Increased use of psychiatric medication following incident celiac autoimmunity

Background

Celiac disease is associated with an increased risk of psychiatric disorders, yet little is known about formal treatment for such conditions among patients.

Methods

Using administrative healthcare data, we conducted a population-based cohort study of individuals newly positive for celiac autoimmunity (tTG) between 2015 and 2023 in Alberta, Canada. Individuals were linked to medication dispensations to assess use of antidepressants, anxiolytics, and antipsychotics. We calculated the proportion of days covered (PDC) by psychiatric medication as the number of days for which medication was prescribed. We conducted identical sub-analyses for individuals with anxiety and/or depression-related healthcare encounters prior to their positive tTG test.

Results

Among 14,323 newly tTG-positive individuals, a greater proportion dispensed antidepressants (22.5 % vs 27.6 %) and antipsychotics (4.6 % vs 6.0 %) post-tTG, while a lower proportion dispensed anxiolytics post-tTG (15.4 % vs 11.4 %), all p < 0.001. We observed higher odds of being dispensed psychiatric medication post-tTG (OR = 1.22; 95 % CI = 1.14, 1.31). Median PDC also significantly increased post-tTG test for antidepressants (2.8 % vs 21.1 %) and antipsychotics (0.4 % vs 6.3 %), p < 0.001. However, a decreased odds of medication dispensation (OR = 0.42; 95 % CI: 0.32, 0.56) and median PDC post-tTG (45.1 % vs. 10.1 %, p < 0.001) were observed among those with a previous depression/anxiety-related healthcare encounter.

Conclusion

These findings highlight a need for increased screening for and/or monitoring of psychiatric comorbidities in the celiac population, and further investigation into what may be underpinning greater use of psychiatric medications after tTG positivity.