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

Blackwell, J; Alexakis, C; Saxena, S; Creese, H; Bottle, A; Petersen, I; Hotopf, M; Pollok, RCG (2021) Association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: a population-based study. BMJ Open Gastroenterol, 8 (1). ISSN 2054-4774 https://doi.org/10.1136/bmjgast-2020-000588
SGUL Authors: Pollok, Richard Charles G

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Abstract

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: 'continuous users', 'intermittent users' and '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, χ2 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.

Item Type: Article
Additional Information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Keywords: brain/gut interaction, inflammatory bowel disease, ulcerative colitis, brain/gut interaction, inflammatory bowel disease, ulcerative colitis
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: BMJ Open Gastroenterol
ISSN: 2054-4774
Language: eng
Dates:
DateEvent
27 May 2021Published
24 February 2021Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
SP2018/3Crohn's & Colitis UKUNSPECIFIED
UNSPECIFIEDWellcome Trusthttp://dx.doi.org/10.13039/100004440
UNSPECIFIEDNational Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
UNSPECIFIEDBritish Heart Foundationhttp://dx.doi.org/10.13039/501100000274
PubMed ID: 34045238
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113319
Publisher's version: https://doi.org/10.1136/bmjgast-2020-000588

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