No Definitive Link Between Depression and IBD Progression

There is limited evidence connecting depression to the disease course of inflammatory bowel disease (IBD), according to a study published in Alimentary Pharmacology and Therapeutics.

In a systematic review, researchers from Imperial College London and St. George’s, University of London investigated the idea of a depressive state leading to the progression of the deterioration of a patient’s bowel. The review included 11 studies and represented 3194 patients with IBD—3 studies included ulcerative colitis (UC) patients, 4 reported on Crohn’s disease (CD) patients, and the last 4 included both CD and UC.

Of the different study categories, Crohn’s disease was the only form of IBD with a strong association between a depressive state and the disease’s progress. In 3 of the 4 exclusively CD studies, there was evidence of the disease worsening when the patient was in a depressive state, while the UC studies found no relationship.

“This study is about investigating whether stress and depression make inflammatory conditions worse,” Sonia Saxena, MBBS, MSc, MD, from the School of Public Health at Imperial, said in a statement. “IBD is associated with major disability during flare ups and patients may have to take expensive drugs, including immunosuppressants, which can have significant side effects and impact on their quality of life.”

The review considered the higher rate of depression among IBD patients than the general population, as some studies report 1 in 5 IBD patients also suffer from depression. However, the minimal number from randomized and control trials make it difficult for conclusions to be made about the relationship.

“We’re trying to answer basic questions on current practice for patients with IBD, including what proportion are depressed, the proportion prescribed medications for their depression and what happens when they are prescribed these medications,” concludes Dr. Saxena.

Despite the discovery of the association between depression and CD, the review acknowledged the need for further studies to fully understand the relationship between IBD and depression or other mental illnesses.