDAI: 275, azathioprine (100 mg) and bowel resections, fluoxetine for pain not effective.

CD

Bupropion 150 mg (3 times daily) for depression (a female) and for pain and smoking cessation (a male)

Female:19-month remission, bupropion dependant, no other medication, CDAI = 0

Male: CDAI = 45, 3–4 diarhoeas daily because of ileal-cecal valve, 50 mg azathioprine, still on bupropion.

Positive effect of bupropion on IBD activity (CD).

Walker et al. 1996 (USA)

Non-randomised open label study

8, recruited between March and October 1993 in tertiary care medical facility in Seattle, English-speaking, 18 y.o. or older, presented with IBD

Not specified

Tools: NIMH Diagnostic Interview Schedule (psychiatric interview), GI symptom interview and the Briere Child Maltreatment interview (history of childhood abuse and neglect), SF-36, Tridimensional Personality Questionnaire Patients diagnosed with major depression (n = 8) have their depression confirmed by the Hamilton Depression Inventory (HAM-D) and started treatment. Treatment: paroxetine (paxil) 20 mg, after 1 month two patients had the dosage increased to 40 mg. Length: 8 weeks and reinterviewed + SF-36 and HAM-D

Decrease in mean HAM-D (pre-treatment 29.0+-7.8; post-treatment 8.1+-6.1; t = 13.6, df = 7, p,0.0001) and significant reduction in functional disability on most scales of the SF-36. The SF-36 measures changes in several domains of patient function including physical limitations, occupational role, emotional role, social function, pain, mental health, vitality, and health perception (higher scores associated with increased quality of life)

Positive effect of paroxetine on IBD activity (not specified).

Scott, Letrent, Hager and Burch 1999 (USA)

Case report

1, 42 y.o., black male, depressed with chronic abdominal pain, weight loss, insomnia, anhedonia, with flare of CD, taking 6-mercaptopurine, prednisone and total parenteral nutrition. Treated in the past for depression with sertraline ineffectively and with amitriptyline successfully.

CD

Amitriptyline gel 80 mg/day intramuscularly. Improvement in mood but not in pain. Then, transdermal gel

Amitriptyline 150 mg applied to the chest at bedtime.

Tool: Hamilton Depression Scale

Follow-up 6 weeks. Depression did not respond adequately to transdermal amitriptyline, however, patient stated that his mood improved. Patient's abdominal pain remained unchanged, however, did not experience any adverse events associated with transdermal medication.

No effect of amitriptyline on IBD activity (CD).

Eirund 1998 (Germany)

Case report

1, male, 67 y.o., 17 years with UC, 4 relapses per year despite the treatment with sulfasalazine

UC

Treatment with paroxetine (20 mg) for panic disorder

Panic disorder cured. No relapse of UC for 10 months.

Positive effect of paroxetine on IBD activity (UC).

Kast 1998 (USA)

Case report

1, female, 33 y.o., 18 years with CD, taking azathioprine (75 mg), prednisone (60 mg) and acetaminophen (3 tablets daily), 3 bowel resections, despite this in relapse

CD

Phenelzine treatment for anxiety-prominent major depressive episode (15 mg 3 times daily – 30 mg 3 times daily)

Depression cured. After 7 days of treatment bowel movements dropped from 10 to 3–4 per day, after the increase to 30 mg 1 bowel movement daily, depression responded, no cramps. Azathioprine and prednisone tapered off. Remission for 2 years until the treatment with phenelzine stopped. After 6 weeks since the stop relapse.

Positive effect of phenelzine on IBD activity (CD).

Kane, Altschuler and Kast 2003 (USA)

Case report

4, (2 women, 2 unspecified)

CD

Treatment with bupropion

(100 mg daily) for smoking cessation

(2 women) and depression

(2 unspecified)

CDAI<150 within 6 weeks (without a change in standard medication for IBD)

Positive effect of bupropion on IBD activity (CD).

Torras Bernaldez et al. 2003 (Spain)

Case report

3 depressed patients, no IBD diagnosed before depression

-

Treatment with Paroxetine for depression

Patients present with chronic diarrhoea, 2 treated with corticosteroid + immunosuppressants, 2 diagnosed with CD, one with unspecified bowel disease.

Controversial paroxetine.

Ginsburg et al. 2005 (USA)

Guideline

0

Not specified

NA

All antidepressants recommended in irritable bowel syndrome recommended in IBD.

Kast 2003 (USA)

Review

NA

CD

NA

Bupropion recommended and mirtazapine not recommended.

Kast and Altschuler 2004 (USA)

Letter

NA

CD

NA

Bupropion recommended.

Kast and Altschuler 2005 (USA)

Review

NA

CD

NA

Bupropion recommended.

Kast 2005

Discussion

NA

CD

NA

Bupropion recommended.


Legend:

CD – Crohn's disease

CDAI – Crohn's Disease Activity Index

HAM-D – Hamilton Depression Inventory

IBD – inflammatory bowel disease

NIMH – National Institute of Mental Health

SF-36 – Medical Outcome Short Form (36) Health Survey

UC – ulcerative colitis

y.o. – years old

Mikocka-Walus et al. Clinical Practice and Epidemiology in Mental Health 2006 2:24   doi:10.1186/1745-0179-2-24

Open Data