Major depressive disorder is the most common psychiatric diagnosis in Crohn's disease.
In other chronic diseases, evidence suggests that depression influences the course of the disease.
Strong evidence of such a mediating role of major depressive disorder in Crohn's disease has never been found.
Professor Paul Rutgeerts and colleagues from Belgium conducted a prospective study included 100 consecutive unselected patients.
The research team assessed the relationship between major depressive disorder and outcome of treatment of luminal Crohn's disease with infliximab.
The patients underwent assessment of psychosocial, demographical disease-related biological and clinical parameters at baseline and 4 weeks after infliximab.
The researchers diagnosed major depressive disorder using the Patient Health Questionnaire.
Subsequently, the team followed up the patients clinically until the next flare during 9 months of the study.
|88% of the patients with major depressive disorder at baseline needed retreatment|
|Alimentary Pharmacology & Therapeutics|
The team found that Crohn's disease responded in 75% of the patients, and remission was achieved in 60%.
The researchers noted that the presence of major depressive disorder at baseline predicted a lower remission rate.
At follow-up, the team found that 88% of the patients needed retreatment.
After using univariate regression analysis, the researchers showed that major depressive disorder significantly decreased time to retreatment.
Multivariate Cox regression confirmed major depressive disorder as an independent determinant of active disease both at baseline and at re-evaluation.
Professor Rutgeerts' team concludes, “Major depressive disorder is a risk factor for failure to achieve remission with infliximab and for earlier retreatment in patients with active luminal Crohn's disease.”
“Assessment and management of major depressive disorder should be part of the clinical approach to patients with Crohn's disease.”