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

Horst, Sara; Chao, Andrew; Rosen, Michael J.; Nohl, Anne; Duley, Caroline; Wagnon, Julianne; Beaulieu, Dawn B.; Taylor, Warren D.; Gaines, Lawrence S.; Schwartz, David A.

doi:10.1007/s10620-014-3375-0

Cited by 62 publications

(43 citation statements)

References 29 publications

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“…While several studies have demonstrated an improvement in overall health-related quality of life with anti-TNF biologic treatment, few have examined the effect of such therapies directly on depression and anxiety, and none with vedolizumab. Horst et al [58] showed in a small sample size study that immunosuppressive therapy decreased depression scores significantly. Another study found similar results after starting infliximab infusions but noted that patients with a current or past depressive disorder at baseline had a higher immune activation as well [59].…”

Section: Discussionmentioning

confidence: 99%

Vedolizumab Therapy Is Associated with an Improvement in Sleep Quality and Mood in Inflammatory Bowel Diseases

et al. 2016

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Introduction Poor sleep, depression, and anxiety are common in patients with inflammatory bowel diseases (IBD) and associated with increased risk of relapse and poor outcomes. The effectiveness of therapies in improving such psychosocial outcomes is unclear but is an important question to examine with increasing selectivity of therapeutic agents. Methods This prospective cohort enrolled patients with moderate-to-severe CD or UC starting biologic therapy with vedolizumab or anti-tumor necrosis factor α agents (anti-TNF). Sleep quality, depression, and anxiety were measured using validated short-form NIH PROMIS questionnaires assessing sleep and mood quality over the past 7 days. Disease activity was assessed using validated indices. Improvement in sleep and mood scores from baseline was assessed, and regression models were used to identify determinants of sleep quality. Results Our study included 160 patients with IBD (49 anti-TNF, 111 Vedolizumab) among whom half were women and the mean age was 40.2 years. In the combined cohort, we observed a statistically significant and meaningful decrease in mean scores from baseline (52.8) by week 6 (49.8, p = 0.002). Among vedolizumab users, sleep T-score improved from baseline (53.6) by week 6 (50.7) and persisted through week 54 (46.5, p = 0.009). Parallel reductions in depression and anxiety were also noted (p < 0.05 by week 6). We observed no difference in improvement in sleep, depression, and anxiety between vedolizumab and anti-TNF use at week 6. Conclusions Both vedolizumab and anti-TNF biologic therapies were associated with improvement in sleep and mood quality in IBD.

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Section: Discussionmentioning

confidence: 99%

Vedolizumab Therapy Is Associated with an Improvement in Sleep Quality and Mood in Inflammatory Bowel Diseases

et al. 2016

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“…A 2015 study showed reduced depressive indices using Patient Health Questionnaire-9 (PHQ-9) scores for IBD patients receiving antitumor necrosis factor therapy 28. Similar findings were shown for IBD patients receiving azathioprine utilizing the health related quality of life and IBD questionnaire 29…”

Section: Discussionmentioning

confidence: 79%

Association of Inflammatory Bowel Disease (IBD) with Depressive Symptoms in the United States Population and Independent Predictors of Depressive Symptoms in an IBD Population: A NHANES Study

et al. 2017

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Background/AimsThere is a paucity of population-based studies on the association between inflammatory bowel disease (IBD) and depression in the U.S. population. We sought to study this association using the National Health and Nutrition Examination Survey (NHANES) database.MethodsWe used NHANES data from 2009 to 2010. Our study included 190,269,933 U.S. adults without IBD and 2,325,226 with IBD. We sought to determine whether IBD is an independent risk factor for depressive symptoms (DS) in the U.S. population and studied the independent predictors of DS in IBD population.ResultsDS was present in 49% of the IBD population versus 23% of the non-IBD population (p<0.001). During the multivariate analysis, we found that IBD was independently associated with DS in the U.S. population (p=0.002). The independent predictors of DS in the IBD population were older age (p=0.048) and divorced/separated/widowed status (p=0.005). There was nonsignificant increase in suicidal risk in IBD population with DS versus that in non-IBD population with DS (27% vs 12%, respectively, p=0.080). Only 36% of IBD individuals with DS visited mental health professional or psychiatrist within the past year.ConclusionsIBD is independently associated with DS in the U.S. population. Further research is warranted on risk stratification, screening and management of those with IBD who are at risk of depression.

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“…Conversely, in a network meta‐analysis in people with rheumatoid arthritis, anti‐TNF therapy showed weaker effects on depressive symptoms compared to other biologicals such as anti‐IL‐6 . In a retrospective study of 69 patients with IBD, anti‐TNF therapy was associated with significant reduction in PHQ‐9 depression scores regardless of IBD disease response, and changes in PHQ‐9 were strongly correlated with changes in CRP . In a prospective observational study in IBD, patients starting anti‐TNF ( n = 49) improved in overall depressive symptoms and sleep over 14 weeks, although data were missing for the majority at follow‐up .…”

Section: Inflammation As a Novel Target For Depressive Symptoms In Ibdmentioning

confidence: 99%

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

Moulton

Pavlidis

Norton

et al. 2019

Clinical and Experimental Immunology

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Summary Depressive symptoms are reported by more than 20% of people with inflammatory bowel disease (IBD), while sleep difficulties and fatigue are even more common. Co‐morbid depressive symptoms predict a poor IBD course, including increased risk of relapse and surgery, which is inconsistently improved by psychological treatments. Rather than being distinct systems, there is compelling evidence for bidirectional communication between gut and brain, driven by neural, metabolic, endocrine and inflammatory mediators. An emerging concept is that depressive symptoms may be mechanistically linked to excess inflammation and dysregulation of the gut–brain axis. Given the close link between the intestinal microbiota and host immune responses, patients prone to shifts in their intestinal microbiome, including smokers, those with poor diet and early life stress, may be exposed to exaggerated immune responses. Excess inflammation is associated with brain changes (depressive symptoms, fatigue, sleep difficulties) and worsening gastrointestinal symptoms, which are exacerbated by psychological distress. Equally, treatments both for depressive symptoms and IBD provide opportunities to break this cycle by reducing the causes and effects of inflammation. As well as addressing potential risk factors such as smoking and diet, treatments to alter the microbiome may reduce depressive symptoms. Observational evidence suggests that anti‐inflammatory treatments for IBD may improve co‐morbid depressive symptoms correlating with reduction in inflammation. With a growing range of treatments targeting inflammation centrally, peripherally and in the gut, IBD provides a unique model to understand the interplay between brain and gut in the pathogenesis of depressive symptoms, both in IBD and in the whole population.

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

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

Cited by 62 publications

References 29 publications

Vedolizumab Therapy Is Associated with an Improvement in Sleep Quality and Mood in Inflammatory Bowel Diseases

Vedolizumab Therapy Is Associated with an Improvement in Sleep Quality and Mood in Inflammatory Bowel Diseases

Association of Inflammatory Bowel Disease (IBD) with Depressive Symptoms in the United States Population and Independent Predictors of Depressive Symptoms in an IBD Population: A NHANES Study

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

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