Depression In Inflammatory Bowel Disease Patients Research Articles

P435 Plasma inflammation-related proteins as markers of anxiety and depression disorders in inflammatory bowel disease patients

Abstract Background Up to 25%-35% of patients with inflammatory bowel disease (IBD) suffer from anxiety or depression. Inflammatory and immune response processes may play an important role in the co-occurrence of IBD and mood disorders. We aimed to investigate the plasma inflammation-related proteins that can characterize the anxiety and depression disorders in IBD patients. Methods Plasma was collected from 61 IBD patients, and the OLINK panel (Target 96 Inflammation) was used to quantify the expression levels of 92 inflammation-related proteins. The Hospital Anxiety and Depression Scale (HADS) was used to assess the anxiety and depression symptoms. Results Among the involved IBD patients (median age 37, 40.98% female), 26.23% had anxiety and 29.51% had depression. Compared with IBD patients without mental disorders, the plasma level of FGF-23 was significantly increased in IBD patients with anxiety or depression disorders (P=0.035). Besides, the levels of CCL20 (P=0.039) and CXCL1 (P=0.021) were up regulated in IBD patients with anxiety and depression, respectively (Figure 1). Correlation analysis showed that the plasma level of CXCL1 (r=0.254, P=0.047) and FGF-23 (r=0.318, P=0.012) were positively correlated with the total degree of anxiety and depression disorders, while DNER (r=-0.300, P=0.018) appeared a reverse correlation trend. On the other hand, the plasma level of FGF-23 (r=0.351, P<0.01) was positively correlated with anxiety degree in IBD patients. As for the depression disorder, we found a positive correlation in plasma CXCL1 (r=0.296, P=0.020) level, and negative correlations were found in levels of IL-8(r=-0.256, P=0.045), uPA (r=-0.264, P=0.038), IL-20 (r=-0.290, P=0.022) and DNER (r=-0.353, P<0.01) (Figure 2). Conclusion We found specific plasma inflammation-related proteins for anxiety and depression disorders in IBD patients. The high incidence of anxiety and depression in IBD patients may be attributed to the stimulation of high levels of inflammatory factors.

P216 Urine Metabolomic Characteristics of Anxiety and Depression Disorders in Patients with Inflammatory Bowel Disease

Abstract Background Up to 25%-35% of patients with inflammatory bowel disease (IBD) suffer from anxiety or depression. We aimed to depict the urine metabolic profile of IBD patients with anxiety and depression disorders and investigate the urinary metabolites that could characterize the mental disorders in IBD patients. Methods Urine samples were collected from IBD patients, and the Liquid Chromatography-Mass Spectrometry (LC-MS) was used to detect the metabolites. The Hospital Anxiety and Depression Scale (HADS) was used to assess the anxiety and depression symptoms. Least absolute shrinkage and selection operator (LASSO) regression model with 10-fold cross-validation was used to establish a metabolite-based prediction model for mental disorders in patients with IBD. Results Among the involved IBD patients (n=23, median age 41, women 61%), 35% had anxiety and 35% had depression. The urine metabolic profiles of IBD patients with anxiety or depression disorders were largely separated from those without mental symptoms (Figure 1 a-b). There were 36 metabolites up-regulated and 25 metabolites down-regulated in the anxiety group, while 10 metabolites up-regulated and 35 metabolites down-regulated in the depression group (Figure 1 c-d). The LASSO model identified the metabolites predicting IBD patients with mental disorders (Figure 2 a-b). Six metabolites (L-Carnitine, Riboflavin-5-phosphate, 2-Ethyl-2-phenylmalonamide, 3-Indoxyl sulphate, Sodium cholate, Tritylalcohol) were selected to construct the prediction model for anxiety, and another six metabolites (D-(-)-Glutamine, dAMP, DL-Stachydrine, dCMP, 5'-Deoxy-5'-(Methylthio)Adenosine, Sakuranin) were selected to construct the prediction model for depression in IBD patients. Both models showed excellent performances with an AUC of 0.992 (95%CI:0.97-1.00) and 0.933 (95%CI: 0.83-1.00) for predicting anxiety and depression, respectively, among patients with IBD (Figure 2 c-d). Conclusion We found significantly different urine metabolic profiles between IBD patients with and without anxiety and depression disorders. The specific urinary metabolites panel may become effective biomarkers for the prediction of anxiety and depression disorders in IBD patients.

Rattan Pepper Polysaccharide Regulates DSS-Induced Intestinal Inflammation and Depressive Behavior through Microbiota-Gut-Brain Axis.

Inflammatory bowel disease (IBD) is a chronic and recurrent disease. Increasing evidence suggests a higher incidence of depression in IBD patients compared with the general population, but the underlying mechanism remains uncertain. Rattan pepper polysaccharide (RPP) is an important active ingredient of rattan pepper, yet its effects and mechanisms on intestinal inflammation and depression-like behavior remain largely unknown. This study aims to investigate the ameliorating effect of RPP on dextran sulfate sodium salt (DSS)-induced intestinal inflammation and depression-like behavior as well as to reveal its mechanism. Our results indicate that RPP effectively ameliorated intestinal microbiota imbalance and metabolic disorders of short-chain fatty acids (SCFAs) and bile acids in mice with DSS-induced inflammation, contributing to the recovery of intestinal Th17/Treg homeostasis. Importantly, RPP effectively alleviated brain inflammation caused by intestinal inflammatory factors entering the brain through the blood-brain barrier. This effect may be attributed to the inhibition of the TLR4/NF-κB signaling pathway, which alleviates neuroinflammation, and the activation of the CREB/BDNF signaling pathway, which improves synaptic dysfunction. Therefore, our findings suggest that RPP may play a role in alleviating DSS-induced gut inflammation and depression-like behavior through the microbiota-gut-brain axis.

Identification and investigation of depression-related molecular subtypes in inflammatory bowel disease and the anti-inflammatory mechanisms of paroxetine.

Up to 40 per cent of people with active inflammatory bowel disease (IBD) also suffer from mood disorders such as anxiety and depression. Notwithstanding, the fundamental biological pathways driving depression in IBD remain unknown. We identified 33 core genes that drive depression in IBD patients and performed consensus molecular subtyping with the NMF algorithm in IBD. The CIBERSORT were employed to quantify the immune cells. Metabolic signature was characterized using the "IOBR" R package. The scoring system (D. score) based on PCA. Pre-clinical models are constructed using DSS. Using transcriptome data from the GEO database of 630 IBD patients, we performed a thorough analysis of the correlation between IBD and depression in this research. Firstly, the samples were separated into two different molecular subtypes (D. cluster1 and D. cluster2) based on their biological signatures. Moreover, the immunological and metabolic differences between them were evaluated, and we discovered that D. cluster2 most closely resembled IBD patients concomitant with depression. We also developed a scoring system to assess the IBD-related depression and predict clinical response to anti-TNF- therapy, with a higher D. score suggesting more inflammation and worse reaction to biological therapies. Ultimately, we also identified through animal experiments an antidepressant, paroxetine, has the added benefit of lowering intestinal inflammation by controlling microorganisms in the digestive tract. This study highlights that IBD patients with or without depression show significant variations and antidepressant paroxetine may help reduce intestinal inflammation.

Substance abuse and inpatient outcomes in inflammatory bowel disease hospitalizations in the United States: a propensity matched analysis.

Inflammatory bowel disease (IBD) is a chronic intestinal inflammation resulting in a genetically susceptible population. The present study aimed to look at the effect of substance abuse on IBD hospitalizations in the United States. We identified primary IBD hospitalizations with substance abuse using the National Inpatient Sample database (2016-2019). A matched comparison cohort of IBD hospitalizations without substance abuse was identified by 1:N propensity score matching using the nearest-neighbor method, based on demographics, hospital-level factors, and comorbidities. We matched 4437 IBD hospitalizations with a diagnosis of substance abuse to 4528 hospitalizations without abuse. The median age was higher in the substance abuse group than no abuse (44 vs. 38 years, P<0.001). There was a higher prevalence of discharge to care facilities (2.9% vs. 2.2%) and against medical advice (4.9% vs. 1.8%) in the substance abuse group compared to the no abuse (P<0.001). The median length of hospital stays (LOS) (P=0.74) and hospitalization charge did not differ significantly (P=0.57). There was no significant difference in 30-day inpatient mortality among cohorts (adjusted hazard ratio 0.74, 95% confidence interval 0.32-1.81; P=0.54). There was a higher prevalence of psychoses (2.5% vs. 1.3%) and depression (18.8% vs. 15.7%) in IBD hospitalizations with substance abuse compared to those without abuse (P<0.001). This study reports no difference in median LOS, hospitalization charge, or mortality risk in IBD hospitalizations based on substance abuse. There is a higher prevalence of psychoses and depression in IBD patients, requiring screening for substance abuse to improve overall outcomes.

Keeping it simple: mental health assessment in the Gastroenterology Department - using the Hospital Anxiety and Depression Scale (HADS) for IBD patients in Israel.

Background:Depression and anxiety are common among inflammatory bowel disease (IBD) patients. Not only do they worsen quality of life, but also worsen the prognosis of the IBD. Yet, there are no widely accepted guidelines for screening for depression or anxiety in this population. The Hospital Anxiety and Depression Scale (HADS) is a self-administered questionnaire designed to measure anxiety and depression in the physically ill. The purpose of this study was to establish the utility of the HADS as a screening tool in IBD patients.Methods:Seventy-nine IBD patients (age 29.86 ± 8.36, 51.9% female, 77.2% Crohn’s disease) were recruited consecutively at the day treatment unit, Gastroenterology Department, Sheba Medical Center. They were asked to complete the HADS, the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). The scores of the HADS depression and anxiety subscales were correlated with the BDI and STAI scores, and the rates of above-threshold scores were calculated and compared between the three questionnaires and findings from previous studies.Results:The two HADS subscales significantly correlated with and the BDI (rs = .69, p < 0.001) and STAI state and trait anxiety (rs = .853, p < 0.001; rs = .744, p < 0.001, respectively). The usual HADS cut-off scores yielded adequate rate of anxiety but lower than expected depression rates.Conclusions:Our findings suggest the HADS as a valid screening tool for anxiety and depression in IBD patients. We recommend administering it routinely in gastrointestinal (GI) follow-ups using a lower cut-off score for depression than anxiety (greater than 7 vs greater than 11, respectively).

P059 Impact of PHQ-9 Screen on Early Identification of Depression in IBD Clinic.

Over the past two decades there has been significant research linking inflammatory bowel disease (IBD) to depression. The chronicity of symptoms coupled with the financial burden of treatment costs, missed days of work/school and interpersonal relationship stress are contributing factors in the diagnosis of depression. The prevalence of depression within the IBD community is 15% and depressive symptoms are noted in 20% of patients. Furthermore, IBD patients with severe uncontrolled disease have higher rates of depression (40.7%) than those in remission (16.5%). The association between IBD and depression is linked to lower quality of life, poor medication compliance, worse disease outcomes, increased hospitalization, and higher suicidal risk. Early diagnosis and treatment of depression in IBD patients is paramount in achieving and maintaining IBD disease remission. While the association between IBD and depression is well-known, identifying depression can be a challenge. Review of recent literature shows that depression is under screened in IBD clinics. We present a prospective quality improvement study at a robust IBD center evaluating the impact of a validated depression screen (PHQ-9) on identifying depression compared to standard of care. We compared the prevalence of depression in the IBD clinic in the control group using the history and diagnosis of depression and compared it against the intervention group after HQ-9 screening. Control group patient data was collected from June 2020 to July 2020 via virtual and in person visits. Intervention group PHQ-9 data was collected in person visits from January - March 2020 and post-intervention data collection was placed on hold until November 2020 due to the COVID pandemic. One randomly selected patient from each clinic session was asked to participate in the study at the time of visit. The primary end point was to compare the rates of depression and identify any barriers in providing early treatment for depression. The secondary endpoint was to identify high risk patients that are prone to depression. Categorical variables were analyzed by chi square analysis or fischer exact tests. Numerical data were analyzed using T-test. A total of 111 patients were screened. 60 patients were randomized to the control group (i.e. EMR based review for depression) and 51 patients were screened via survey during in person clinic visit. The identified depression rate from control vs intervention group is 20% vs. 35% (p = 0.071). Rates of depression were 15% in non-fistulizing Crohn's disease vs. 41.4% in fistulizing Crohn's disease (p = 0.003). Multivariate model for predicting depression noted to be significant for extra-intestinal manifestations OR of 3.06 (1.03, 9.12) p = 0.045 and age OR of 0.97 (0.94, 1.00) p = 0.042. Control vs. intervention identification of depression in patients with extra-intestinal manifestations is notable for OR of 3.31 (1.15, 9.52) p = 0.026 in the univariate model and OR of 3.30 (1.07, 10.16) p = 0.038 in the multivariate model. Key findings including identification of depression is higher in the intervention group compared to the control group. Though the data is not statistically significant, this is likely secondary to the small sample size in the setting of the pandemic. In addition, univariate analysis revealed a statistically significant finding that the older the age of the patient, the less likely they are to have depression. Our data showed that the mean age of depressed patients was 38.3 compared to nondepressed patients whose mean age is 47.1. Further analysis can help elucidate this finding, for example identifying if older patients are being treated for depression or more likely to seek out therapists compared to younger patients. Univariate analysis also revealed that intestinal Crohn's disease was a risk factor for depression. This is possibly secondary to the severity of disease in these individuals, especially if their IBD is causing an impact on their quality of life. Looking into the number of hospitalizations, days off from work or school, and coexisting medical diagnoses can allow us to further understand if depression stems from their disease. Given preliminary findings, we plan to continue this study for a larger sample size and further determine if there is a significant delay in identifying depression with the current standard of care.

Effectiveness of cognitive-behavioral therapy on quality of life, anxiety, and depressive symptoms among patients with inflammatory bowel disease: A multicenter randomized controlled trial.

Inflammatory bowel disease (IBD) is characterized by a low level of quality of life (QoL) and a high prevalence of anxiety and depression, especially in patients with poor QoL. We examined the effect of IBD-specific cognitive-behavioral therapy (CBT) on QoL, anxiety, and depression in IBD patients with poor mental QoL. This study is a parallel-group multicenter randomized controlled trial. One hundred eighteen IBD patients with a low level of QoL (score ≤23 on the mental health subscale of the Medical Outcomes Study Short Form 36 Health Survey [SF-36]) were included from 2 academic medical centers (Academic Medical Center Amsterdam, VU University Medical Centre Amsterdam) and 2 peripheral medical centers (Flevo Hospital, Slotervaart Hospital) in the Netherlands. Patients were randomized to an experimental group receiving CBT (n = 59) versus a wait-list control group (n = 59) receiving standard medical care for 3.5 months, followed by CBT. Both groups completed baseline and 3.5 months follow-up assessments. The primary outcome was a self-report questionnaire and disease-specific QoL (Inflammatory Bowel Disease Questionnaire [IBDQ]). Secondary outcomes were depression (Hospital Anxiety and Depression Scale-Depression Subscale [HADS-D], Center for Epidemiologic Studies Depression Scale [CES-D]), anxiety (HADS-Anxiety Subscale [HADS-A]) and generic QoL (SF-36). Data were analyzed both on intention to treat as well as on per protocol analysis (completed ≥5 sessions). CBT had a positive effect on disease-specific-QoL (Cohen's d = .64 for IBDQ total score), depression (Cohen's d = .48 for HADS-D and .78 for CES-D), anxiety (Cohen's d = .58 for HADS-A), and generic QoL (Cohen's d = 1.08 for Mental Component Summary of the SF-36; all ps < .01). IBD-specific CBT is effective in improving QoL and in decreasing anxiety and depression in IBD patients with poor QoL. Clinicians should incorporate screening on poor mental QoL and consider offering CBT. (PsycINFO Database Record

The Prevalence of Depression and Its Association with Opioid Exposure in IBD Patients

Introduction: According to the World Health Organization, depression has a lifetime prevalence of 17% in the general population, and 16 million people are afflicted in the United States alone. It is a common comorbidity in chronic diseases such as chronic obstructive pulmonary disease (COPD) (25% prevalence) and heart failure (22% prevalence). The presence of depression is a major determinant of health related quality of life (HR-QOL) in patients with inflammatory bowel disease (IBD). IBD patients have a higher rate of opioid usage than the general population. Opioid usage is associated with an increased rate of depression. The role of this study is to assess the prevalence of depression in IBD patients and the association of lifetime opioid exposure to depression. Methods: An automated data extraction was performed on patients enrolled in a tertiary medical center's IBD program. Data from 792 patients was obtained and analyzed. Antidepressant usage was used as a marker for a diagnosis of depression. The charts of patients prescribed antidepressants were reviewed to confirm that the antidepressant was given for a diagnosis of depression and not some other indication such as chronic pain. A patient was deemed to have used opioids if they had ever been prescribed opioids for any disease process. The primary endpoints were assessed with the Fisher's Exact Test. Results: The prevalence of depression among the IBD Program patients was 28% (24.9-31.3%; 95% CI). The prevalence of depression in IBD patients was significantly higher compared to the general population. When compared to chronic diseases such as COPD and heart failure, the prevalence is similar, 28% compared to 25% and 22%. 67% of patients in the IBD program had been prescribed opioids. There was a statistically significant (p < 0.0001) associated between depression and opioid exposure in IBD patients. Conclusion: The patients enrolled in the IBD Program were more likely to be depressed than the general population. The rates of depression were similar to patients with other chronic diseases such as heart failure and COPD. There is an association between opioid exposure and depression when compared to opioid naïve patients in this single tertiary medical center's IBD Program. Routine depression screening should be performed for all patients and opioids should be avoided if possible.

Impact of Inflammatory Bowel Disease on Depression in U.S. Population and Independent Predictors of Depression in IBD Population: An NHANES Study

Introduction: Inflammatory bowel disease (IBD) patients have been found to have high rates of psychiatric disorders, however there is paucity of population-based studies on the true impact of IBD on depression in US population. We sought to study the impact of depression on IBD patients and also identify independent predictors of depression in IBD population using NHANES database. Methods: We used data from 2009-2010 NHANES which is a cross-sectional study representative of US population. All adults of 20-69 years old were included. We first compared IBD and non-IBD population and sought to see if IBD is an independent risk factor for depression in US population. Then we tried to elicit the independent predictors of depression in IBD population. Results: After weighing for national estimate, our study included 190,269,933 US adults without IBD and 2,325,226 with IBD. Depression was present in 49% of IBD population verses 23% in non-IBD population (unadjusted OR: 3.1, 95% CI 1.6-6.1, p=51 vs 20-50: adjusted OR 3.1, 95% CI 1.01-9.70, p=0.05) and divorced/separated/widowed status (vs married/living together: adjusted OR 33, 95% CI 4-378, p=0.005). Ulcerative colitis had higher prevalence of depression than Crohn's disease on univariate analysis (53% vs 23%, unadjusted OR: 3.8, 95 % CI 1.9-7.5, p < 0.0001), but the difference in prevalence was non-significant on multivariate analysis (adjusted OR: 3.3,95 % CI 0.6-18.1, p=0.1). There was trend toward increased risk of suicide in depressed IBD population verses depressed non-IBD population (27% vs 12%, p=0.08).Figure 1Figure 2Figure 3Conclusion: Our study, based on the NHANES database, showed IBD patients to be at increased risk of depression over the general population. Contrary to the general population, we found that older age and divorced/separated/widowed status to be independent predictors of depression in IBD population. Our study also found a non-significant increase in suicide risk in depressed IBD population than that in depressed non-IBD population, which implies increased severity of depression in IBD patients.

Low prevalence of behavioural and emotional problems among Swiss paediatric patients with inflammatory bowel disease

ObjectivesWhether behavioural and emotional maladjustment is more prevalent in children with inflammatory bowel disease (IBD) than in healthy controls remains controversial. The aim of this study was to assess paediatric...

Depressive mood and disease activity in inflammatory bowel disease

Background and study aimSome mood disorders are more prevalent in chronic medical conditions compared with the general population. The relationship between inflammatory bowel disease (IBD) and psychiatric disorders has been raised as an area of interest for investigation. In this study, we aimed to assess the probable relationship between depression and disease activity in IBD patients in Golestan province, northeast of Iran. Patients and methodsDuring February 2008 to February 2010, 50 patients recently diagnosed as IBD cases attended the Golestan Research Center of Gastroenterology and Hepatology (GRCGH), northeast of Iran. The Simple Clinical Colitis Activity Index (SCCAI) was used to evaluate the disease activity. The Beck Depression Inventory (BDI) was used to assess the severity of depressive symptoms. Depression was assumed when the BDI score was 13 points or higher. ResultsSixteen cases (32%) had depressive characteristics. SCCAI and the Beck score were not significantly different between the two sexes. There was a non-significant correlation between SCCAI, Beck score, age and body mass index (BMI). ConclusionsWe reported a relatively high percent of depression in IBD patients, although no significant relationship was seen.

Suicidal ideation resulting from severe Inflammatory Bowel Disease symptoms

Inflammatory bowel disease (IBD) is associated with an increased prevalence of depression when compared to the general population. Studies have suggested that depression may be more pronounced in the early period of diagnosis, with the strongest association occurring within one year of diagnosis. It has also been documented that depression can amplify symptoms, decrease medication compliance, alter self-perception and worsen individuals' adaptation to their disease. It is recommended that all IBD patients be screened for depression. We present 2 cases of patients with IBD who were hospitalized with suicidal ideation at the time or shortly following their IBD diagnosis. These cases emphasize the need to screen for depression with assessment for severity. Case 1: A 45 year old man was hospitalized with depression and suicidal ideation with a plan. His psychiatric interview revealed that he was profoundly depressed as a result of ‘years' of chronic, frequent (50-60 times daily) diarrhea with blood, urgency, nocturnal awakening and fecal incontinence which had worsened in recent months. He had no history of depression or psychiatric disorders and a previous history of cocaine dependency was not thought to contribute to his depression. Gastroenterology consult was obtained and following an evaluation he was diagnosed with ulcerative colitis. Treatment with 6-mercaptopurine, mesalamine, and tapering steroids (with discontinuation) resulted in clinical improvement of his gastrointestinal symptoms and resolution of his depression. Case 2: A 37 year old woman without significant past medical history transferred her care to our institution and presented to Gastroenterology clinic for a second opinion of rectal pain and bleeding following a hemorrrhoidectomy. Medical records revealed that she presented to an outside surgeon with complaints of hemorrhoids. Rectal fissures and a large hemorrhoid complex were noted and she underwent a fissurectomies and a hemorrhoidectomy which resulted in chronic fecal drainage and incontinence. A rectal exam under anesthesia revealed rectal ulcerations and a large nonhealing wound in the posterior midline which extended through her internal and part of her external sphincter. A colonoscopy revealed pancolitis with biopsies demonstrating chronic active colitis and noncaseating granulomas. She was diagnosed with Crohn's disease. Two weeks following the diagnosis she was hospitalized with depression and suicidal ideation. Psychiatric interview revealed that her depression was related to her gastrointestinal symptoms and new Crohn's diagnosis. Improvement of her symptoms with oral and topical mesalamine, 6-mercaptopurine and tapering steroids has resulted in improvement of her depression. The psychiatrists did not believe that her steroid therapy precipitated or exacerbated her depression. She is not maintained on antidepressants. While there is a higher prevalence of depression in IBD patients, there are limited reports addressing suicide or suicidal ideation. It is critical that physicians are aware of the association of depression with IBD and recognize that increased occurrence occurs early after diagnosis and with severe symptoms. It is important that physicians caring for IBD remain vigilant in assessing for depression. Recognizing suicidal ideation, while rarely occurs, is critical to ensure effective intervention and enhance clinical outcome.

Reactivation of Inflammatory Bowel Disease in a Mouse Model of Depression

Patients with inflammatory bowel disease (IBD) frequently also have depression, yet little is known of its role in IBD pathogenesis. We investigated whether the development of depression after the establishment of chronic inflammation reactivates an acute relapse of IBD and underlying pharmacologic mechanisms in mouse models. Colitis was induced by administration of dextran sulfate sodium (DSS) or dinitrobenzenesulfonic acid to C57BL/6 mice. Depression was induced by olfactory bulbectomy or chronic intracerebroventricular injection of reserpine. Colitis was reactivated by subsequent exposure to DSS or dinitrobenzenesulfonic acid. Some mice were given the antidepressant desmethylimipramine. Acute DSS-colitis was induced in mice lacking the alpha 7 subunit of the nicotinic acetylcholine receptor (alpha 7nAchR), and vagotomy was performed. Disease severity and colon tissue histology and inflammation were evaluated. Levels of C-reactive protein and proinflammatory cytokines were determined by enzyme-linked immunosorbent assay analysis of colon samples and macrophage culture. Induction of depression reactivated inflammation in mice in which colitis had been established and become quiescent. The induction was associated with impaired cholinergic inhibition of proinflammatory cytokine secretion by macrophages and mediated by alpha 7nAchR on these cells; macrophages isolated from depressed mice showed increased proinflammatory cytokine secretion. Depression-induced reactivation of colitis was prevented by desmethylimipramine and accompanied by a normalization of proinflammatory cytokine secretion. Depression reactivates dormant chronic colitis via the alpha 7nAchR. These findings encourage closer monitoring of behavior for signs of depression in IBD patients because treatment might prevent inflammatory conditions. Furthermore, alpha 7nAchR agonists might achieve this effect without the need for psychotropic medication.

A prospective study of the relationship between disease activity and psychologic distress in patients with inflammatory bowel disease.

The evaluation of psychologic states is very useful in the management of inflammatory bowel disease (IBD) patients, particularly when related to disease activity (DA). Our aim was to prospectively evaluate the relationship between psychologic distress and DA. DA and psychologic distress were evaluated in 104 IBD outpatients by means of clinical criteria and the Hospital Anxiety and Depression Scale (HADS) at base line and after 6 months. Patients were grouped in unchanged, improved, and worsened DA from base line to follow-up. Repeated-measures ANOVA showed a significant group-by-time interaction for HADS anxiety (F = 89.6, P = 0.0001) and depression (F = 3.67, P = 0.03) subscales. Over time changes in DA significantly affect psychologic distress and are closely related to corresponding increases and decreases in anxiety and depression in IBD patients. Our findings therefore suggest that the assessment of psychologic distress, particularly anxiety, should be included in the clinical management of IBD patients.