Treatment with SSRI or SNRI for people with inflammatory bowel disease

Question

What systematic reviews have been published regarding the treatment with SSRI or SNRI for people with inflammatory bowel disease?

Method

A systematic literature search was performed using the following databases: Medline (via Ovid), Scopus and PsycInfo.
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Two relevant systematic reviews with moderate risk of bias were identified [1, 2]. The results and conclusions are presented in Table 1. In two relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [3, 4].

Table 1 Systematic reviews with moderate risk of bias.

Included studies	Population, Intervention, Control	Outcome and Results
Mikocka-Walus et al, 2019 [1] Adjuvant therapy with antidepressants for the management of inflammatory bowel disease.
4 studies (188 participants) Design RCT: 2 studies CT: 1 study Retrospective case-matched: 1 study Setting: Australia: 1 study Iran: 1 study Poland: 1 study UK: 1 study	Population: Individuals diagnosed with IBD of any type. IBD: 2 studies CD: 1 study UC: 1 study Intervention: Antidepressants SSRI: 1 study SNRI: 1 study TCA: 1 study Various AD: 1 study Control: Placebo: 3 studies TAU: 1 study	Adverse events at 12 months RR: 2.29 95% CI, 0.78 to 6.73 (1 study, 26 participants) Low Maintenance of remission at 12 months RR: 0.96 95% CI, 0.55 to 1.69 (1 study, 26 participants) Low Endoscopic relapse at 12 months RR: 0.14 95% CI, 0.01 to 2.65 (1 study, 60 participants)  Very low
Authors' conclusion: ”The results for the outcomes assessed in this review are uncertain and no firm conclusions regarding the efficacy and safety of antidepressants in IBD can be drawn.”
Wang et al, 2023 [2] Effect of antidepressants on psychological comorbidities, disease activity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis.
13 studies (884 participants) Design RCT: 13 studies Setting: China: 11 studies Australia: 1 study Iran: 1 study	Population: Individuals diagnosed with IBD of any type. IBD: 2 studies CD: 1 study UC: 10 studies Intervention: Antidepressants SSRI: 11 studies SNRI: 2 studies Control: ST: 11 studies ST and placebo: 2 studies	Disease activity scores Overall (8 studies, 500 participants) SMD = −0.32 95% CI, −0.50 to –0.15 p-value: < 0.001 SSRI (6 studies, 425 participants) Pooled SMD: -0.28 95% CI, –0.47 to –0.09 p-value: 0.01 SNRI (2 studies, 75 participants) Pooled SMD: –0.6 95% CI, –1.07 to –0.12 p-value: 0.01 Clinical remission RR: 1.38 95% CI, 1.18 to 1.63 p-value < 0.001 (10 studies, 779 participants) Clinical response RR: 1.01 95% CI, 0.85 to 1.21 p-value: 0.88 (9 studies, 761 participants)
Authors' conclusion: “Our study demonstrated that antidepressants improved outcomes in IBD patients, including comorbidities of depression and anxiety, disease activity, clinical remission, physical and social QoL, and IBDQ. However, antidepressants did not show advantages in terms of clinical response, psychological QoL, and environmental QoL. In conclusion, antidepressants are a potential adjunctive therapy for IBD. Considering that most of these studies have a very small sample size (<100 in most) and the low quality of some studies, high-quality studies are warranted in the future.”

References

1. Mikocka-Walus A, Prady SL, Pollok J, Esterman AJ, Gordon AL, Knowles S, Andrews JM. Adjuvant therapy with antidepressants for the management of inflammatory bowel disease. Cochrane Database Syst Rev. 2019;4(4):CD012680. Available from: https://doi.org/10.1002/14651858.CD012680.pub2.
2. Wang L, Liang C, Chen P, Cao Y, Zhang Y. Effect of antidepressants on psychological comorbidities, disease activity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2023;16:17562848231155022. Available from: https://doi.org/10.1177/17562848231155022.
3. Mikocka-Walus AA, Turnbull DA, Moulding NT, Wilson IG, Andrews JM, Holtmann GJ. Antidepressants and inflammatory bowel disease: a systematic review. Clin Pract Epidemiol Ment Health. 2006;2:24. Available from: https://doi.org/10.1186/1745-0179-2-24.
4. Tarricone I, Regazzi MG, Bonucci G, Rizzello F, Carini G, Muratori R, et al. Prevalence and effectiveness of psychiatric treatments for patients with IBD: A systematic literature review. J Psychosom Res. 2017;101:68-95. Available from: https://doi.org/10.1016/j.jpsychores.2017.07.001.