Association between selective serotonin reuptake inhibitor use and developing irritable bowel syndrome through retrospective analysis.

brain-gut-microbiome axis irritable bowel syndrome selective serotonin reuptake inhibitors

Journal

Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909

Informations de publication

Date de publication:
13 Nov 2023
Historique:
revised: 14 09 2023
received: 30 03 2023
accepted: 21 10 2023
medline: 14 11 2023
pubmed: 14 11 2023
entrez: 14 11 2023
Statut: aheadofprint

Résumé

Serotonin affects the balance and integrity of the gut microbiome; however, studies have confirmed the influence of selective serotonin reuptake inhibitors (SSRIs) on irritable bowel syndrome (IBS). We evaluated the association between SSRI use and subsequent IBS occurrence in a real-world setting. A multivariate Cox proportional hazard model was adopted, and the National Health Insurance Service cohort claims database between 2010 and 2019 was used. Non-SSRI users were selected using the propensity score matching method. Subgroup analyses were performed using the point of use, cumulative dose, and duration of SSRI use. Additional analysis was performed using a control group without psychiatric medications. We included 2901 SSRI users and 2727 non-SSRI users. After adjusting covariates, the risk of developing IBS in SSRI users was 1.54 times that in non-SSRI users (95% confidence interval [CI]: 1.01-2.33). The hazard ratio (HR) of the recent, heavy, and short-term user groups were 3.19 (95% CI: 2.03-4.99), 2.22 (95% CI: 1.50-3.29), and 4.83 (95% CI: 3.02-7.73), respectively, compared with that of non-users. In patients without a history of psychiatric medications, the risk of IBS incidence after SSRI use increased significantly (HR: 1.61, 95% CI: 1.06-2.42), whereas HR was insignificant in patients with a history of psychiatric medications (HR: 1.25, 95% CI: 0.98-1.60). The risk of subsequent IBS occurrence following SSRI use was high in patients who initially took a heavy SSRI dose and those who did not have a history of psychiatric drug use.

Sections du résumé

BACKGROUND AND AIM OBJECTIVE
Serotonin affects the balance and integrity of the gut microbiome; however, studies have confirmed the influence of selective serotonin reuptake inhibitors (SSRIs) on irritable bowel syndrome (IBS). We evaluated the association between SSRI use and subsequent IBS occurrence in a real-world setting.
METHODS METHODS
A multivariate Cox proportional hazard model was adopted, and the National Health Insurance Service cohort claims database between 2010 and 2019 was used. Non-SSRI users were selected using the propensity score matching method. Subgroup analyses were performed using the point of use, cumulative dose, and duration of SSRI use. Additional analysis was performed using a control group without psychiatric medications.
RESULTS RESULTS
We included 2901 SSRI users and 2727 non-SSRI users. After adjusting covariates, the risk of developing IBS in SSRI users was 1.54 times that in non-SSRI users (95% confidence interval [CI]: 1.01-2.33). The hazard ratio (HR) of the recent, heavy, and short-term user groups were 3.19 (95% CI: 2.03-4.99), 2.22 (95% CI: 1.50-3.29), and 4.83 (95% CI: 3.02-7.73), respectively, compared with that of non-users. In patients without a history of psychiatric medications, the risk of IBS incidence after SSRI use increased significantly (HR: 1.61, 95% CI: 1.06-2.42), whereas HR was insignificant in patients with a history of psychiatric medications (HR: 1.25, 95% CI: 0.98-1.60).
CONCLUSIONS CONCLUSIONS
The risk of subsequent IBS occurrence following SSRI use was high in patients who initially took a heavy SSRI dose and those who did not have a history of psychiatric drug use.

Identifiants

pubmed: 37961007
doi: 10.1111/jgh.16406
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Ministry of Food and Drug Safety
ID : 21153MFDS602

Informations de copyright

© 2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Références

Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006; 130: 1480-1491.
Oka P, Parr H, Barberio B, Black CJ, Savarino EV, Ford AC. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol. Hepatol. 2020; 5: 908-917.
Hirsch M, Birnbaum RJ. Selective Serotonin Reuptake Inhibitors: Pharmacology, Administration, and Side Effects. Waltham, MA: UpToDate, 2020.
Goldstein BJ, Goodnick PJ. Selective serotonin reuptake inhibitors in the treatment of affective disorders-III. Tolerability, safety and pharmacoeconomics. J. Psychopharmacol. 1998; 12: 55-S87.
Spigset O. Adverse reactions of selective serotonin reuptake inhibitors. Drug Saf. 1999; 20: 277-287.
Buono JL, Carson RT, Flores NM. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea. Health Qual. Life Outcomes 2017; 15:35.
Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology 2002; 122: 1140-1156.
Gershon M, Wade P, Kirchgessner A, Tamir H. 5-HT receptor subtypes outside the central nervous system. Roles in the physiology of the gut. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology 1990; 3: 385-395.
De Ponti F. Pharmacology of serotonin: what a clinician should know. Gut 2004; 53: 1520-1535.
Lukić I, Getselter D, Ziv O et al. Antidepressants affect gut microbiota and Ruminococcus flavefaciens is able to abolish their effects on depressive-like behavior. Transl. Psychiatry 2019; 9:133.
Vich Vila A, Collij V, Sanna S et al. Impact of commonly used drugs on the composition and metabolic function of the gut microbiota. Nat. Commun. 2020; 11: 1-11.
Sjöstedt P, Enander J, Isung J. Serotonin reuptake inhibitors and the gut microbiome: significance of the gut microbiome in relation to mechanism of action, treatment response, side effects, and tachyphylaxis. Front. Psych. 2021; 12: 682868.
Lorman WJ. Pharmacology update: the selective serotonin reuptake inhibitors. J. Addict. Nurs. 2018; 29: 260-261.
NICE. Depression in adults: treatment and management. 2022.
Gabriel FC, de Melo DO, Fráguas R et al. Pharmacological treatment of depression: a systematic review comparing clinical practice guideline recommendations. PLoS ONE 2020; 15: e0231700.
Ott S, Musfeldt M, Wenderoth D et al. Reduction in diversity of the colonic mucosa associated bacterial microflora in patients with active inflammatory bowel disease. Gut 2004; 53: 685-693.
Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology 2014; 146: 1489-1499.
Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol. Hepatol. 2016; 1: 133-146.
Bundeff AW, Woodis CB. Selective serotonin reuptake inhibitors for the treatment of irritable bowel syndrome. Ann Pharmacother 2014; 48: 777-784.
Kyoung D-S, Kim H-S. Understanding and utilizing claim data from the Korean National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA) database for research. J. Lipid Atherosclerosis 2022; 11: 103.
Lin W-T, Liao Y-J, Peng Y-C et al. Relationship between use of selective serotonin reuptake inhibitors and irritable bowel syndrome: a population-based cohort study. World J. Gastroenterol. 2017; 23: 3513.
Jung H-K, Kim YH, Park JY et al. Estimating the burden of irritable bowel syndrome: analysis of a nationwide Korean database. J. Neurogastroenterol Motility 2014; 20: 242.
Lee YY, Annamalai C, Rao SS. Post-infectious irritable bowel syndrome. Curr. Gastroenterol. Rep. 2017; 19: 1-10.
Hanevik K, Wensaas K-A, Rortveit G, Eide GE, Mørch K, Langeland N. Irritable bowel syndrome and chronic fatigue 6 years after giardia infection: a controlled prospective cohort study. Clin. Infect. Dis. 2014; 59: 1394-1400.
Shin J. Depression in primary care. KJFP 2020; 10: 401-406.
Fadgyas-Stanculete M, Buga A-M, Popa-Wagner A, Dumitrascu DL. The relationship between irritable bowel syndrome and psychiatric disorders: from molecular changes to clinical manifestations. J. Mol. Psychiatry 2014; 2:4.
Fond G, Loundou A, Hamdani N et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur. Arch. Psychiatry Clin. Neurosci. 2014; 264: 651-660.
Peter J, Fournier C, Durdevic M et al. A microbial signature of psychological distress in irritable bowel syndrome. Psychosom. Med. 2018; 80: 698.
Staudacher HM, Mikocka-Walus A, Ford AC. Common mental disorders in irritable bowel syndrome: pathophysiology, management, and considerations for future randomised controlled trials. Lancet Gastroenterol. Hepatol. 2021; 6: 401-410.
Banerjee A, Sarkhel S, Sarkar R, Dhali GK. Anxiety and depression in irritable bowel syndrome. Indian J. Psychol. Med. 2017; 39: 741-745.
Nam SY, Kim BC, Ryu KH, Park BJ. Prevalence and risk factors of irritable bowel syndrome in healthy screenee undergoing colonoscopy and laboratory tests. J. Neurogastroenterol. Motil. 2010; 16: 47.
Ohlsson B. The role of smoking and alcohol behaviour in management of functional gastrointestinal disorders. Best Pract. Res. Clin. Gastroenterol. 2017; 31: 545-552.
Reding KW, Cain KC, Jarrett ME, Eugenio MD, Heitkemper MM. Relationship between patterns of alcohol consumption and gastrointestinal symptoms among patients with irritable bowel syndrome. Am. J. Gastroenterol. 2013; 108: 270.
Thorkelson G, Bielefeldt K, Szigethy E. Empirically supported use of psychiatric medications in adolescents and adults with IBD. Inflamm. Bowel Dis. 2016; 22: 1509-1522.
Collins SM. Interrogating the gut-brain axis in the context of inflammatory bowel disease: a translational approach. Inflamm. Bowel Dis. 2020; 26: 493-501.
McQuade RM, Stojanovska V, Abalo R, Bornstein JC, Nurgali K. Chemotherapy-induced constipation and diarrhea: pathophysiology, current and emerging treatments. Front. Pharmacol. 2016; 7: 414.
NHS. Side effects-selective serotonin reuptake inhibitors (SSRIs): National Health Service [updated 8 December 2021]. 2021. Available from: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/side-effects/
Moret C, Isaac M, Briley M. Problems associated with long-term treatment with selective serotonin reuptake inhibitors. J. Psychopharmacol. 2009; 23: 967-974.
Oliva V, Lippi M, Paci R et al. Gastrointestinal side effects associated with antidepressant treatments in patients with major depressive disorder: a systematic review and meta-analysis. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2021; 109: 110266.
Kennedy PJ, Cryan JF, Dinan TG, Clarke G. Irritable bowel syndrome: a microbiome-gut-brain axis disorder? World J Gastroenterol: WJG 2014; 20: 14105-14125.

Auteurs

Nayoung Kwak (N)

Graduate Program of Industrial Pharmaceutical Science, Yonsei University, Incheon, Korea.

Hankil Lee (H)

College of Pharmacy, Ajou University, Suwon, Korea.
Department of Biohealth Regulatory Science, Graduate School of Ajou University, Suwon, Korea.

Beom Kyung Kim (BK)

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.

Yun Mi Yu (YM)

College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea.

Hye-Young Kang (HY)

College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea.

Classifications MeSH