Editorial: how effective is vedolizumab in the ‘real world’?

as depression, and outcomes in IBD is warranted. It is clear that the relationship between depression and disease course is bidirectional. That is, worse disease may not only lead to higher risk of depression, but also that depression itself may lead to poorer disease course. Although disease severity has been shown to be a risk factor for developing depression, proving the reverse is much harder. We agree that a more proactive approach is required in the diagnosis and management of co-existent depression amongst patients with IBD. Early screening for symptoms of depression and anxiety are paramount and are underscored in European consensus guidelines. Yet, gastroenterologists are poor at recognising the presence and severity of psychiatric disorders in their patients. Screening patients for resilience is a novel approach to identifying those that may be vulnerable. It is an appealing idea to go down the route of primary prevention of depression in IBD. However we still do not yet fully understand who is and who is not vulnerable, and as yet, there is limited evidence that resilience training works in this population. Resilience may be associated with a readiness for transition to adult care in younger IBD populations, but further work is needed to establish its role in older patients. Furthermore, it may be challenging to intervene in this way at disease onset given that patients may be unwell at this time. Gastroenterologists and allied health care professionals ideally need training to screen for signs of psychiatric disorders and traits like resilience. To enable the optimum management of such patients, stronger links between gastroenterology and liaison psychiatry need to be forged against a background of what are very often hard pressed services. Integrated care models between physicians and liaison psychiatry are already operating successfully in several London trusts. It is likely, even with approaches like resilience-building, depression will remain a major outcome. Certainly, more work is needed to identify appropriate interventions for the treatment of depression and related potential improvements in physical disease outcomes in IBD. Given the burden of depression in these patients, we keenly support evidenced-based approaches to the identification and treatment of IBD patients with concurrent depressive illnesses, such as those described by Dr Keefer. We also emphasise the need to explore the efficacy of other interventions, such as the impact of anti-depressant medications, on shortand long-term outcomes in IBD.