Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and Ulcerative colitis (UC) is a chronic condition with no permanent cure. In the UK the rates of new onset IBD are rising with lifetime healthcare costs comparable to those associated with heart disease and cancer. Patients with IBD are at a higher risk of developing depression and anxiety compared to individuals without IBD. Depression and anxiety in IBD may be caused by psychological factors associated to the disease or shared biological mechanisms. The presence of depression and anxiety in IBD associates to several poor outcomes including higher rates of hospitalisation, more frequent relapses, and higher rates of surgery.
While anti-depressants could mitigate the increased risk of these outcomes, recent research has shown that most individuals with IBD end anti-depressant treatment early, meaning psychiatric symptoms may not be fully treated and could relapse. Early discontinuation of anti-depressants in patients with IBD may be reflect their differing efficacy and tolerability in these individuals compared to those without IBD. As IBD can affect the absorption of anti-depressants and increase sensitivity to side effects, certain anti-depressants may be preferred for individuals with IBD.
This research will use primary care data to explore if anti-depressant treatment courses differ in length between patients with and without IBD, and if there are certain anti-depressants patients with IBD can take for the recommended duration. Findings will help inform guidelines and future trials aimed at discovering which are the best anti-depressants for patients with depression and/or anxiety alongside IBD.
Background: Depression and anxiety are prevalent in inflammatory bowel disease (IBD) and associate to a poor prognosis including higher rates of hospitalisation, more frequent relapses, and more surgical interventions. While anti-depressants may mitigate these outcomes, recent research has shown that most patients with IBD do not complete a full anti-depressant course (6-9 months after the cessation of symptoms). Early anti-depressant discontinuation may mean psychiatric symptoms are not fully treated and an increased relapse risk. As patients with IBD may absorb anti-depressants differently to those without IBD, and be more sensitive to side effects, certain anti-depressants may be more effective and better tolerated for this cohort.
Aims: This study will assess if anti-depressant treatment durations differs in patients with IBD compared to patients without IBD, and if so which anti-depressants can patients with IBD take for the full treatment duration. The study aims to also explore how clinical and demographic factors impact on the duration of anti-depressant treatment in patients with IBD, and compare the incidence of adverse mental health and anti-depressant outcomes across IBD and non-IBD groups.
Methods: The study is a matched retrospective cohort using cox proportional hazard regression analysis with duration of anti-depressant treatment as an outcome and IBD as an exposure. Multivariate survival analyses will assess how gender, age, IBD type, IBD severity and symptom profile affect treatment duration. Cox proportional hazard regression analysis will be conducted to explore if treatment duration differs across specific anti-depressants or anti-depressant classes. Secondary analyses will compare the incidence anti-depressant related adverse events and mental health outcomes. This research will provide new insights on which anti-depressants are best tolerated for patients with IBD. This will provide a public health benefit by informing clinical guidelines and help patients with IBD and depression to take the full anti-depressant treatment course.
Primary outcomes include the incidence of depression and anxiety events in patients with pre-existing inflammatory bowel disease (IBD); the percentage of anti-depressant treatment episodes that are the minimum recommended duration (7 months); the patterns of treatment continuation and/or discontinuation.
Secondary outcomes include healthcare utilisation (e.g. hospital admission, primary care consultations), IBD progression and self-harm and suicide events
Matthew Cohen - Chief Investigator - King's College London (KCL)
Matthew Cohen - Corresponding Applicant - King's College London (KCL)
Alex Dregan - Collaborator - King's College London (KCL)
Calum Moulton - Collaborator - King's College London (KCL)
Khalida Ismail - Collaborator - King's College London (KCL)
Mark Ashworth - Collaborator - King's College London (KCL)
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation