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Association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: a
Jonathan Blackwell1,2,3, Christopher Alexakis3,4, Sonia Saxena5,3
1Imperial College London Department of Primary Care and Public Health, London, UK j.blackwell@imperial.ac.uk.
BMJ Open Gastroenterology
|May 28, 2021
Summary
Continuous antidepressant medication (ADM) use in ulcerative colitis (UC) patients does not offer protection and is linked to higher corticosteroid dependency. ADM use may indicate a need for more intensive treatment in UC. Keywords: ulcerative colitis, antidepressant medication, corticosteroid dependency.
Area of Science:
- Gastroenterology
- Clinical Pharmacology
- Epidemiology
Background:
- Animal studies suggest antidepressant medications (ADMs) may protect against colitis.
- However, the effect of ADM use in human ulcerative colitis (UC) patients remains unclear.
- This study investigates the association between ADM use and corticosteroid dependency in UC.
Purpose of the Study:
- To examine the relationship between antidepressant medication (ADM) use and corticosteroid dependency in patients with ulcerative colitis (UC).
Main Methods:
- A cohort of 6373 UC patients diagnosed between 2005 and 2016 was identified from the Clinical Practice Research Datalink.
- Patients were categorized into 'continuous users', 'intermittent users', and 'non-users' of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) within three years of diagnosis.
- Logistic regression analysis was employed to determine the adjusted risk of corticosteroid dependency based on ADM exposure.
Main Results:
- Continuous use of SSRIs or TCAs was associated with a higher frequency of corticosteroid dependency compared to non-users (24% and 19% vs. 14%, respectively).
- Continuous SSRI users showed a 1.62-fold increased risk (OR 1.62, 95% CI 1.15 to 2.27), and continuous TCA users showed a 2.02-fold increased risk (OR 2.02, 95% CI 1.07 to 3.81) of corticosteroid dependency.
- Intermittent ADM use did not significantly alter the risk of corticosteroid dependency compared to non-users.
Conclusions:
- Continuous antidepressant medication use in ulcerative colitis patients does not confer a protective effect in clinical practice.
- Continuous ADM use is associated with an increased risk of corticosteroid dependency, suggesting a potential marker for more severe disease.
- Antidepressant medication use in UC patients may signal a need for more intensive medical management and closer monitoring for adverse outcomes.
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