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Treatment with Immunosuppressive Therapy May Improve Depressive Symptoms in Patients with Inflammatory Bowel Disease

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Abstract

Introduction

Recent research suggests a relationship of inflammatory bowel disease (IBD) and depression. Our objective was to evaluate for improvement of depressive symptoms with treatment of IBD using immunosuppressive medications.

Methods

A retrospective study of consecutive patients with IBD started on immunosuppressive agents [anti-tumor necrosis factor (anti-TNF) or immunomodulator therapy] was conducted. Patients were evaluated if disease activity indices using Harvey Bradshaw Index for Crohn’s disease (CD) and Simple Clinical Colitis Disease Activity Index for ulcerative colitis (UC) and depressive indices using Patient Health Questionnaire-9 (PHQ-9) scores were obtained before and at least 30 days after initiation of therapy.

Results

Sixteen patients with UC and 53 patients with CD (all with active disease symptoms) were evaluated over a 60 day median follow-up evaluation (range 30, 140 days). Twenty-two patients started on immunomodulator therapy, and 47 patients started on anti-TNF therapy. Crohn’s disease patients had significantly decreased PHQ-9 scores at follow-up [median 9 (range 3, 14) to 4 (1, 8)], with significant decreases only in those started on anti-TNF therapy. Changes in PHQ-9 and CRP were correlated (ρ = 0.38, p < 0.05). In patients with UC, PHQ-9 scores [5 (3, 9) to 2 (0, 5)] were significantly decreased. Percentage at risk of moderate to severe depression (PHQ-9 scores ≥10) was lower after treatment [Crohn’s disease 51–18 % (p < 0.05), ulcerative colitis 18–0 %].

Conclusion

Depressive scores decreased significantly in patients with IBD treated with immunosuppressive therapy and the number at risk for moderate to severe depression improved significantly.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA

    Sara Horst, Andrew Chao, Anne Nohl, Caroline Duley, Julianne H. Wagnon, Dawn B. Beaulieu, Lawrence Gaines & David A. Schwartz

  2. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Michael Rosen

  3. Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA

    Warren Taylor & Lawrence Gaines

Authors
  1. Sara Horst
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  2. Andrew Chao
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  3. Michael Rosen
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  4. Anne Nohl
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  5. Caroline Duley
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  6. Julianne H. Wagnon
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  7. Dawn B. Beaulieu
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  8. Warren Taylor
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  9. Lawrence Gaines
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  10. David A. Schwartz
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Correspondence to Sara Horst.

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Horst, S., Chao, A., Rosen, M. et al. Treatment with Immunosuppressive Therapy May Improve Depressive Symptoms in Patients with Inflammatory Bowel Disease. Dig Dis Sci 60, 465–470 (2015). https://doi.org/10.1007/s10620-014-3375-0

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  • DOI: https://doi.org/10.1007/s10620-014-3375-0

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