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Depression in inflammatory bowel disease: risk factor, prodrome or extraintestinal manifestation?
  1. Calum D Moulton1,
  2. Christine Norton2,
  3. Nick Powell3,
  4. Zahra Mohamedali4,
  5. Christopher W P Hopkins5
  1. 1 Department of Psychological Medicine, King’s College London, London, UK
  2. 2 Florence Nightingale School of Nursing & Midwifery, King’s College London, London, UK
  3. 3 Centre for Inflammation Biology and Cancer Immunology, King’s College London, London, UK
  4. 4 GKT School of Medical Education, King’s College London, London, UK
  5. 5 Prospect Park Hospital, Berkshire Healthcare NHS Foundation Trust, Reading, UK
  1. Correspondence to Dr Calum D Moulton, Department of Psychological Medicine, King’s College London, London SE5 9RJ, UK; calum.moulton{at}

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We read with interest Frolkis and colleagues’ recent study, in which depression was associated with increased risk of incident IBD in a large primary care database.1 While treatment of depression in IBD has been suggested to improve IBD outcomes,2 this study goes further, suggesting that assertive pharmacological treatment of depression could reduce the incidence of IBD altogether.

Despite the study’s manifest strengths, we wish to draw the authors’ attention to an important limitation of its current design that tempers its conclusions. Temporality between exposure and outcome is a key test of causality.3 This is challenging in the context of depression and IBD because their symptoms …

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  • Contributors CDM, CH and ZM conceived the manuscript. CDM wrote the first draft. All authors revised the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Patient consent for publication Not required.