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Association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: A population-based study

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Jonathan Blackwell, Christopher Alexakis, Sonia Saxena, Hanna Creese, Alex Bottle, Irene Petersen, Matthew Hotopf, Richard C.G. Pollok

Original languageEnglish
Article numbere000588
JournalBMJ open gastroenterology
Issue number1
Published27 May 2021

Bibliographical note

Funding Information: Funding This work was supported by the Living with IBD Research Programme at Crohn’s & Colitis UK (grant number: SP2018/3). RCGP received support by a Wellcome Trust Institute Strategic Support Fund (ISSF) grant. SS is funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) and NIHR Northwest London Applied Research Collaboration (ARC). The School for Public Health Imperial College London is also grateful for support from the Imperial NIHR Biomedical Research Centre. MH Is funded by the NIHR Biomedical Research Centre at the Maudsley and is an NIHR Senior Investigator. The Dr Foster Unit at Imperial is affiliated with the National Institute of Health Research (NIHR) Imperial Patient Safety Translational Research Centre. The NIHR Imperial Patient Safety Translational Centre is a partnership between the Imperial College Healthcare NHS Trust and Imperial College London. The Dr Foster Unit at Imperial College are grateful for support from the NIHR Biomedical Research Centre funding scheme. AB and the Unit are additionally funded by grants from NIHR and the British Heart Foundation. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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Background Animal studies indicate a potential protective role of antidepressant medication (ADM) in models of colitis but the effect of their use in humans with ulcerative colitis (UC) remains unclear. Objective To study the relationship between ADM use and corticosteroid dependency in UC. Design Using the Clinical Practice Research Datalink we identified patients diagnosed with UC between 2005 and 2016. We grouped patients according to serotonin selective reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) exposure in the 3 years following diagnosis: Â 'continuous users', 'intermittent users' and â 'non-users'. We used logistic regression to estimate the adjusted risk of corticosteroid dependency between ADM exposure groups. Results We identified 6373 patients with UC. Five thousand two hundred and thirty (82%) use no ADMs, 627 (10%) were intermittent SSRI users and 282 (4%) were continuous SSRI users, 246 (4%) were intermittent TCA users and 63 (1%) were continuous TCA users. Corticosteroid dependency was more frequent in continuous SSRI and TCA users compared with non-users (19% vs 24% vs 14%, respectively, χ 2 p=0.002). Intermittent SSRI and TCA users had similar risks of developing corticosteroid dependency to non-users (SSRI: OR 1.19, 95% CI 0.95 to 1.50, TCA: OR 1.14, 95% CI 0.78 to 1.66). Continuous users of both SSRIs and TCAs had significantly higher risks of corticosteroid dependency compared with non-users (SSRI: OR 1.62, 95% CI 1.15 to 2.27, TCA: OR 2.02, 95% CI 1.07 to 3.81). Conclusions Continuous ADM exposure has no protective effect in routine clinical practice in UC and identifies a population of patients requiring more intensive medical therapy. ADM use is a flag for potentially worse clinical outcomes in UC.

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